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   2020| October-December  | Volume 21 | Issue 4  
    Online since December 28, 2020

 
 
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ORIGINAL ARTICLES
Analysis of corneal asphericity (Q value) and its related factors in adult Egyptians: a cross-sectional study
Mohamed R Elsayed, Islam Saeed, Abdelmonem M Hamed, Haitham M Fayk, Tarek N Attia
October-December 2020, 21(4):236-241
DOI:10.4103/DJO.DJO_39_20  
Purpose The aim of this study was to determine the corneal Q value and its related factors in adult Egyptians and to compare the Q value of Egyptians with other ethnic groups. Design This was a cross-sectional study. Patients and methods The study included 500 eyes of 250 Egyptian patients. There were 130 female and 120 male patients, with a mean age of 29.96±9.31 years (range=20–60 years). The corneal mean Q value at 6.0- and 8.0-mm diameter together with Q value from each quadrant (nasal, temporal, superior, and inferior) and two meridians (horizontal and vertical) at 8.0-mm diameter were measured using Pentacam HR. Eyes were stratified by age, sex, and spherical equivalent (SE) refractive error. The mean radius of curvature (Rm) and maximum keratometry reading (K-max) of the anterior corneal surface, corneal thinnest location, and anterior chamber depth were measured. Results The average Q values of the anterior surface were −0.27 (±0.125) and −0.37 (±0.141) at 6.0 and 8.0 mm diameter, respectively. The average Q value of each quadrant (nasal, temporal, inferior, and superior) and horizontal and vertical meridians was −0.55 (±0.245), −0.244 (±0.130), −0.33 (±0.189), −0.35 (±0.27), −0.40 (±0.144), and −0.34 (±0.178) at the 8-mm diameter, respectively. The average Q values of the anterior surface were significantly correlated with age, sex, SE refractive errors, maximum keratometry reading (K-max), mean radius of curvature (front), and anterior chamber depth. There was no significant correlation between the average Q values and corneal thickness at the thinnest location. The adult Egyptian Q values were close to African Americans but different from other ethnic groups. Conclusion There was a significant correlation between Q value and age, sex, refractive error, K-max, mean radius of curvature (Rm), and anterior chamber depth. Corneal Q values of adult Egyptians were different from previous studies involving Europeans, white Americans, and Asian populations and was close to African Americans.
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Eccentric viewing training for low-vision rehabilitation in patients with central scotoma
Adel G Zaky, Boshra El Bayoumi, Esraa S El-ghoubashy, Abdelrahman E Sarhan, Marwa A Zaky
October-December 2020, 21(4):261-267
DOI:10.4103/DJO.DJO_29_20  
Background Eccentric viewing (EV), also known as eccentric fixation, involves identifying a functioning area of the retina that is as close to the fovea as possible and to learn to use it effectively, which is known as the preferred retinal locus. Objective The aim of this study was to evaluate the value of subjective EV training in vision rehabilitation in patients with central scotoma. Patients and methods The direction of EV was monitored in 33 low-vision patients with bilateral central scotomas. The preferred retinal locus was identified, and the preserved visual field was found. The patients were divided randomly into two groups regarding their use of optical low-vision devices with EV training. After 2 months of training, changes in near and far best-corrected visual acuity (BCVA) and reading speed were evaluated. Results After 2 months of EV training, the near BCVA and mean reading speed significantly improved, whereas the far BCVA did not significantly improve (0.1 LogMar on average). The mean near BCVA improved from 0.97±0.19 to 0.63±0.26 LogMar (P<0.001), and the mean reading speed improved from 26.48±9.31 words per minute (wpm) to 53.82±10.81 wpm. The group that used low-vision devices with EV training showed significantly more improvement in near and far BCVA than the group that did not use low-vision devices. The group that used low-vision devices with EV training showed significantly more improvement in near BCVA (0.41±0.17 LogMar) than the group that did not use low-vision devices (0.78±0.28 LogMar, P<0.001). Moreover, the group that used low-vision devices with EV training showed significantly more improvement in far BCVA (0.75±0.17 LogMar) than the group that did not use low-vision devices (1.02±0.28 LogMar, P<0.001). Conclusion EV training can be used as a very effective method for low-vision rehabilitation in patients presenting with central scotomas. It can give very good results by using simple and inexpensive equipment.
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Evaluation of the efficacy of autologous cryoprecipitate for attaching conjunctival autograft after primary pterygium excision
Hazem E Haroun, Ahmed M Hassan, Safaa A Aboud
October-December 2020, 21(4):229-235
DOI:10.4103/DJO.DJO_35_20  
Purpose The aim of this study was to evaluate the long-term safety and efficacy of using autologous cryoprecipitate for attaching conjunctival autograft and to compare the results of such technique with the use of vicryl sutures in patients undergoing primary pterygium excision, in terms of surgical time, postoperative patient comfort, visual acuity, complications, and recurrence rate. Patients and methods This is a prospective, interventional, comparative clinical study. It included 200 patients with primary nasal pterygium for whom surgical excision of the pterygium with conjunctival autograft obtained from the same eye was performed. The patients were divided into two groups: autologous cryoprecipitate was used in 100 patients (glue group) and absorbable sutures (8/0 vicryl sutures) were used in 100 patients (suture group) to attach the free conjunctival graft. The main outcome measures included operative time, postoperative pain, lacrimation, foreign body sensation, recurrence rate, and complications. The follow-up period was 24 months. Results The mean operative time was 20.28±2.73 min in the glue group and 31.04±6.52 min in the suture group, with a statistically significant difference (P<0.05). At the first postoperative day, pain, foreign body sensation, and lacrimation were reported by all patients in the suture group, whereas in the glue group, pain was reported in all patients, foreign body sensation was reported in 40 patients, and lacrimation was reported in 70 patients, with a statistically significant difference between the two groups (P<0.001). Pain and foreign body sensation persisted beyond the first week in 44 patients in the suture group and in only five patients in the glue group, with a statistically significant difference (P<0.001). Postoperative subconjunctival hemorrhage was reported in five patients in the glue group and in 15 patients in the suture group, with a statistically significant difference (P<0.05). Recurrence occurred in three patients in the glue group and in 12 patients in the suture group, which was statistically significantly lower in the glue group (P<0.05). Conclusion Using autologous cryoprecipitate for attaching conjunctival autograft in primary pterygium surgery resulted in shorter operative time and less postoperative pain, foreign body sensation, lacrimation, and subconjunctival hemorrhage. In addition, it decreased the recurrence rate. The cryoprecipitate method appeared to be effective, reliable, and safe after long-term follow-up.
  674 129 -
Flap thickness and side-cut angle using sub-Bowman keratomileusis microkeratome, 200-kHz femtosecond laser system, and Moria M2 microkeratome
Sarah Azzam, Mohamed Hosny, Zahed Chehab, Mohamed Anis
October-December 2020, 21(4):242-248
DOI:10.4103/DJO.DJO_37_20  
Purpose The aim of this study was to compare the thickness and side-cut angle of corneal flap in candidates undergoing laser-assisted in situ keratomileusis using sub-Bowman keratomileusis (SBK) microkeratome, femtosecond (FS) laser, or Moria M2 microkeratome (MK). Patients and methods This prospective clinical study included 60 eyes of 30 patients. They were divided into three groups (20 eyes in each group). The study was conducted from January 2019 till December 2019. Corneal flaps were created using Moria SBK microkeratome, Alcon Wavelight FS-200 FS laser, or Moria MK. Heidelberg anterior segment optical coherence tomography was done 1 month postoperatively to assess the central flap thickness and side-cut angle. Results The mean error cut angle was −39.00±19.00, 24.75±12.56, and −25.65±10.31° in the SBK, FS, and MK groups, respectively (P<0.001). The mean difference between the intended and achieved flap thickness was 1.50±8.06 μm in the SBK group, −1.20±6.86 μm in the FS group, and 16.25±29.73 μm in the MK group (P=0.340). Conclusion There was a statistically significant difference between the intended and achieved side-cut angle in the three groups. Flap thickness was more predictable in the SBK and FS group, with an insignificant difference between the intended and achieved flap thickness, whereas in the MK group, the difference was statistically significant.
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Assessment of choroidal thickness and macular microvascular changes in amblyopic eyes using optical coherence tomography angiography
Sherin H Sadek, Sherif A Eissa, Ghada I Gawdat, Ragai M Hatata
October-December 2020, 21(4):255-260
DOI:10.4103/DJO.DJO_34_20  
Aim This study aimed to assess microvascular and choroidal thickness (CT) changes in cases with unilateral amblyopia and to compare optical coherence tomography angiography parameters with the fellow eyes as well as with age-matched controls. Study design This is a prospective case–control study. Patients and methods The study included 44 eyes; 12 eyes had unilateral anisometropic amblyopia compared with their fellow 12 eyes and 20 eyes from normal age-matched controls. Spectral-domain optical coherence tomography angiography was used to assess the vessel density (VD) of the superficial capillary plexus (SCP) and the deep capillary plexus (DCP) in both 3×3 and 6×6 mm scans. In addition, central macular thickness, foveal avascular zone size, and CT were measured. Results The mean age of amblyopic patients was 25.1±10.8 years with a mean BMI of 22.4±4.7 compared with the mean age of the control group (26.4±2.8 years) with a mean BMI of 21.0±2.1. Amblyopic eyes showed a statistically nonsignificant decrease in subfoveal CT (mean=328.58±34.46 μm) and temporal CT (mean=318.42±33.93 μm) compared with their fellow eyes (321.00±42.41 and 317.33±57.21 μm, respectively) and with the control eyes (subfoveal CT 349.80±72.33 μm and temporal CT 346.50±40.61 μm, P=0.178 and 0.177, respectively). There was a significantly decreased VD in the SCP of amblyopic eyes at the 3 mm scan (P=0.032) with a mean of 43.87±4.67% in the whole image. In addition, DCP VD in the 6 mm scan showed a statistically significant decrease (mean=43.91±7.26%) compared with the fellow and control eyes (P=0.001). The foveal avascular zone size was almost the same in all groups (0.28±0.13 mm2) with no significant difference. Conclusion Amblyopic eyes showed decreased VD in both SCP and DCP compared with that of the fellow eyes and controls.
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Clinical outcome after Descemet membrane endothelial keratoplasty in vitrectomized eyes
Mohamed B Goweida
October-December 2020, 21(4):249-254
DOI:10.4103/DJO.DJO_36_20  
Purpose The aim of the present study was to evaluate the clinical outcome after Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous vitrectomy. Patients and methods This is a retrospective review of medical records and surgical videos of all DMEK cases in vitrectomized eyes (total or anterior vitrectomy) that were done at Alexandria Main University Hospital, Alexandria, Egypt, between January 2015 and November 2019. The primary outcome measure was the improvement in best-corrected visual acuity. Secondary outcome measures were unfolding time and technique, endothelial cell loss, and rebubbling rate. Results A total of 18 vitrectomized eyes of 18 patients with bullous keratopathy were included in this study. Follow-up duration ranged from 6 to 53 months, with a mean of 23.8±15.2 months. At the end of the follow-up, the best-corrected visual acuity improved from 1.9±0.5 log MAR units to 0.7±0.4 log MAR units. The mean endothelial cell density was 1136.6±204.4 cells/mm2, representing 53% loss of the mean preoperative donor endothelial cells (2388.3±114.8 cells/mm2). The mean graft unfolding time was 13.7±5.4 min. A total of 11 (61%) eyes needed rebubbling owing to postoperative Descemet membrane detachment. Conclusion DMEK is an effective surgical modality for treatment of bullous keratopathy in vitrectomized eyes. Restoration of corneal clarity and significant visual improvement were possible in all patients, despite the need for complex surgical steps, prolonged surgical time, and the increased rebubbling rate.
  454 68 -
CASE REPORT
Histologically confirmed ocular tuberculosis: an unusual case and review of literature
Fatma Hammami, Makram Koubaa, Ichrak Bougharriou, Salma Gargouri, Slim Charfi, Tahya Boudawara, Jamel Feki, Mounir B Jemaa
October-December 2020, 21(4):282-286
DOI:10.4103/DJO.DJO_21_20  
Ocular tuberculosis (OTB) is the first cause of ocular inflammation of infectious origin in developing countries. It can affect all structures of the eye without pathognomonic presentation. Its diagnosis remains challenging owing to the difficulty of sampling for histopathological and microbiological investigations. A 36-year-old male patient with no previous medical history was admitted for a scleral mass in his right eye, which was diagnosed elsewhere 45 days before. On examination, a minimal intraocular inflammatory reaction and right eyelid swelling were noted. A scleral lesion in the superior nasal quadrant of the right eye was observed and was responsible for globe displacement inferolaterally and for restricted eye motility. An excision biopsy of the suspicious lesion was made. Histological examination revealed a tuberculous granuloma associated with caseous necrosis. Sputum smear result was negative for Mycobacterium tuberculosis. Further investigations excluded extra-OTB involvement. The patient received 6 months of antitubercular therapy. The disease evolution was favorable. The authors also reviewed all reported cases of histologically confirmed OTB in the literature by search in PubMed till December 2019. Cases with histopathology results revealing granulomatous inflammation without caseous necrosis and cases of tubercular dacryoadenitis were excluded from the search, at enrollment.
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ORIGINAL ARTICLES
The effects of a novel preadapted ocular prosthesis on the quality of life of patients with anophthalmic contracted sockets
Amr M Awara, Osama E Shalaby
October-December 2020, 21(4):275-281
DOI:10.4103/DJO.DJO_25_20  
Purpose The aim of this study was to evaluate the effectiveness of a novel preadapted polymethyl methacrylate pressure prosthesis in patients with anophthalmic contracted sockets and its effect on their quality of life. Patients and methods This is a controlled randomized clinical trial that included two groups of patients, with 19 patients in each. Group A received the new preadapted customized prosthesis fixed by periosteal sutures through custom-made holes during the primary reconstruction, whereas group B received the traditional transparent conformer for 6–20 weeks followed by the final cosmetic prosthesis. Prosthesis tolerability, socket inflammation, edema, contraction, and quality of life were assessed by the Medical Outcome Study short form-36 items. Results Most of the patients (89.5%) in group A had a stable and well-centered prosthesis. Only two cases in this group had slightly shifted prosthesis without significant effect on the patient’s appearance. Group A had significantly shorter time (7.5±1.2 days) to return to their usual life activities and to uncover their prosthetic eye than group B (P<0.001). They also had significant improvement in the emotional health-related domains in the Medical Outcome Study short form-36 than group B. Complications in group A were minimal, as only one case had extrusion of the prosthesis owing to local infection. Conclusion The preadapted polymethyl methacrylate pressure prosthesis with periosteal fixation is a simple and effective method in cases of severe anophthalmic socket contraction and resulted in early rehabilitation and improvement of patient’s quality of life.
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Symptomatic acquired lacrimal passage obstruction: clinical evaluation of the level of obstruction in adult patients
Mohamed F.K Ibrahiem, Ahmed M Sabry, Sahar T.A Abdelaziz
October-December 2020, 21(4):268-274
DOI:10.4103/DJO.DJO_15_20  
Purpose The aim of this study was to detect the anatomical level of acquired lacrimal passage obstruction among adult patients with epiphora. Patients and methods In a 3-year period, 266 eyes of 223 adult patients with obstructive epiphora were evaluated clinically by probing/irrigation of the lacrimal passages to detect the anatomical level of obstruction. Patients were divided into four groups: punctal, canalicular, nasolacrimal duct (NLD), and mixed groups according to the level of obstruction. Results The age of the patients ranged from 18 to 75 years, and 83.46% of the patients were living in rural areas. Overall, 82% of the patients were females, and 78.99% of them used to apply Kohl as eyeliner cosmetic for an average of 15.62 years. Punctal disorders were detected in 14.67% of the patients, of whom 9.78% had isolated punctal disorders and 4.89% were in the mixed multiple level subgroup. Punctal obstruction represented 69% of the patients with isolated punctal disorders. Canalicular disorders represented 65.4% of all patients, where 70% had isolated canalicular disorder and 30% were in the mixed subgroup. Overall, 39% of all patients had acquired NLD obstruction; 63.5% of them had isolated NLD disorder and 36.5% had multifocal obstruction. Multifocal obstruction of the lacrimal passages was reported in 19.17% of all patients. Conclusion The main site of obstruction was the common canaliculus as two-thirds of the patients had canalicular problems. The second common site of obstruction was the NLD followed by the puncta.
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