2014-10-31T06:46:45Z http://www.medknow.com/oai2
oai:medknow.com:57681 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Trachoma in the Middle Eastern Countries Khandekar, R Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/1/57681 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57684 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Elevation of plasma nitrate and malondialdehyde in patients with age-related cataract El-Ghaffar, AA Aziz, MA Mahmoud, AM Al-Balkini, SM Purpose. To determine plasma levels of nitrate and malondialdehyde (MDA) in patients with age-related cataract. Patients and Methods. Serum nitrate and MDA levels were measured in 17 patients with posterior subcapsular cataract and systemic hypertension, 12 patients with cortical cataract, 19 patients with nuclear cataract and a history of cigarette smoking (> 15 years), and 12 age-matched controls without cataract. Results. The mean plasma levels of nitrate and MDA were significantly higher in all 3 groups of cataract when compared to controls. The highest levels of nitrate and MDA were in patients with posterior subcapsular cataract and hypertension. The lowest levels were recorded in patients with cortical cataract. There was a statistically significant correlation between elevated plasma levels of nitrate and MDA in patients with all 3 types of cataract. Conclusion. There is a possible role for elevated levels of nitrate and MDA in the pathogenesis of cataract in the human eye. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/13/57684 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57685 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Seroprevalence of Toxocara antibodies in asymptomatic pregnant women and infants Issa, RM Purpose. To compare the use of enzyme-linked immunosorbent assay (ELISA) with Toxocara canis embryonated egg (TEE) antigen and the use of antigen capture ELISA with toxocara excretory/secretory or exoantigen (TEX) in the diagnosis of toxocariasis in asymptomatic pregnant women and infants. Patients and Methods. Serum specimens were collected from 28 asymptomatic pregnant women, as well as from their 28 infants, at El-Salam Center of Family Planning between August 2005 and April 2006. During the same time interval, serum specimens were also collected from 79 apparently healthy infants at Abu El-Reash Teaching Hospital. Toxocara antibody titers were measured using ELISA-TEE<sup> </sup> and antigen capture ELISA-TEX by previously described methods. Results. Using the ELISA-TEE method, Toxocara antibodies were detected in 7 (25.0%) of 28 pregnant women; in comparison, 12 (42.9%) positive titers were determined using the ELISA-TEX method. Of the 28 infants of the pregnant women, 3 (10.7%) were determined to have Toxocara antibodies using the ELISA-TEE method, whereas 7 (25.0%) positive titers were found using the ELISA-TEX method. Among asymptomatic infants, Toxocara antibodies were detected in 13 (16.5%) of 79 infants using the ELISA-TEE method as compared to 20 (25.3%) positive titers detected using the ELISA-TEX method. On examination, 1 case of active ocular toxocariasis and 4 cases of inactive ocular toxocariasis were detected. Conclusion. The ELISA-TEX method detected a higher prevalence of positive Toxocara antibody titers in asymptomatic women and their infants, as well as in apparently healthy infants, than did the ELISA-TEE method. The ELISA-TEX method was more effective in discriminating between positive and negative titers than the ELISA-TEE method. Ophthalmologists should be aware that active and inactive ocular toxocariasis may be present in these asymptomatic patients. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/16/57685 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57686 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Homocysteine levels in plasma of cataract patients with and without pseudoexfoliation syndrome Yaghoubi, G Heydari, B Raza, MM Zohre, B Purpose. To compare serum homocysteine levels in cataract patients with and without pseudoexfoliation (PXF). Patients and Methods. This study included 29 patients with cataract and PXF syndrome, as well as 29 age- and sex-matched controls with cataract but without PXF syndrome. Patients with systemic and ocular conditions known to be associated with hyperhomocysteinemia were excluded from the study. Results. The mean serum homocysteine level was significantly elevated among patients with cataract and PXF syndrome when compared to those without PXF syndrome (16.61 vs. 11.67 ΅mol/L; P = .01). The percentage of patients with PXF syndrome and elevated serum homocysteine was significantly higher than in patients without PXF syndrome (56% vs. 14%; P<.0001). Logistic regression analysis identified elevation in plasma homocysteine levels as a significant risk factor for the development of PXF syndrome (odds ratio = 8.85; 95% confidence interval, 2.40-32.12). Conclusion. Hyperhomocysteinemia is significantly associated with PXF syndrome in patients with cataract. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/22/57686 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57687 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The trachoma ecosystem: A hypothesis on the transmission of trachoma Babalola, OE There is compelling evidence that trachoma-inclusion conjunctivitis (TRIC) agents can and do persist in clinically "healed" subjects, raising the possibility that such persistent cases may constitute reservoirs of infection. The percentage of persistent cases, with antigen detection utilizing polymerase chain reaction, ligase chain reaction, or Giemsa stain techniques, varies from 24% to 53%. The hypothesis put forth in this review is that persistent antigens can cause the endogenous reactivation of clinical disease after being triggered by factors that cannot be clearly elucidated at the present time. Based on the findings of existing studies, it is not evident at this time if single-dose azithromycin will eradicate persistent infection and prevent reactivation through this pathway. Repeat cycles of infection are probably, in large part, caused by this endogenous reactivation, which leads to conjunctival scarring/shrinkage and entropion/trichiasis. The evolution of trachoma from incipient to healed stages, coupled with the infection, reinfection and reactivation cycles, and the interaction of these cycles and stages with environmental factors, compels the postulation of a trachoma ecosystem in which all these factors are integrated. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/24/57687 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57688 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Extensive plexiform neurofibroma in a patient with neurofibromatosis type I Batal, AH Hassanien, BG We describe the case of 2-year-old boy with neurofibromatosis type I who developed an extensive diffuse plexiform neurofibroma of the right orbit. A paraspinal mass that involved the right parotid and parapharyngeal space with extension through the foramen ovale into the right cavernous sinus was also detected. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/28/57688 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57682 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Vitreous, aqueous, and serum levels of vascular endothelial growth factor and angiopoietin-2 in patients with proliferative diabetic retinopathy and diabetic macular edema Azab, A Purpose. Proliferative diabetic retinopathy (PDR) and diabetic macular edema (DME) may be a response to abnormal angiogenic growth factors, such as vascular endothelial growth factor (VEGF) and angiopoietin (Ang)-2. The purpose of this study is to compare vitreous, aqueous, and serum levels of VEGF and Ang-2 in diabetic patients who have PDR and DME with those of nondiabetic patients, and to identify correlations between the vitreous, aqueous, and serum levels of these angiogenic cytokines. Patients and Methods. Aqueous humor, vitreous fluid, and serum samples were obtained during cataract and vitreous surgery from 16 eyes of 16 patients with PDR (10 eyes) and DME (6 eyes), as well as from 8 eyes of 8 nondiabetic patients with macular holes, and analyzed for levels of VEGF and Ang-2. Results. The mean vitreous level of VEGF was significantly higher in the samples from patients with PDR (182.1 ± 19.0 ng/mL) and from patients with DME (152.2 ± 46.3 ng/mL) when compared to that of the samples from the control group (63.0 ± 37.2 ng/mL) (P<.001; P<.01, respectively). The mean vitreous level of Ang-2 was significantly higher in patients with PDR (369.3 ± 352.2 pg/mL) and in patients with DME (495.3 ± 434.7 pg/mL) than in the control group (28.6 ± 20.9 pg/mL) (P < .001; P<.05, respectively). There was a significant correlation between vitreous and aqueous levels of VEGF (r) = 0.985; P<.001), but not between vitreous and aqueous levels of Ang-2 (r) = 0.087; P = not significant [NS]). There was no correlation between glycosylated hemoglobin (HbA<sub> 1c</sub> ) and intraocular levels of VEGF (vitreous and aqueous) or Ang-2. <sub> </sub> Conclusion. VEGF and Ang-2 are significantly elevated in vitreous and aqueous humor in the eyes of patients with PDR and DME when compared to control eyes of patients without diabetes. Among diabetics, there is no correlation between HbA<sub> 1C</sub> and intraocular levels of VEGF or Ang-2. Correlations do exist between the vitreous, aqueous, and serum levels of VEGF, but not of Ang-2, in patients with PDR and DME. Measuring the aqueous humor level of VEGF may be useful in analyzing the pathogenesis of PDR and in predicting disease activity. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/3/57682 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57689 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Endogenous Staphylococcus aureus panophthalmitis Hassan, NA Al-Baqsomi, A Reddy, MA Endogenous bacterial endophthalmitis is a rare but visually devastating disease. We report the case of a 43-year-old man with septic arthritis and bacterial endocarditis who presented with sudden, complete, and permanent loss of vision caused by endogenous Staphylococcus aureus endophthalmitis. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/32/57689 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57690 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Human cowpox ocular infection Al-Towerki, A A 38-year-old man was treated at King Khaled Eye Specialist Hospital for bilateral cicatricial conjunctivitis and keratitis associated with human cowpox infection. To the best of our knowledge, this is the first such case reported in the Kingdom of Saudi Arabia. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/35/57690 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57691 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Non-hodgkin's lymphoma of the conjunctiva Al-Towerki, A The majority of lymphomas of the ocular adnexa are non-Hodgkin's B-cell lymphomas; many of which occur as primary tumors without systemic involvement. A 16-year-old Saudi male was treated at King Khaled Eye Specialist Hospital for primary non-Hodgkin's B-cell lymphoma without evidence of systemic involvement. Over a 4-year period of follow-up, there was no evidence of recurrent conjunctival tumor or systemic lymphoma development. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/37/57691 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57683 2007-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Morphological changes of the rabbit retina induced by intracameral injection of indocyanine green Karam, SH Fahmy, BG Omar, OA Purpose . To evaluate the potential adverse retinal effects of indocyanine green (ICG) when used in staining the anterior lens capsule. Materials and Methods . This study included 12 rabbits, which were placed into 2 different groups. The first group (3 rabbits) was used as a control. The second group was divided into three subgroups, based upon time of sacrifice: at 2 days (3 rabbits), 10 days (3 rabbits), and 20 days (3 rabbits). Eyes were enucleated and examined using light and electron microscopy. Results. Histopathologic retinal abnormalities were present as early as 2 days in eyes in which ICG staining of the anterior lens capsule had been performed. These changes increased in severity 10 days and 20 days after ICG staining. Conclusion. ICG staining of the anterior capsule may be associated with retinal toxicity. Medknow Publications 2007-01-01 http://www.meajo.org/text.asp?2007/14/1/7/57683 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57692 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Aqueous humor outflow facility in ocular cicatricial pemphigoid Daoud, YJ Letko, E Nguyen, QD Soukiasian, SH Samson, CM Sangwan, V Harper, SL Shawkat, M Schuman, JS Foster, CS Purpose. It has been reported that glaucoma is more prevalent in ocular cicatricial pemphigoid (OCP) patients as compared to the general population. The majority of OCP patients with glaucoma were in stage III or IV at the time of OCP diagnosis. Therefore, it was hypothesized that the etiology of glaucoma in such patients could be caused by an impairment of the aqueous humor outflow facility in the context of long-standing inflammation. The aim of this study was to determine whether the aqueous humor outflow facility is impaired in OCP patients. Patients and Methods. The aqueous humor outflow facility was compared between the following groups: (1) OCP patients with high pressure glaucoma (HPG) (n = 15) to patients with primary open angle glaucoma (POAG) (n = 13) and no history of OCP or chronic cicatrizing conjunctivitis (CCC); (2) OCP patients without a history of HPG (n = 15) to a group of normal individuals (n = 14); (3) OCP patients in stage II, with or without HPG (n = 12), to OCP patients in stage III (n = 25), with or without HPG. Results. There was no statistically significant difference in outflow facility between OCP patients with HPG and patients with POAG and no history of OCP, or between OCP patients without HPG and individuals with no history of OCP or glaucoma. The difference in outflow facility between patients in stage II of OCP and those in stage III of OCP was not statistically significant. Conclusion. Glaucoma in patients with OCP might not be related to resistance to the aqueous humor outflow facility. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/41/57692 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57693 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Viscocanalostomy without deep scleral excision Abdelrahman, AM Purpose. To describe and evaluate a modified viscocanalostomy. Patients and Methods. Viscocanalostomy without deep scleral excision was performed on 11 eyes of 11 patients. Results. The mean age of the patients was 51.6 ± 10.6 years. The mean preoperative intraocular pressure (IOP) was 29.5 ± 8.3 mmHg, with a mean number of 2.6 ± 0.7 medications. The mean follow-up period was 7.4 months. The mean IOP at the conclusion of the follow-up period was 10.6 ± 4.5 mmHg, with a mean number of 0.2 ΁ 0.4 medications. Of 11 patients, 1 patient, who originally had anterior uveitis, developed posterior cortical cataract 5 months postoperatively; 1 patient required Neodymium:YAG (Nd:YAG) laser goniopuncture 4 months postoperatively. Conclusion. Viscocanalostomy without deep scleral excision is a promising surgical technique for treating glaucoma. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/46/57693 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57694 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
A comparison between the ice test and single-fiber electromyography (SFEMG) in the diagnosis of ptosis caused by myasthenia gravis El-Toukhy, EA Hosni, HH Purpose. To compare the results of the ice test with those attained with single-fiber electromyography (SFEMG) in the diagnosis of ocular myasthenia gravis (MG). Patients and Methods. Ice was placed on the upper lids of 14 patients (10 females, 4 males) with ptosis who were suspected of having MG; the change in lid height was noted. After SFEMG was performed, the results of the 2 tests were then compared. Results. A positive response to the ice test was elicited in 12 (85.7%) patients. All 12 patients with a positive ice test had abnormal SFEMG findings. Both patients with a negative ice test had normal SFEMG findings. Conclusion. A positive response to the ice test is a sensitive method of diagnosing ptosis caused by MG and correlates well with SFEMG testing. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/51/57694 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57695 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Two-stage LASIK for correction of refractive errors after penetrating keratoplasty Al-Towerki, A Purpose. To evaluate the efficiency of two-stage laser-assisted in situ keratomileusis (LASIK) for correction of spherical anisometropia and high astigmatism after penetrating keratoplasty (PKP). Patients and Methods. Retrospective analysis of 8 eyes from 8 patients who underwent two-stage LASIK after PKP for keratoconus. Results. After flap creation, there was a mean spherical shift of 2.32 diopters (D) (P < .01) and a mean astigmatic shift of 2.19 D (P < .01). After excimer laser treatment, there was a mean spherical shift of 2.41 D (P < .01) and a mean astigmatic shift of 3.97 D (P < .01). The spherical equivalent after the two-stage treatment was within 1 D of emmetropia in 7 eyes (87.5%). No patient experienced a reduction of best spectacle-corrected visual acuity (BSCVA) or uncorrected visual acuity (UCVA) after corneal flap creation or excimer laser treatment. The UCVA was 20/40 or better in 7 eyes (97.5%) and 20/30 or better in 5 eyes (62.5%), 6 months after completion of treatment. Conclusion. LASIK is effective in reducing spherical anisometropia and high astigmatism after PKP. Because of a statistically significant change in refractive error after creation of the LASIK flap, it is recommended that the procedure be performed in 2 stages. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/54/57695 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57696 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Outcome of laser in situ keratomileusis (LASIK) of initial cases performed by supervised anterior segment fellows Al-Tobaigy Faisal M, KKESH Excimer Laser Study Group Purpose. To determine the outcome of initial laser in situ keratomileusis (LASIK) procedures performed by anterior segment fellows in a supervised training program. Patients and Methods. A retrospective chart review of the first 20 LASIK procedures performed by supervised anterior segment fellows at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, between March 1 and December 31, 2003, was conducted. Results. During the study period, 10 anterior segment fellows each performed LASIK on 20 eyes of 10 patients. The mean spherical refractive error was -4.82 diopters (D) (range,-1.5 to -11.00 D). The mean patient age was 28.0 years (range, 18-50 years), and the follow-up period was 123.8 days (range, 14-389 days). After primary LASIK and 8 enhancement procedures (4.0%), 163 eyes (81.5%) had postoperative uncorrected visual acuity (UCVA) that was within 1 line of preoperative best spectacle corrected visual acuity (BSCVA); 194 eyes (97.0%) had postoperative UCVA that was within 2 lines of preoperative BSCVA. The difference between the mean preoperative BSCVA (20/22.25) and the postoperative UCVA (20/26.06) was -0.381 lines of Snellen acuity. Of 200 eyes, 6 eyes (3.0%) lost 2 or more lines of BSCVA. Prior to enhancement, 180 eyes (90.0%) were within 1 D of intended correction, including 14 eyes (7.0%) with undercorrection and 6 eyes (3.0%) with overcorrection. After 8 enhancements (all for undercorrection), 188 eyes (94.0%) were within 1 D of emmetropia. The incidence of intraoperative complications was 2.5%, all of which were incomplete flaps. There were no complete or buttonhole flaps. Postoperative complications occurred in 2.5% of eyes, the most serious being bilateral ectasia, which occurred in 1 patient with no preoperative evidence of keratoconus. Conclusion. LASIK should be taught in a well-structured, supervised setting to minimize the adverse impact of complications that may occur during the early learning curve of this procedure. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/58/57696 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57709 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal limbal stem cells: II. ocular surface reconstruction with limbal stem cell transplantation Jastaneiah, S Ocular surface reconstruction has evolved greatly in the past few decades because of increased understanding of limbal stem cell location and function, as well as improved microsurgical and stem cell culture techniques. Proper diagnoses of corneal limbal stem cell dysfunction, provision of appropriate presurgical intervention and management, logical selection of the appropriate limbal stem cell transplantation technique, optimum postoperative management, and performance of lamellar or penetrating keratoplasty, when indicated, are essential steps to maximize the prognosis for graft survival and visual outcome in eyes with limbal stem cell deficiency. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/63/57709 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57710 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Primary orbital mantle cell lymphoma Chaudhry, IA Al-Sheikh, O Al-Katan, H The clinical, imaging, and histopathological features of a periocular region tumor in a middle-aged man are described. A diagnosis of mantle cell lymphoma is made, based on immunohistochemical staining results. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/70/57710 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57711 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral pseudodendritic keratitis: A presentation of tyrosinemia type II Al-Rashed, WA Kalantan, HA Al-Ahmadi, AS A 9-month-old girl who presented with bilateral pseudodendritic keratitis was unresponsive to antiviral therapy. A diagnosis of tyrosinemia type II (Richner-Hanhart syndrome) was confirmed by high plasma tyrosine levels (2017 ΅mol/L). After the patient was placed on a low-protein diet that was supplemented with a tyrosine-restricted and phenylalanine-restricted formula (Mead-Johnson 3200 AB), the ocular symptoms and signs resolved. Tyrosinemia type II should be suspected in cases of resistant forms of bilateral dendritic keratitis. Timely initiation of dietary regimen will result in the rapid resolution of signs and symptoms, and prevent serious complications. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/73/57711 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57712 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral optic neuritis in a 10-year-old girl Badr, M Al-Smayer, S Idiopathic inflammation of the optic nerve occurs in isolation or in the context of a more widespread demyelinating disease. Children are more likely to have bilateral visual loss; anterior optic nerve involvement with papillitis; an associated bacterial, viral, or parainfectious etiology; and better visual recovery than adults. Optic neuritis is less often associated with multiple sclerosis in children than it is in adults. We present a case of a 10-year old with idiopathic bilateral optic neuritis, who experienced a complete recovery with no evidence of demyelination, following treatment. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/76/57712 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:57713 2007-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Intractable diplopia following monocular patching Khan, AO Although acquired strabismus in a visually mature adult typically causes double vision, this diplopia usually resolves if the eyes are realigned because of the patient's previous ability to fuse. In some adults, however, acquired strabismus and diplopia are secondary to a loss of fusional ability. Such patients can suffer from intractable diplopia, which is often more symptomatic if vision is improved and/or if the eyes are realigned. An illustrative case is presented and discussed. Medknow Publications 2007-04-01 http://www.meajo.org/text.asp?2007/14/2/79/57713 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53366 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Editorial Bialasiewicz, A Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/1/53366 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53369 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Tear function and abnormalities of ocular surface: Relationship with subjective symptoms of dry eye in Ibadan, Nigeria Bekibele, CO Baiyeroju, AM Ajaiyeoba, A Akang, E Ajayi, B Objective: To determine the relationship between tear function and ocular surface abnormalities with subjective symptoms of dry eye. Methods: Patients with various ocular irritation symptoms suggestive of dry eye were examined for tear break up time (TBUT), Schirmer's test 1, and Rose Bengal staining pattern. They were compared with a group of asymptomatic healthy subjects. Results: There were 63 subjects, mean age 43.8 years (+/-14.7 years) with various complaints of dryness presenting as having irritation or foreign body sensation. A group of 17 asymptomatic subjects, mean age 42.1 years (+/-12.7 years) were studied as controls. There were 22 (34. 9 %) males and 41(65.1%) females in the symptomatic group while the control group had 4 (23.5%) males and 13(76.5%) females. Ocular irritations included itching 38(60.3%), pricking and itching 10 (15.9%). Mean Shirmer's test values were lower for symptomatic subjects (mean 14.5mm +/-12.3 right eye; 14.9mm +/-12.4 left eye), compared to the controls (23.0mm +/-13.4 right eye; 17. 9mm +/-13.4 left eye) P=0.02, for right eye and 0.4 for left. The mean TBUT were also lower amongst the symptomatic subjects (10.5 seconds, right eye and 10.1 seconds left eye), while for controls mean TBUT was 12.7 seconds right eye and 12.1 seconds left eye (P=0.2). Fifty -six out of 126 (46.8%) eyes of all symptomatic subjects compared to 7 out of 34 (20.6%) eyes of asymptomatic subjects had positive staining of conjunctiva with rose Bengal (p=0.06). For subjects with itching as the primary symptom 44.7% of them as opposed to 23.5% of the controls were likely to stain positive with rose Bengal, (sensitivity of itching as screening tool for dry eye was 81% , specificity 38.2%). Itching and pricking sensation together (sensitivity 46.2% and specificity improved to 65%). Rose Bengal grades were also inversely correlated with mean Schirmers values (Pearson correlation -0.429; P = 0.001) and TBUT (Pearson correlation -0.316, P=0.005). Conclusion: Itching and other ocular irritation symptoms may be indicative of underlying abnormal tear function and ocular surface damage, their presence calls for further examination for tear deficiency and prompt institution of treatment for dry eye. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/12/53369 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53370 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Orbital pseudotumor: Distinct diagnostic features and management Chaudhry, IA Shamsi, FA Arat, YO Riley, FC Purpose: To provide an overview of the spectrum of diseases known as 'idiopathic orbital inflammatory syndrome' also known as orbital pseudotumor, with emphasis on specific diagnostic challenges in the evaluation and management of patients with this disorder. Methods: Review of the relevant literature and summarize recent findings regarding the epidemiology, diagnosis, pathophysiology and treatment of orbital pseudotumor. Results : Orbital pseudotumor is a benign intraorbital process confined to the orbit but extra orbital involvement can occur. It is among the 3<sup> rd</sup> most common orbital diseases along with thyroid orbitopathy and lymphoproliferative disorder and accounts for 5-10% of orbital processes. Clinically, orbital pseudotumor has been categorized as myositis, dacryoadenitis, anterior, apical and diffuse process. Patients may present with diplopia, conjunctival chemosis, proptosis or abnormal computed tomography scan (CT-scan) findings. Patients may also have associated optic neuropathy. Diagnosis is based on careful history, ultrasonography (U/S), CT-scan and magnetic resonance imaging (MRI) studies which may also provide prognostic information. Treatment consists of systemic corticosteroids in the form of oral or intravenous administration. Confirmation is made by orbital biopsy. In addition to radiation, cytotoxic agents, immunosuppressant, IV immunoglobulin, biological therapy, TNF-alpha inhibitor monoclonal antibody and Mycophenolate Moftil have been found to be useful in the management of refractory orbital pseudotumor. Conclusion: Understanding of the clinical features of patients with orbital pseudotumor, differentiating it from other orbital processes by use of imaging techniques and timely implementation of available treatment strategies may help prevent visual loss and associated morbidity from this condition. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/17/53370 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53371 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Scleral buckle infection with aspergillus flavus Bouhaimed, M Al-Dhibi, H Al-Assiri, A Purpose: To present a case of scleral buckle infection with Aspergillus flavus in a tertiary eye center in Saudi Arabia. Methods: A retrospective case report of a 28-year-old Saudi male who presented with a six-month history of conjunctival injection and discharge from the left eye which had undergone uncomplicated conventional retinal detachment surgery, at the King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, in the form of cryopexy, subretinal fluid drainage and scleral buckle (grooved segmental sponge and circumferential band with sleeve) for a macula on retinal detachment four years earlier. A diagnosis of infected extruded scleral buckle was made and the buckle was removed. Results: The infected scleral buckle was removed under local anesthesia with administration of sub-conjunctival irrigation of 50 mg solution of Vancomycin, and sub-conjunctival injection of 25mg of Vancomycin. Post operative microbiological studies revealed infection with silver staining of moderate Aspergillus flavus hyphae. Visual acuity of the left eye improved from 20/200 before surgery to 20/60 in the two years follow-up visit. Conclusion: This case report indicates the importance of considering infection with multiple organisms - including fungal ones - in cases of scleral buckle infections in our population. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/28/53371 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53367 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Causes of blindness among adult Yemenis: A Hospital-based study Al-Akily, SA Bamashmus, MA Purpose: This hospital-based retrospective study was aimed to assess the causes of blindness among adults aged 17 years and over who attended a teaching eye hospital in Yemen. Methods: The case notes of 3845 consecutive new patients over 12 months attending Ibn Al-Haitham Eye Center which is affiliated to the University of Science and Technology in Sana'a (the capital of Yemen) were retrieved and analysed. Data collected included age, gender, chief complaint and complete eye examination. Results: 7.7 percent (296) were uniocularly blind and 11.2 percent (432) were binocularly blind (best corrected visual acuity <3/60 in the better eye). The leading causes of uniocular blindness were cataract, trauma related ocular complications, corneal opacity, amblyopia and glaucoma. Binocular blindness was mainly due to cataract, glaucoma, diabetic retinopathy, age related macular degeneration and corneal opacity. Conclusions: These data imply that the preliminary results give us some insight about the magnitude of the problem of blindness in Yemen while awaiting a national survey on the prevalence and causes of blindness. Cataract was found to be the main cause of unilateral and bilateral blindness and this will require surgical relief, either in public hospitals, private hospitals and clinics, or in eye camps. Trauma related ocular complications were found to be the second most common cause of uniocular blindness. Health education, implementing work safety measures and bringing ophthalmological care to the doorstep of underprivileged rural community will improve their level of awareness. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/3/53367 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53372 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Anterior segment ischemia in a young myopic following transposition surgery A 35-year-old Kuwaiti lady, who is a known myope, developed severe anterior segment ischemia following extra-ocular muscle transposition surgery. The patient was treated with topical and systemic steroids. Her best corrected visual acuity after complete resolution of the inflammation was 20/40. She also developed pupillary mydriasis and anterior lens changes. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/31/53372 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53373 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Intraocular lens power calculation after phototherapeutic keratectomy: Case report and a new method Kirat, O To report a case of cataract extraction and intraocular lens (IOL) implantation after phototherapeutic keratectomy (PTK). The IOL power was calculated using the single-K and the double-K SRK/T formula, as well as the Haigis formula after modifying the post PTK corneal power using methods described for corneal power measurements after myopic excimer laser treatment (photorefractive keratectomy (PRK) and LASIK). A new method for IOL power calculation after PTK is introduced. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/34/53373 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53374 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Late opacification of a hydrophilic acrylic intraocular lens Al-Bdour, MD Dahabreh, LS Cataract extraction and intraocular lens implantation is considered to be a safe procedure in most cases. However, the new advances in the surgical technique namely phacoemulsification and hence the increased use of foldable intraocular lenses have given rise to new complications including late opacification of intraocular lenses. In this case we report late opacification of a foldable hydrophilic acrylic intraocular lens and the surgical technique for its exchange. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/37/53374 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53375 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
An unusual case of marble intraocular foreign body Omoti, AE Dawodu, OA Ogbeide, OU This report presents a case of marble intraocular foreign body that developed toxic complications during surgery. The patient is a 25 years old male who presented to the University of Benin Teaching Hospital with a history of trauma to the right eye while cutting marble. He was examined, had an ocular ultrasound scan and subsequently had an extracapsular cataract extraction. His visual acuity in the right eye was light perception. There was an entry point on the cornea, the lens was opaque, there was vitreous haemorrhage and the intraocular foreign body was localized in the posterior part of the posterior segment by ultrasound scan. He had extracapsular cataract extraction. During anterior capsulotomy, the cornea suddenly and rapidly became cloudy with a brownish tinge and the corneal epithelium started desquamating.Marble on its own may not be toxic but the other chemicals including cement, used in the processing of the marble were responsible for this delayed toxicity. Ultrasound scan is valuable in localisation of intraocular foreign bodies. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/39/53375 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53376 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Management of deep orbital dermoid cysts Chaudhry, IA Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/43/53376 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53368 2008-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Psychiatric profile of retinal detachment surgery under regional block Abboud, E Mansour, A Riad, W Purpose: The aim of this study was to investigate whether Saudi patients undergoing retinal surgery are more prone to perioperative anxiety and/or depression, to determine the relation between pre and postoperative emotional upset and also, to find the relation between severity of visual impairment and psychological dysfunction. Methods: Forty patients with retinal detachment (RD) undergoing Pars Plana Vitrecctomy were enrolled in this descriptive study. Regional block was performed using peribulbar technique in order to avoid confounding psychological effects of general anesthesia. The patients were tested for anxiety and depression using Hamilton Anxiety Rating Scale (HARS) and Beck Depression Inventory (BDI) one day before surgery and before discharge. Results: Psychological disturbance reported only by 17.5 percent of the studied patients. Preoperatively 71 percent of them showed mild to moderate anxiety. After the procedure, 80 percent of anxious patients maintained or experienced decrease level of anxiety. In addition to anxiety, 20 percent of anxious patient developed postoperative mild depression. 14 percent of the psychologically disturbed patients had moderate depression before surgery which became milder after it. Another 14 percent showed severe anxiety and moderate depression only postoperatively. Severe visual impairment was reported by 86 percent of psychological disturbed patients. Conclusion: Saudi patients with RD undergoing retinal procedures infrequently suffered anxiety and/or depression. Preoperative psychological disturbances were a good predictor of postoperative emotional upset. Perioperative psychological disturbances were related positively to the severity of visual impairment. Medknow Publications 2008-01-01 http://www.meajo.org/text.asp?2008/15/1/7/53368 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51991 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Progress in understanding mitochondrial disorders Ganesh, A Kumaramanickavel, G Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/49/51991 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51992 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Visually evoked potentials after panretinal photocoagulation in omani patients with uncontrolled diabetes mellitus Shenoy, R Al-Belushi, H Al-Ajmi, S Al-Nabhani, SM Ganguly, SS Bialasiewicz, AA Aim: To report on the changes of latency and amplitudes of the pattern VEP in patients with uncontrolled diabetes mellitus II and I before and after panretinal laser treatment. Design: Single center hospital based comparative study. Methods: One hundred eyes of patients with proliferative diabetic vitreoretinopathy, and HbA1C ≥ 10 percent were subjected to Pattern Visually Evoked Potentials (Medtronic keyopint system, Nicolet) prior to and 4 weeks after PRP. Results were compared to age-matched non-diabetic controls. Chi-Square test, and paired 't' test were used for statistical analysis. Results: Preoperative mean VEP amplitude was 8.35mV±3.71, and not significantly different to the control group (mean 10.51mV±3.34) (chi square test p=1). Mean preoperative P100 latency was 106.93±7.90ms and significantly different to the control group (103.21±7.65ms) (paired t-test p=0.001). After laser treatment, VEP amplitudes decreased in 48/100 eyes (mean total 5.11mV±2.4), and P100 latency increased in 75/100 eyes (mean total 110.47±7.35ms). Conclusion: In this study, PRP was followed by a significant decrease in VEP amplitudes in 48 percent and increase in latency in 75 percent of eyes. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/51/51992 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51993 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Intra-operative 5-FU in glaucoma surgery: A Nigerian teaching hospital experience Adegbehingbe, BO Oluwatoyin, HO Background: 5-Fluorouracil (5-FU) is an anti-metabolite used as an adjunct during the initial stages of a trabeculectomy to prevent excessive post-operative scarring and thus reduce the risk of failure. Objectives: To assess the effects of intra-operative 5-FU in trabeculectomy in Nigerians. Methods : Trabeculectomy with an intra-operative sponge soaked with 5-FU was performed in 49 eyes of 34 patients. The reduction in intra-ocular pressure (IOP), Visual acuity changes and complications were noted. Results: The mean presenting and preoperative IOP was 35.6+/-12.5mmHg and 25.5+/-6.6mmHg respectively. The mean post-operative IOP was 10.0+/- 5.2mmHg on the second post-operative day and 16.5+/7.3mmHg at 3 months. Post-operative complications included ocular hypotony in 4 (25 percent), shallowing of anterior chamber in 3 (18.8 percent), hyphema and cystic bleb in 2 (12.5 percent) each. None had bleb failure. 5 FU appears to reduce the relative risk of failure of trabeculectomy in those undergoing surgery for the first time (relative risk 0.29, 95 percent confidence interval 0.16 to 0.53). Conclusions: The use of 5-FU during trabeculectomy is associated with significant benefit in terms of intraocular pressure lowering beyond 3 months postoperatively. The results of surgery in Nigerian patients compare well with other reported series. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/57/51993 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51994 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Visual rehabilitation by scleral fixation of posterior chamber intraocular lenses in amblyopic aphakic children Ganesh, A Bialasiewicz, AA Al-Zuhaibi, SM Sabt, BI Ganguly, SS Background/Aims: To report on the outcome of scleral fixated posterior chamber intraocular lens (S-IOL) implantation in aphakic amblyopic children after 1 year. Methods: Amblyopic children with aphakia after traumatic and congenital cataract surgery unsuitable for spectacle or contact lens correction were operated with an anterior vitrectomy and inside-out double thread scleral fixation of an Alcon CZ70BD pcIOL. Refraction and vision was compared after 12 months. Results: From 2001-2006, 23 S-IOLs were implanted in 16 children (19 unilateral, 4 bilateral) aged 2-16 years: 10 eyes with traumatic [Group A], and 13 eyes with congenital cataracts including 3 eyes with ectopia lentis [Group B]. Preoperative UCVA compared to postoperative UCVA improved in 9/10 eyes in group A and 12/13 eyes in group B. Preoperative BCVA compared to postoperative UCVA improved in 9/10 eyes (90 percent) in group A and 4/13 eyes (31 percent) in group B. Mean age at surgery in group A was 6.8 years (1.5-16yrs) and in group B 10.5 years (4-16 years). More than one year elapsed in 2/10 eyes of group A and 8/13 eyes in group B. Postoperative refraction was within 2.0D of target in 17/23 eyes. Complications included temporary IOP rise in 2, vitreous hemorrhage in 1, and iris capture in 3 eyes. Two eyes required revision surgery. Conclusion: S-IOL implantation may be beneficial for aphakic children lacking other means for visual rehabilitation to improve vision. Amblyopia may be improved in most trauma, but only few congenital cataract eyes. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/61/51994 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51995 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Impact of intravitreal injection of Bevacizumab (Avastin) on rabbit's choroid and retina Karawya, S Said, DG Salaheldin, MM Zaky, I Aim: The aim of the study was to evaluate the impact of intravitreal injection of bevacizumab (Avastin) on chorio-capillaris permeability as well as structure changes in the choroid and the retina of pigmented rabbits. Material and Methods: The study included 10 pigmented rabbits (20 clinically free eyes) ranged in weight between 1.2 and 2 kg (mean 1.7± 0.05). The rabbits were subjected to intravitreal injection of 5 mg, 0.1mg Avastin in the right eyes (10eyes), while the left eyes (10eyes) were injected with equal volumes of balanced salt solution. 1 week later, Clinical examination and fundus fluorescein angiography (FFA) were done. Histological examination was performed on specimens of retina & choroid of Avastin & BSS injected eyes of sacrificed rabbits using light microscopy (LM) & transmission electron microscopy (TEM). Results were recorded and compared.th Results: Post injection clinical examination of the eyes showed no abnormality of cornea, lens, vitreous and fundus. FFA showed remarkable decrease in background chorio-capillaris fluorescence in 7 eyes (70 percent) injected with Avastin as compared with eyes injected with BSS. No change was observed in regards to retinal vasculature, or abnormal dye leak. LM examination : specimens from Avastin group were evaluated in comparison to control eyes Treated eyes exhibited the same microscopic appearance in most specimens (8/10, 80 percent). The chorio-capillaris layer showed elongated, stretched monolayer of capillaries with flat, elongated endothelial cell lining. The laminae showed closely packed RBCs arranged in a monolayer with ribbon like shape. The surrounding interstitial tissue showed stretched, elongated & compact collagen fibers. The RPE cells were tightly adherent to each other with prominent nuclei. The different retinal layers were in concomitance with the control specimens, however mild to moderate disruption of photoreceptor outer segments together with mild vacuolization in the ganglion cell layer were seen. TEM examination of both control and treated specimens confirmed the findings recorded by LM. The endothelial cell limning of the choriocapillaris exhibited reduced fenestrations in between the cells. TEM also highlighted the compact lamellae of collagen fibers. The RPE cells showed remarkable increase in the number of mitochondria and prominent endoplasmic reticulum. Variable sized melanosomes were also seen th Conclusion: Though single intravitreal injection of Avastin does not cause appreciable histological changes in rabbit retina and choroid, yet, it imposes definite effect on choriocapillaris permeability as evidenced by FFA and ultra structural changes. Repeated intravitreal injections might alter the hemostasis of the chorio-capillaris RPE complex. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/67/51995 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51996 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular disorders in adult patients with tuberculosis in a tertiary care hospital in Nigeria Egbagbe, EE Omoti, AE Objectives: To determine the ocular disorders in adult tuberculosis (TB) patients in Benin City, Nigeria. Methods: A prospective study of adult TB patients presenting at the University of Benin Teaching Hospital, Benin City, Nigeria, between March 2006 and October 2006 was undertaken. The patients were interviewed and examined by the authors and the ocular findings recorded. Results: There were 92 patients (45 males and 47 females) with mean age 37.9 years (SD±15.6). Only one (1.1 percent) was HIV positive. Among the ocular findings in patients with TB, 8 patients had monocular blindness that included cataracts in 3 (37.5 percent), glaucoma in 2 (25 percent), optic atrophy, retinal vasculitis and maculopathy accounting for one case each (12.5 percent). Ocular disorders due to TB occurred in 9 patients (9.8 percent). These include cataract in 2 cases (2.2 percent), phlyctenular conjunctivitis in 2 cases (2.2 percent), glaucoma, anterior uveitis, chorioretinitis, retinal vasculitis, maculopathy, and optic atrophy each occurring in 1 case (1.1 percent). Conclusion: Tuberculosis is a cause of ocular morbidity, visual impairment and blindness. Prevention, early diagnosis and early treatment of TB may prevent avoidable visual loss. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/73/51996 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51997 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Risk factors for diabetic retinopathy among Jordanian diabetics Al-Bdour, MD Al-Till, MI Purpose: To identify the risk factors associated with diabetic retinopathy among diabetic patients at Jordan University Hospital. Methods: A total of 986 patients with diabetes mellitus were assessed at Jordan University Hospital. The assessment included detailed relevant history, complete medical and ophthalmic evaluation. Results: Out of the 1961 eye examined, 64.1 percent had one form of diabetic retinopathy; 54.8 percent had nonproliferative diabetic retinopathy (NPDR), 9.3 percent had proliferative diabetic retinopathy (PDR) and 30.8 percent had maculopathy. Of all participants, 23.5 percent had combined NPDR and maculopathy while 7.6 percent had PDR and maculopathy. Using logistic regression analysis it was shown that old age group, long duration of diabetes, poor glycemic control, uncontrolled blood pressure and the presence of nephropathy were significantly associated with diabetic retinopathy. The incidence of maculopathy was significantly associated with the presence of hypertension, protienuria and high cholesterol level. Conclusion: The challenge for the primary care physician and diabetologist is to attain excellent glycemic control, aggressive control of blood pressure and normalization of blood lipid in order to reduce the risk of blindness and lessen the burden from diabetic retinopathy. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/77/51997 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51998 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Mitochondrial disorders with significant ophthalmic manifestations Al-Enezi, M Al-Saleh, H Nasser, M Mitochondrial diseases are a clinically hetyerogenous group of disorders. They can be caused by mutations of nuclear or mitochondrial DNA (mtDNA). Some affect a single organ, but many involve multiple organ systems and often present with prominent neurologic and myopathic features. The eye is frequently affected, along with muscles and brain, but multisystem disease is common. Ophthalmic manifestations include cataract, retinopathy, optic atrophy, cortical visual loss, ptosis and ophthalmoplegia. Kearns-Sayre Syndrome (KSS), Mitochondrial Encephalopathy, Lactic Acidosis Stroke (MELAS), Myoclonic Epilepsy and Ragged Red Fiber myopathy (MERRF) and Lebers Hereditary Optic Neuropathy (LHON) are well known clinical entities that are secondary to mtDNA abnormalities, which has ophthalmic manifestations. Mitochondrial Dysfunction should be considered in the differential diagnosis of progressive multisystem disorder and specifically if there is associated neuro-ophthalmic manifestations, which may be the presenting symptom of these disorders. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/81/51998 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51999 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Isolated microcornea: Case report and relation to other "small eye" phenotypes Hazin, R Khan, AO Isolated microcornea is a very rarely-described condition of reduced cornea size (less than 11 mm horizontal diameter) in an individual without other significant ocular (or systemic) findings. This case report describes the biometric features of a boy with isolated microcornea (the youngest and most completely described patient to the best of our knowledge) and suggests that the condition is the same entity as relative anterior microphthalmos. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/87/51999 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:52000 2008-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Idiopathic polypoidal choroidal vasculopathy in a young man: Case report and literature review Al-Rashaed, S Purpose : To report a case of idiopathic polypoidal choroidal vasculopathy and its angiographic characteristics in a young man. Method : Clinical data including visual acuity, color fundus photography, fluorescein angiograph and indocyanine green findings and management of this case are presented. Results: A young healthy male was presented with sudden loss of vision in the left eye for 3 weeks duration and a visual of 1/200. Fundus examination of the eye showed vitreous hemorrhage with massive sub retinal yellowish old blood in the posterior pole with epiretinal fresh blood on the fovea. Intra-venous Fluorescein angiography and Indocyanine green tests showed features of Idiopathic Polypoidal Choroidal Vasculopathy. The patient received photodynamic therapy twice without significant visual improvement. Conclusion : Idiopathic Polypoidal Choroidal Vasculopathy can occur in a young age group and can lead to severe visual impairment despite treatment with PDT. Medknow Publications 2008-04-01 http://www.meajo.org/text.asp?2008/15/2/90/52000 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51984 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Visual outcome of pars plana vitrectomy for retained lens fragments after phacoemulsification Al-Amri, AM Purpose: To evaluate the visual outcome of patients who underwent pars plana vitrectomy (PPV) for posteriorly dislocated lens fragments after phacoemulsification. Methods : A retrospective chart review was conducted of all patients who had PPV for posteriorly dislocated lens fragments after phacoemulsification between January 2000 and September 2004 in the Vitreoretinal Service at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia. Demographics, preexisting eye diseases, details of the previous cataract surgery, findings at presentation, details of the vitreoretinal procedures, final visual acuity, and complications observed during the follow-up were evaluated. Results: Of the 60 patients identified, 37 patients (37 eyes) had a full set of data and were included in the study. In 21 eyes (56.8%), PPV was performed within 1 week of cataract extraction; in 15 eyes (40.5%), PPV was performed more than 1 week postcataract extraction. An initial visual acuity of 20/200 or worse was found in 34 eyes (91.9%). The final visual acuity was 20/40 or better in 10 eyes (27%), and 20/200 or worse in 13 eyes (35.1%). Retinal detachments were found in 3 eyes (8.1%): 1 before and 2 after vitrectomy. Conclusion: There was no statistically significant difference in outcome between those having vitrectomy the first week after cataract surgery and those having it later; however, there was a trend of better visual outcome in early vitrectomy patients (within 1 week). Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/107/51984 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51985 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Idiopathic intracranial hypertension in children: Clinical presentations and management Background: Idiopathic intracranial is common in adults, particularly obese young women, but also occurs in children and adolescents. Aim: C linical presentation of idiopathic intracranial hypertension in the pediatric population and how the presenting signs and symptoms may be different from those seen among adult patients. Results: This study is a prospective study conducted in the Alexandria Medical School, Egypt, between the periods starting from January 2003 till December 2007. Ten patients were included in this study, 9 patients were treated with repeated spinal taps while only one patient necessitated insertion of a theco-peritoneal shunt. Conclusion: Idiopathic intracranial hypertension may occur in children as among adults. If diagnosed early, visual acuity can be saved with proper management . Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/113/51985 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51986 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Mersilene mesh brow suspension: A new modified fox's procedure - five years clinical experience Hafez, A Mahmoud, MS Purpose: The aiming was to study the long-term clinical outcome and the merit of the author's modification of the fox's procedure. Methods: Mersilene mesh brow suspension (MMBS) procedure was performed in 50 upper lids with severe blepharoptosis and poor levator function. Results: The improvement in lid height was evaluated by preoperative and postoperative vertical palpebral aperture measurements and ranged from 2 to 6 mm (average 4 mm). The functional and cosmetically accepted results were maintained in 94% of the lids during mean follow-up of 39.4 months. Conclusion: In the present non-comparative study we believe that late Mersilene knot extrusion and forehead granuloma formation can be prevented by the modification adopted by the authors. Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/117/51986 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51987 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Phaco prechop versus divide and conquer phacoemulsification: A prospective comparative interventional study Elnaby, EA Abdelrahman, AM Ibrahim, HE Purpose: To compare two phaco techniques, namely Phaco Prechop and Divide and conquer, basically during their early learning curves. Patients and Methods: The study included 50 patients divided into 2 groups, each including 25 patients; group (A) where phaco Prechop was performed, and group (B) in which divide and conquer was performed. The mean effective ultrasound time, mean endothelial cell count, mean endothelial cell loss, corneal thickness, intraoperative complications, and the best corrected visual acuity were reported in the two groups both preoperative and postoperative. Results: The mean effective ultrasound time in group A was 19.36 ± 8.51 seconds, and in group B, it was 24.44 ± 7.86 seconds with a statistically significant difference between the two groups (P = 0.033). The mean endothelial cell count 3 months postoperative in group A was 2139.88 cells/mm<sup> 2</sup> . In group B, the mean endothelial cell count 3 months postoperative was 2087.08 cells/mm<sup> 2</sup> . The difference between the two groups was statistically insignificant (P = 0.558), however The difference in endothelial cell loss 3 months postoperatively between the two groups was statistically significant. (P = 0.001). Four cases in groups A (16%) had posterior capsular rents compared to three cases (12 %) in group B. Postoperative best corrected visual acuity in group B was 6/12 or better in 88% of cases as compared to 92% in group A with no statistical difference. Conclusion: Early cataract surgical cases performed with the Phaco Prechop and divide and conquer techniques showed comparable results and complications. However the former technique utilized less phaco time and energy without significant effect on the final surgical outcome. Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/123/51987 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51988 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Visual disabilities in children including childhood blindness Khandekar, R We should address visual disabilities in children instead of only the childhood blindness. Diseases related to nutritional, communicable diseases should be addressed through strategies for achieving 'Millennium Development Goals'. Facilities in African countries and countries with populations like India and China must be strengthened to address curable/preventable visual disabilities in children. Even though all efforts are done to strengthen, we will have 0.93 million blind children by 2020. Role of family physicians and paediatricians in trans-disciplinary approach to address visual disabilities in children is very crucial. If rational distribution of skilled human resource is not planned visual disabilities will not reduce effectively. Rehabilitation of visually disabled children should be integral part of addressing childhood blindness. All stakeholders including parents of children with visual disabilities should work together to achieve the goals. Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/129/51988 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51989 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
The association between dominant macular drusen and central retinal artery occlusion in young females with cardiac valve disease Al-Dhibi, H Bouhaimed, M To describe uncommon association between central retinal artery obstruction and dominant macular drusen in two young female patients. First patient, a 22-year-old female was presented with right central artery obstruction associated with bilateral dominant macular drusen. Systemic evaluation disclosed the presence of mitral valve regurge. Second patient, a 34-year-old female with a previous history of right central retinal artery obstruction diagnosed elsewhere. Fundus exam showed bilateral dominant macular drusen and her systemic evaluation revealed severe rheumatic valve stenosis, moderate aortic regurge with moderate to severe tricuspid regurge and she underwent mitral valve replacement. To the best of our knowledge, the association between central retinal artery obstruction and dominant macular drusen was not previously reported. Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/135/51989 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51990 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral optic nerve sheath meningioma with intracanalicular and intracranial component in a 25-year-old Saudi patient Badr, MA Elkhamary, SM Al, SS Al, TA Bilateral optic nerve sheath meningioma is rare. A meningioma is a benign neoplastic lesion from meningothelial cells of the meninges. They usually involve the intracanalicular portion of the optic nerve but may extend into the optic canal and through it to occupy the intracranial space. We present a case of 25-year-old Saudi female with bilateral optic nerve sheath meningioma. The diagnosis was delayed more than six years from initial symptoms. Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/138/51990 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51982 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
OCT - An insight into retinal disorders Keshavamurthy, R Grover, S Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/97/51982 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:51983 2008-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Transconjunctival sutureless 23-gauge vitrectomy for vitreoretinal diseases: Outcome of 30 consecutive cases El-Batarny, AM Background : To describe the initial experience, effectiveness, and safety profile of 23-gauge instrumentation for a variety of vitreoretinal conditions. Methods : A retrospective review of 30 consecutive 23-gauge vitrectomy cases done by a single vitreoretinal surgeon for various posterior segment conditions was done. All surgeries were performed using the two-step 23-gauge system developed by Dutch Ophthalmic Research Center (DORC). All patients had at least 3-month follow-up. Main outcome measures included surgical success, visual acuity, intraocular pressure, and operative complications. Results : Mean follow-up was 7.7 months (range 3-12 months). Indications for surgery included rhegmatogenous retinal detachment (n=8), nonclearing vitreous hemorrhage (n=6), tractional retinal detachment (n=5), macular hole (n=5), epiretinal membrane (n=3), retained lens fragments (n=2) and endophthalmitis (n=1). Gas tamponade was used in 18 eyes (60%) and silicone oil in six eyes (20%). Mean overall preoperative visual acuity was 20/1053 and final acuity was 20/78 ( P = 0.001). Mean intraocular pressure after 6 hours was 15.1mmHg (range 4-25 mmHg) and on postoperative day one was 14.5 mmHg (range 2-21 mmHg). Four eyes (13.3%) required suturing of sclerotomy intraoperatively. Conversion to 20-gauge was done in one eye (3.3%). Hypotony was reported in one eye (3.3%) postoperatively. Subconjunctival silicone oil reported in one eye (3.3%). There were no postoperative complications of endophthalmitis, retinal or choroidal detachment. Conclusion : 23-gauge transconjunctival sutureless vitrectomy was effective in the management of wide variety of vitreoretinal surgical indications. The safety profile compared favorably with published rates for 25-gauge systems. Medknow Publications 2008-07-01 http://www.meajo.org/text.asp?2008/15/3/99/51983 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48851 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Celebrating the past and looking ahead Edward, DP Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/1/48851 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48860 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Neovascular glaucoma at King Khaled Eye Specialist Hospital - etiologic considerations Al-Shamsi, HN Dueker, DK Nowilaty, SR Al-Shahwan, SA Background: Neovascular glaucoma (NVG) is a severe form of secondary glaucoma caused by the growth of new vessels over the trabecular meshwork. The principal causes are associated with retinal ischemia. Ablative treatment of the retina can prevent, halt, and even reverse the growth of new vessels on the iris and angle. It is an essential part of the management in most cases. Aims: To determine the causes of NVG among Saudi patients, presented at the King Khaled Eye Specialist Hospital. Methods: A retrospective review of 337 Saudi patients with NVG was obtained. All cases were reviewed for the evidence and causes of the disease, and their basic demographic information. A subset of 100 diabetic patients with PDR was further studied in greater detail for clinical findings and treatment history. Results: The most common primary etiologic associations for NVG included diabetic retinopathy (DR) (56.06%), retinal venous obstruction (26.40%), and chronic retinal detachment (03.56%). A history of diabetes mellitus was reported in 65.04%, systemic arterial hypertension was noted in 61.00%, and evidence of renal impairment was documented in 22.00%. Vision was markedly reduced in most eyes with NVG (median: hand motion). The median best visual acuity in the fellow eye was 20/160. Among the 100 cases, with DR as a cause of NVG, 43 patients had bilateral neovascularization of the iris (NVI) and 72 had bilateral PDR. Sixty-one patients had no previous laser treatment before the diagnosis of NVG. Among these, who received treatment, the median number of total laser spots was 1,003. Conclusions: Diabetes is a major cause of NVG presented to this tertiary eye care center in the Kingdom of Saudi Arabia followed by retinal venous obstruction. Close monitoring and full pan-retinal photocoagulation (PRP) were absent in most of the diabetic cases. It is important to recognize that the "unaffected" fellow eye, particularly in diabetic patients, may require fairly urgent treatment as well. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/15/48860 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48862 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Bleb-related endophthalmitis: Clinical presentation, isolates, treatment and visual outcome of culture-proven cases Ba'arah, BT Smiddy, WE Purpose: To investigate clinical features, causative organisms and their antibiotic sensitivity, management, and visual acuity outcomes of eyes with bleb-related endophthalmitis (BRE). Design: Retrospective, noncomparative, consecutive eye series. Methods: Clinical and microbiological records of patients with culture positive bleb-related endophthalmitis treated at a single institution between April 1995 and February 2002 were revised retrospectively. Main Outcome Measures: Final visual acuity, loss of eye and complications. Results: There were 34 cases with presenting visual acuities ranging from 20/200 to light perception. Decrease of visual acuity was the most frequent sign (94%) followed by pain (79%) and hypopyon (53%). Associated features included pseudophakia (79%), vitreous wick (29%), and wound leak (12%). The most frequent organisms isolated from vitreous specimens, were streptococcus species (55%) and gram positive coagulase negative staphylococci (20%). Polymicrobial growth was noted in 27% of cases. The cultured organisms were sensitive to antibiotics used in 94% of cases. Treatment modality used was vitreous tap with antibiotic injection without (65%) or with vitrectomy (35%). The most common intravitreal antibiotics combination was vancomycin with ceftazidime, Intravitreal dexamethsone was administered in 56% of cases. Final visual outcome of 20/400 or better was noticed in 50% of cases without and 33% with vitrectomy, but this was not statistically significant (p=0.45). The difference in final visual acuity of cases infected by gram-positive coagulase-negative staphylococci and streptococcus species were not statistically significant (p= 0.18). Overall, final visual outcome of 20/400 or better was noticed in 47% of cases, while no light perception was recorded in 8 (24%) cases. Of no light perception cases 7 underwent evisceration or enucleation. Overall, 32% of the cases experienced other complications like retinal detachment with dislocated intraocular lens, phthisis bulbi, and epiretinal membrane formation. Conclusion: BRE is associated with substantial visual morbidity. Prompt treatment of BRE with intravitreal vancomycin and broad spectrum antibiotics recommended while culture results are pending. Neither tap-injection with vitrectomy nor tap-injection without vitrectomy proved superior in the management of this condition. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/20/48862 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48864 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Non-traumatic ocular findings in industrial technical workers in Delta state, Nigeria Omoti, AE Edema, OT Akinsola, FB Aigbotsua, P Purpose: To determine the pattern of non-traumatic ocular disorders in industrial technical workers in the Delta state, Nigeria. Methods: A cross-sectional study of the pattern of non-traumatic ocular disorders among industrial technical workers in 3 factories in Ughelli North local Government Area of Delta state, Nigeria was conducted between February, 2002 and May, 2002. In addition to the demographic, the workers were studied for the presence of any non-trauma related ocular findings. Visual acuity of these workers was obtained as well as ocular examination was performed by using the Snellen's chart, pen torch, ophthalmoscope, Perkins hand-held tonometer, Ishihara plates. Patients were refracted if their visual acuity was less than normal. Results: Five hundred technical workers were screened that included 200 (40%) from the construction industry, 180 (36%) from the rubber factory and 120(24%) from the oil mill. All the workers studied were males. Ocular disorders were seen in 664 (66.4%) of the eyes. The most common ocular disorders were pingueculum 215 (21.5%), presbyopia 97 (9.7%), refractive error 94 (9.4%), pterygium 86 (8.6%) and chronic conjunctivitis 45 (4.5%). None of the workers was blind from non-traumatic causes. Only 36 (7.2%) workers wore any protective eye devices at work. Conclusion: Non-traumatic ocular disorders are common in the industrialized technical workers in the Delta state of Nigeria. The use of protective eye devices is low in these workers and suggests that measures to implement ocular safety should be undertaken in these industries. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/25/48864 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48865 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Low vision Aids provision for visually impaired Egyptian patients - a clinical outcome Shaaban, S El-Lakkany, AR Swelam, A Anwar, G Purpose: To evaluate a low vision rehabilitation service implemented for heterogeneously diverse group of Egyptianpatients with vision loss in terms of improving their visual performance and fulfilling their visual needs. Methods: Fifty patients with low vision were included in a prospective study. History taking, ophthalmic examinationand evaluation of the visual functions were performed for all patients. The required magnification was calculated, andsubsequently a low vision aid was chosen after counseling with patients. Low vision aids were tried in office, followedby a period of training before patients received their own low vision aids. Follow up was done for 6 months. Results: All patients who were referred to the low vision unit were not satisfied with their current spectacles or lowvision aids. After training and prescription of suitable LVAs, the improvement in distance and near visual acuity wasstatistically significant (p<0.001). Fifty-six per cent of the patients (n=28) showed improvement in distance visualacuity of 5 lines or more, and 57% of the patients (n=27) could discern N8 print size or better. The most commonlyused aids were high powered near adds. Despite the complaints about the appearance and use of LVAs, 76% of thepatients reported being moderately to highly-satisfied with their aids. Conclusions: The significant improvement in the visual performance of patients with low vision after the prescriptionand training on the use of LVAs, associated with patients' satisfaction, confirms the importance of expanding lowvision rehabilitative services and increasing the public awareness of its existence and benefits. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/29/48865 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48855 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Microbial keratitis in Kingdom of Bahrain: Clinical and microbiology study Al-Yousuf, N Background: Microbial keratitis is a potentially vision threatening condition worldwide . Knowing the predisposing factors and etiologic microorganism can help control and prevent this problem. This is the first study of its kind in Kingdom of Bahrain. Objective: To study the profile of microbial keratitis in Bahrain with special focus on risk factors, clinical outcome and microbilogical results. Methods: A retrospective analysis of all patients admitted in Salmaniya Medical Complex over a period of three years from January 2005 to January 2007 was performed. A total of 285 patients with keratitis were analysed. Non infectious corneal ulceration were excluded. Data collected from medical records were demographic features, predisposing factors, history of corneal trauma, associated ocular conditions, visual acuity at the time of presentation and the clinical course. Predisposing risk factors measured were contact lens use, presence of blepharitis, diabetes, lid abnormalities, dry eyes, keratoplasty and refractive surgery. For contact lens wearers any contact lens related risk factors that can lead to keratitis were measured . Pearson's chi-square test was used to carry out statistical analysis wherever required. Results: Contact lens wear, as a risk factor for microbial keratitis, formed 40% of the total study population. Other risk factors identified were dry eyes 24 cases (8%), 10 blepharitis (3%), 22 trauma (8%), abnormal lid position 14 cases (5%). 6 patients keratitis in a graft (2%), 3 had refractive surgery (1%). The most common causative organism isolated was pseudomonas aeroginosa (54%) followed by streptococcus 12%, staph 10%, other organisms 6%. 95% of contact lens wearers had pseudomonas Aeroginosa. This was statistically significant (p< 0.0001). The vast majority, 92% healed with scarring. 1% needed therapeutic keratoplasty and 7% lost to follow up. Risk factors in contact lens wearers were; 41 patients (36%) slept with the contact lenses.12 (8%) had contact lens related trauma and 8 (7%) had poor hygiene. Sleeping with the contact lenses was statistically significant (p<0.0001). Conclusion & Recommendation: Contact lens wear is the major risk factor for microbial keratitis in Bahrain. Pseudomonas aeroginosa was the commonest bacteria isolated. Sleeping with the contact lenses is the major risk factor among contact lens wearers. Majority of keratitis patients resulted in permanent scarring on the cornea. Educating the public, especially on contact lens care and precaution, can help reduce this visual morbidity. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/3/48855 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48866 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Directed therapy: An approach to the improved treatment of exfoliation syndrome Angelilli, A Ritch, R Exfoliation syndrome (XFS) is an age-related, generalized disorder of the extracellular matrix characterized by the production and progressive accumulation of a fibrillar extracellular material in many ocular tissues and is the most common identifiable cause of open-angle glaucoma worldwide. Exfoliation syndrome plays an etiologic role in open-angle glaucoma, angle-closure glaucoma, cataract, and retinal vein occlusion. It is accompanied by an increase in serious complications at the time of cataract extraction, such as zonular dialysis, capsular rupture, and vitreous loss. It is associated systemically with an increasing number of vascular disorders, hearing loss, and Alzheimer's disease. Exfoliation syndrome appears to be a disease of elastic tissue microfibrils. Directed therapy simply means devising specific treatments for specific diseases. There was little incentive to attempt to distinguish between various open-angle glaucomas if the treatments were essentially the same. However, this view also prevented the application of directed therapy in those instances in which such was available and applicable. Pilocarpine has multiple beneficial actions in eyes with XFS. Not only does it lower IOP, but by increasing aqueous outflow, it should enable the trabecular meshwork to clear more rapidly, and by limiting pupillary movement, should slow the progression of the disease. Theoretically, miotics should be the first line of treatment. Pilocarpine 2% q.h.s. can provide sufficient limitation of pupillary mobility without causing these side effects. In 2007, two common single nucleotide polymorphisms in the coding region of the lysyl oxidase-like 1 ( LOXL1 ) gene located on chromosome 15 were specifically associated with XFS and XFG. LOXL1 is a member of the lysyl oxidase family of enzymes, which are essential for the formation, stabilization, maintenance, and remodelling of elastic fibers and prevent age-related loss of elasticity of tissues. LOXL1 protein is a major component of exfoliation deposits and appears to play a role in its accumulation and in concomitant elastotic processes in intra- and extraocular tissues of XFS patients. This discovery should open the way to new approaches and directions of therapy for this protean disorder. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/35/48866 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48867 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Neuro-ophthalmic afferent system diagnoses a general ophthalmologist should (almost) never make alone Lee, AG The general ophthalmologist might be called upon to make the diagnosis of neuro-ophthlamic conditions which are either rare or require extensive testing to exclude alternative diagnoses. This paper reviews some common afferent system neuro-ophthlamologic diagnoses that the general ophthalmologist should rarely if ever make alone.These include posterior ischemic optic neuropathy, chronic optic neuritis, retinal migraine, and optic atrophy. Although these diagnoses do exist they are typically diagnoses of exclusion that require neuroimaging and ancillary testing and have no diagnostic test to confirm the diagnosis. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/41/48867 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48868 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The SCHWIND AMARIS total-tech laser as an all-rounder in refractive surgery Arbelaez, MC Mosquera, SA Purpose: To describe and argument an overview of the main features and unique technical points of AMARIS Total-Tech Laser, coupled with patient outcomes supporting the decision to perform LASIK treatments with maximised outcomes. Settings: Dr. M.C. Arbelaez, Muscat Eye Laser Center, Muscat, Sultanate of Oman. Methods: The findings collected during 18-month experience using SCHWIND AMARIS Total-Tech Laser have been reviewed to provide arguments for supporting the decision to perform LASIK treatments with maximised outcomes. For updated clinical outcomes, the last 100 myopic astigmatism treatments, the last 100 hyperopic astigmatism treatments, the last 30 ocular-wavefront-guided treatments, and the last 30 corneal-wavefront-guided treatments, all with 6-month follow-up, were included. For all those, LDV femtosecond system was used to prepare the flaps, and AMARIS flying spot system was used to perform ablations. Clinical outcomes were evaluated in terms of predictability, refractive outcome, safety, wavefront aberration, and contrast sensitivity. Results: 6-month postoperatively, mean defocus was -0.14±0.31D and astigmatism 0.25±0.37D. 70% eyes were within ±0.25D of emmetropia. 43% eyes gained lines of best spectacle-corrected visual acuity. For Aberration-Free treatments, none of the aberration metrics changed from pre- to postoperative values in a clinically relevant amount. For ocular-wavefront-guided treatments, the surgery did not change coma or spherical aberration, and reduced trefoil (p<0.005). For corneal-wavefront-guided treatments, the trefoil, coma, and spherical aberrations, as well as the total root-mean-square values of higher order aberration, were significantly reduced (p<.05) when the pre-existing aberrations were greater than the repeatability and the biological noise. Conclusions: Although this review does not allow for evidence-based conclusions, following our strategy, LASIK results were excellent. LASIK surgery with AMARIS system yield excellent outcomes. Refractions were reduced to subclinical values with no induction of High-Order-Aberrations. Neither adverse events nor complications were observed. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/46/48868 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:48858 2009-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Subjective and quantitative measurement of wavefront aberrations in nuclear cataracts - a retrospective case controlled study Wali, UK Bialasiewicz, AA Al-Kharousi, N Rizvi, SG Baloushi, H Purpose: To measure, quantify and compare Ocular Aberrations due to nuclear cataracts. Setting: Department of ophthalmology and school for ophthalmic technicians, college of medicine and health sciences, Sultan Qaboos University, Muscat, Oman. Design: Retrospective case controlled study. Methods: 113 eyes of 77 patients with nuclear cataract (NC) were recruited from outpatient clinic of a major tertiary referral center for Ophthalmology. Patients having NC with no co-existing ocular pathologies were selected. All patients were subjected to wavefront aberrometry (make) using Hartmann-Shack (HS) aberrometer. Consents were taken from all patients. Higher order Aberrations (HOA) were calculated with Zernike polynomials up to the fourth order. For comparison 28 eyes of 15 subjects with no lenticular opacities (control group) were recruited and evaluated in an identical manner. No pupillary mydriasis was done in both groups. Results: Total aberrations were almost six times higher in NC group compared to control (normal) subjects. The HOA were 21 times higher in NC group, and coma was significantly higher in NC eyes compared to normal (control) group. The pupillary diameter was significantly larger in control group (5.48mm ± 1.0024, p<.001) compared to NC (3.05mm ± 1.9145) subjects (probably due to younger control age group). Amongst Zernike coefficients up to fourth order, two polynomials, defocus (Z<sub>2</sub><sup> 0</sup> ) and spherical aberration (Z<sub>4</sub><sup> 2</sup> ) were found to be significantly greater amongst NC group, compared to normal control group. Conclusion: Nuclear cataracts predominantly produce increased defocus and spherical aberrations. This could explain visual symptoms like image deterioration in spite of normal Visual acuity. Medknow Publications 2009-01-01 http://www.meajo.org/text.asp?2009/16/1/9/48858 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53861 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
The importance of structured scientific enquiry: A priority for the MEAJO editorial board Khandekar, R Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/55/53861 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53862 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Carotid cavernous fistula: Ophthalmological implications Chaudhry, IA Elkhamry, SM Al-Rashed, W Bosley, TM Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external carotid artery or both. These fistulas may be divided into spontaneous or traumatic in relation to cause and direct or dural in relation to angiographic findings. The dural fistulas usually have low rates of arterial blood flow and may be difficult to diagnose without angiography. Patients with CCF may initially present to an ophthalmologist with decreased vision, conjunctival chemosis, external ophthalmoplegia and proptosis. Patients with CCF may have predisposing causes, which need to be elicited. Radiological features may be helpful in confirming the diagnosis and determining possible intervention. Patients with any associated visual impairment or ocular conditions, such as glaucoma, need to be identified and treated. Based on patient's signs and symptoms, timely intervention is mandatory to prevent morbidity or mortality. The conventional treatments include carotid ligation and embolization, with minimal significant morbidity or mortality. Ophthalmologist may be the first physician to encounter a patient with clinical manifestations of CCF, and this review article should help in understanding the clinical features of CCF, current diagnostic approach, usefulness of the available imaging modalities, possible modes of treatment and expected outcome. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/57/53862 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53863 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Assessment and management of children with visual impairment Labib, TA Mohamed, B Sabra, NM Purpose: The aim of this work was to evaluate the role of low vision aids in improving visual performance and response in children with low vision. Study Design: Prospective clinical case series. Materials and Methods: This study was conducted on 50 patients that met the international criteria for a diagnosis of low vision. Their ages ranged from 5 to 15 years. Assessment of low vision included distance and near visual acuity assessment, color vision and contrast sensitivity function. Low vision aids were prescribed based on initial evaluation and the patient's visual needs. Patients were followed up for 1 year using the tests done at the initial examination and a visual function assessment questionnaire. Results: The duration of visual impairment ranged from 1 to 10 years, with mean duration ± SD being 4.6± 2.3299. The near visual acuities ranged from A10 to A20, with mean near acuity ± SD being A13.632 ± 3.17171. Far visual acuities ranged from 6/60 (0.06) to 6/24 (0.25), with mean far visual acuity ± SD being 0.122 ± 0.1191. All patients had impaired contrast sensitivity function as tested using the vision contrast testing system (VCTS) chart for all spatial frequencies. Distance and near vision aids were prescribed according to the visual acuity and the visual needs of every patient. All patients in the age group 5-7 years could be integrated in mainstream schools. The remaining patients that were already integrated in schools demonstrated greater independency regarding reading books and copying from blackboards. Conclusion: Our study confirmed that low vision aids could play an effective role in minimizing the impact of low vision and improving the visual performance of children with low vision, leading to maximizing their social and educational integration. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/64/53863 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53864 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence of uncorrected refractive error and other eye problems among urban and rural school children Padhye, AS Khandekar, R Dharmadhikari, S Dole, K Gogate, P Deshpande, M Background: Uncorrected refractive error is an avoidable cause of visual impairment. Aim: To compare the magnitude and determinants of uncorrected refractive error, such as age, sex, family history of refractive error and use of spectacles among school children 6-15 years old in urban and rural Maharashtra, India. Study Design: This was a review of school-based vision screening conducted in 2004-2005. Materials and Methods: Optometrists assessed visual acuity, amblyopia and strabismus in rural children. Teachers assessed visual acuity and then optometrists confirmed their findings in urban schools. Ophthalmologists screened for ocular pathology. Data of uncorrected refractive error, amblyopia, strabismus and blinding eye diseases was analyzed to compare the prevalence and risk factors among children of rural and urban areas. Results: We examined 5,021 children of 8 urban clusters and 7,401 children of 28 rural clusters. The cluster-weighted prevalence of uncorrected refractive error in urban and rural children was 5.46% (95% CI, 5.44-5.48) and 2.63% (95% CI, 2.62-2.64), respectively. The prevalence of myopia, hypermetropia and astigmatism in urban children was 3.16%, 1.06% and 0.16%, respectively. In rural children, the prevalence of myopia, hypermetropia and astigmatism was 1.45%, 0.39% and 0.21%, respectively. The prevalence of amblyopia was 0.8% in urban and 0.2% in rural children. Thirteen to 15 years old children attending urban schools were most likely to have uncorrected myopia. Conclusion: The prevalence of uncorrected refractive error, especially myopia, was higher in urban children. Causes of higher prevalence and barriers to refractive error correction services should be identified and addressed. Eye screening of school children is recommended. However, the approach used may be different for urban and rural school children. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/69/53864 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53865 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Intravitreal bevacizumab (avastin) as an adjuvant treatment in cases of neovascular glaucoma Ghanem, AA El-Agamy, AF Purpose: To evaluate the effect of intravitreal bevacizumab (avastin) injection in cases of neovascular glaucoma. Study Design: Clinical case series. Materials and Methods: Sixteen eyes of 16 patients with rubeosis iridis and secondary glaucoma were administered intravitreal injection of bevacizumab (2.5 mg). The patients were followed for 2 months. Results: We noted partial or complete regression of iris neovascularization 1 week after injection of bevacizumab. Reproliferation of new vessels was detected in 25% of the cases after 2 months. The mean intraocular pressure (IOP) before injection was 28± 9.3 mm Hg under topical β-blocker and systemic acetazolamide. One week after injection, the IOP decreased to 21.7± 11.5 mm Hg (5 cases without anti-glaucoma drugs, 6 cases with topical β-blocker and 5 cases with both topical β-blocker and systemic acetazolamide). Conclusion: Intravitreal bevacizumab (avastin) injection leads to regression of iris neovascularization with subsequent drop of IOP in eyes with neovascular glaucoma. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/75/53865 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53866 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Presenting visual acuities in a referral eye center in an oil-producing area of Nigeria Waziri-Erameh, JM Omoti, AE Objectives: To determine the pattern of presenting visual acuities at an eye center in the Niger Delta region of Nigeria. Study Design: Retrospective chart review Methods: A retrospective review of patient records attending a private referral eye center providing services for company patients and the general public in the region. Information was obtained from computerized medical records of 6533 patients who attended the center for various eye concerns in a 5-year period (January 1998 to December 2002). Results: A total of 6533 patients were seen in this 5-year period of which 2472 (37.8%) were company patients and 4061 (62.2%). were private patients. There were 3879 males (59.4%) and 2654 females (40.6%). A visual acuity of 6/6 or better was seen in 50.8% of the patients. In 76.6% of patients, a visual acuity of 6/18 or better was recorded. There were 21.4% of patients in the low vision group. Bilateral blindness occurred in 2.1% of patients. Monocular blindness occurred in 3.7% of patients. Low vision occurred in 16.9% of company patients and 24.1% of private patients. Bilateral blindness occurred in 0.9% of company patients and 2.7% of private patients, while monocular blindness occurred in 1.2% of company patients and 5.2% of private patients. The main ocular problems were refractive error, glaucoma, conjunctivitis, headaches, ocular trauma, retina and related pathologies, cataract, uveitis, pterygium and corneal problems. Conclusion: The incidence of low vision and blindness is high in the oil-producing area of the Niger Delta region of Nigeria. Low vision and blindness were more common in private patients than in company patients. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/80/53866 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53867 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence of punctal stenosis among ophthalmology patients Bukhari, A Purpose: To estimate the prevalence of punctal stenosis among patients visiting the general ophthalmology clinic for routine checkup. Design: Prospective, observational case series. Materials and Methods: A total of 682 patients were evaluated for evidence of punctal stenosis from May to November 2008. Any associated findings from clinical examination were recorded. Results: As many as 54.3% (370/682) of the candidates had punctal stenosis. The prevalence is associated significantly with increasing age (p=.001), and no gender predilection was found. It was due to chronic blepharitis in 97% (359/370), entropion in 1.4% (5/370) and unknown causes in 1.6% (6/370) of the patients. As many as 58.1% (215/370) did not have subjective or objective evidence of epiphora, and all of them had a tear film breakup time of less than 10 seconds and positive corneal fluorescein staining. Conclusion: Punctal stenosis is a common finding among patients presenting for routine eye checkup. It increases with advancing age, and the most common predisposing factor is chronic blepharitis. A significant number of patients can be asymptomatic as they have concurrent dry eye disease. Surgical intervention is not recommended unless the patient is symptomatic after treating any associated blepharitis and dry eye disease. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/85/53867 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53868 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Cataract surgical outcomes in diabetic patients: Case control study Onakpoya, OH Bekibele, CO Adegbehingbe, SA Purpose: To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria. Design: A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria. Subjects: Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005. Main outcome: Mean post operative visual acuity and surgical complications. Results: Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 ± 7.2 years. The mean post operative visual acuity in diabetics was 0.11±0.38, 0.33±0.57 and 0.38±0.49 at one week, two months and six months compared with 0.23±0.19, 0.46±0.37 and 0.48±0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively). Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications. Conclusion: Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/88/53868 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53869 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Traditional medicine in Oman: Its role in ophthalmology Shenoy, R Bialasiewicz, A Khandekar, R Al, BB Al, BH Aim: To present three patients with ocular disease who developed a range of complications following use of traditional medications. Settings and Design: Case series Methods: Three patients who were examined in the Ophthalmic department of a tertiary care teaching hospital in the Sultanate of Oman between 2003 and 2004, seeking care following use of traditional medicines and or healing practices for various ophthalmic problems described below. Results: The first patient was a computer professional with a chalazion; the patient used a plant extract from 'Calotropis procera' as a part of the treatment. He developed corneal edema with decrease in vision in his left eye following application of the plant extract. Treatment with topical steroids and antibiotics resulted in a complete clinical and visual recovery. The second patient developed a fungal corneal ulcer (dermatophyte - Trichophyton mentagrophyte) after sustaining injury with an animal tail to the right eye and used honey for pain relief prior to presentation. She responded poorly to anti-fungal treatment, underwent a penetrating keratoplasty with recurrence of infection in the graft that resulted in a vascularized corneal scar. The third patient was a five-year-old child who was treated with 'wasam' on the occiput for intraocular inflammation following bilateral uncomplicated cataract extraction. Following this treatment the topical steroid was discontinued. The "Wasam" treatment indirectly resulted in exacerbation of the intraocular inflammation and secondary glaucoma and poor vision as well as 'Wasam ulcers' on the occiput. Despite treatment of the intraocular inflammation, the visual outcome was poor. Conclusion: Traditional medicine in Oman is sought by many for variable reasons. Lack of evidence-based scientific data on its safety or efficacy does not deter the Omanis from flocking the traditional healers. However, when applied in the treatment of ocular diseases, traditional medicine and healing practices seem to cause more harm than benefit for the patient. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/92/53869 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:53870 2009-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Late occurrence of lens particle glaucoma due to an occult glass intralenticular foreign body Hassan, NA Reddy, MA Reddy, SS We report a case of traumatic mature cataract with a late occurrence of lens particle glaucoma after 11 years of trauma due to a presence of an occult intralenticular glass foreign body which was detected accidentally during the cataract surgery. Medknow Publications 2009-04-01 http://www.meajo.org/text.asp?2009/16/2/97/53870 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56218 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Glaucoma surgery: How do we get from here to there? Kahook, MY Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/105/56218 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56219 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Results from the tube versus trabeculectomy study Gedde Steven J, the Tube Versus Trabeculectomy Study Group The Tube Versus Trabeculectomy (TVT) Study is a multicenter randomized clinical trial comparing the safety and efficacy of tube shunt surgery to trabeculectomy with mitomycin (MMC) in eyes with previous cataract and/or failed glaucoma surgery. Tube shunt surgery was more likely to maintain intraocular pressure (IOP) control and avoid persistent hypotony, reoperation for glaucoma, or loss of light perception vision than trabeculectomy with MMC during the first year of follow-up. Both surgical procedures had similar IOP reduction at 1 year, but less supplemental medical therapy was used following trabeculectomy. The incidence of postoperative complications was higher after trabeculectomy with MMC relative to tube shunt surgery, but serious complications associated with vision loss and/or reoperation developed with similar frequency after both of the procedures. There was no significant difference in the rate of vision loss following trabeculectomy with MMC and tube shunt surgery after 1 year of follow-up. Cataract progression was common, but occurred with similar frequency with both of the surgical procedures. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/107/56219 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56220 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
The moorfields safer surgery system Dhingra, S Khaw, PT This review presents the 'Moorfields Safer Surgery System', which is designed to improve the consistency and outcomes of trabeculectomy surgery. Evidence-based recommendations are made for each step of the surgery. This system requires a minimum of equipment and can be easily implemented by most surgeons. The system is ultimately designed to preserve the vision in our patients by minimising complications while maintaining a desired intraocular pressure. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/112/56220 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56221 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Update on laser trabeculoplasty El, SF Helal, M Newer techniques of Laser Trabeculoplasty have revived the procedure and gained widespread acceptance by the ophthalmic community. This review was undertaken to address the evolution of different laser trabeculoplaty techniques, proposed mechanisms of action as well as review current studies of the therapeutic effects of these interventions. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/116/56221 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56222 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Cataract surgery to lower intraocular pressure Berdahl, JP Cataract and glaucoma are common co morbidities. Cataract surgery is frequently performed in patients with glaucoma. In this study, a review of literature with search terms of cataract, glaucoma and intraocular pressure is followed by evaluation and synthesis of data to determine the effect of cataract surgery on intraocular pressure. Cataract surgery seems to lower intraocular pressure on a sustained basis, especially in patients with higher preoperative intraocular pressure. The mechanism of action of these finds remains speculative. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/119/56222 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56223 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Deep sclerectomy: Safety and efficacy Varga, Z Shaarawy, T Deep Sclerectomy is a non penetrating surgical procedure for the treatment of open angle glaucoma. In this article we will describe the surgical technique, the indications for surgery and will review the scientific literature on surgical outcome following this procedure. We will also discuss the important role played by antimetabolites, implants and the use of gonipuncture to achieve the desired IOP reduction. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/123/56223 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56224 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Canaloplasty using iTrack 250 microcatheter with suture tensioning on Schlemm's canal Khaimi, MA Open angle glaucoma (OAG) necessitating surgery has traditionally been treated with filtering procedures using antifibrotics. Unfortunately, such filtering procedures are not without the risk of postsurgical complications. Increasing interest in blebless surgery has led to innovative surgical procedures aimed at rejuvenating the natural trabeculo canalicular outflow pathway. Circumferential catheterization with suture tensioning of Schlemm's canal has emerged as a safe and effective way to surgically treat OAG. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/127/56224 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56225 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Endocyclophotocoagulation Falkenberry, SM Siegfried, CJ Endocyclophotocoagulation is becoming a widely accepted and popular treatment of refractory glaucoma and as an adjunct to cataract surgery in both medically controlled and uncontrolled glaucoma. We present a brief review of the indications, technique, safety and efficacy of endoscopic photococylocoagulation. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/130/56225 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56226 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
The ex-press mini glaucoma shunt: Technique and experience Sarkisian, SR The Ex-Press Mini Glaucoma Shunt has been available internationally for almost a decade with almost 35,000 implantations world wide. The device shunts aqueous from the anterior chamber to a subconjunctival reservoir in a similar fashion as trabeculectomy, without removal of any sclera or iris tissue. Developments in ophthalmic surgery have been focused on smaller incisions to improve patient outcomes and visual recovery. The Ex-Press is an example of these developments. This article will review the surgical technique for implanting the Ex-Press Mini Glaucoma Shunt and will highlight the clinical experience with the device. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/134/56226 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56227 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Glaukos iStent<sup>®</sup> trabecular micro-bypass Nichamin, LD The iStent trabecular micro-bypass system (Glaukos Corp. Laguna Hills, CA) was developed to address the limitations of current medical and surgical therapies for glaucoma treatment. The iStent<sup>;</sup> is inserted ab interno through a small temporal clear corneal incision, bypassing the trabecular meshwork and placed in Schlemm's canal at the lower nasal quadrant. Implantation of this stent into Schlemm's canal allows aqueous humor to drain directly from the anterior chamber into Schlemm's canal bypassing the obstructed trabecular meshwork. For this review, a Medline search was performed using the terms "trabecular micro-bypass stent" and "trabecular bypass stent." The online abstract database for the American Academy of Ophthalmology was also reviewed. Abstracts which duplicated published articles were excluded. All relevant papers (n is equal to three) and abstracts (n is equal to one) were included in this review. Multiple, prospective multi-country, clinical trials have demonstrated the safety and efficacy of iStent in reducing IOP, when compared to traditional treatment modalities, while reducing/ eliminating the need for ocular antihypertensive drugs when implanted in OAG patients during combined cataract surgery or in patients with glaucoma refractory to traditional treatment modalities. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/138/56227 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56228 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Detection of early glaucomatous damage in pseudo exfoliation syndrome by assessment of retinal nerve fiber layer thickness Mohamed, MM Purpose : To detect early glaucomatous changes in pseudo exfoliative patients with normal intraocular pressure (IOP), visual field and optic nerve head appearance; by measuring retinal nerve fiber layer (RNFL) thickness using optical coherence tomography (OCT). Design : A prospective observational case-control study. Participants : Twenty non-glaucomatous (normal IOP, fundus and visual field) pseudo exfoliative patients and 20 age matched healthy control subjects. Materials and Methods : The RNFL thickness (global and four quadrants) was assessed using combined imaging system OTI (OCT/SLO) and compared with age matched normal control subjects. Results : The RNFL in patients with pseudo exfoliation syndrome (PXS) was significantly thinner in all quadrants except the nasal quadrant compared to the control group (p less than 0.05). Conclusion : Measurement of RNFL thickness by OCT is useful in detecting early RNFL damage which in turn provides clinically relevant information in detecting early glaucomatous changes in pseudo exfoliative patients. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/141/56228 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56229 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Vascular risk factors for open angle glaucoma in African eyes Omoti, AE Enock, ME Okeigbemen, VW Akpe, BA Fuh, UC Context : The exact patho physiological mechanizm of optic nerve damage in glaucoma is not fully understood. Aim : To assess the vascular risk factors in open angle glaucoma in African eyes. Settings and Design : Prospective multicenter hospital-based study in Edo State, Nigeria. Materials and Methods : Three hundred and twenty-two glaucoma patients and 184 control subjects were included in the study comprising 200 male glaucoma patients (62.11%) and 122 females (37.89%). A cohort of consecutive patients with a diagnosis of primary open angle glaucoma and age and sex matched control subjects were included in this prospective, cross-sectional, and multicenter hospital-based study conducted during the period January-June 2008. Blood pressure (BP), pulse and intraocular pressure findings were recorded and mean BP, pulse and perfusion pressure for each eye calculated. Statistical Analysis Used : Mean, standard deviations, 95% confidence intervals, Welch's t test, and Fisher's exact test were calculated. Results : The mean IOP in the 644 eyes of the 322 glaucoma patients was 22.65 mmHg (SD plus/minus 11.06). The systolic blood pressure (P < 0.0001), diastolic blood pressure (P < 0.0001), mean arterial blood pressure (P < 0.0001), pulse pressure (P < 0.01), systolic perfusion pressure (P < 0.01) were all significantly higher in glaucoma patients than in control. Conclusions : Higher systolic, diastolic, mean arterial BP and pulse pressure was found in Black African patients with open angle glaucoma. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/146/56229 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:56230 2009-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Ahmed glaucoma valve implant: Experience in East Africa Kiage, DO Gradin, D Gichuhi, S Damji, KF Purpose : To describe short term outcomes of Ahmed Glaucoma Valve [AGV] implantation in East African patients. Materials and Methods : In this multi-center retrospective case series we reviewed eyes of Black African patients with refractory glaucoma, treated consecutively with Ahmed Glaucoma Valve implantation, in two centers in Kenya between January 2006 and October 2007. Results : About 25 cases including 18 [72%] pediatric eyes and seven [28%] adult eyes were identified. Results have been presented with a median follow-up of two months with inter-quartile range [IQR] of one to 12 months. intraocular pressure [IOP] was reduced from a mean of 36.4 mmHg preoperatively to 16.7 mmHg and glaucoma medications were lowered from a mean of 1.32 before surgery to 0.2 after surgery. The success rate during short term follow-up was 79%. The mean visual acuity dropped slightly from 6/18 pre-operatively to 6/24. There was only one major complication of an extruded, infected valve in a child. Conclusions : The Ahmed Valve Implant is safe and effective in lowering IOP for the short term in pediatric and adult East African patients with refractory glaucoma. Further studies with more patients and longer term follow-up are needed in this population. Medknow Publications 2009-07-01 http://www.meajo.org/text.asp?2009/16/3/151/56230 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58413 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Uveitis update: An overview by the society for ophthalmo-immunoinfectiology in Europe Herbort, CP Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/157/58413 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58416 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Appraisal, work-up and diagnosis of anterior uveitis: A practical approach Herbort, CP This article presents a comprehensive approach of the diagnosis of anterior uveitis and appropriate investigational tests based on clinical signs. Uveitis has classically been presented by uveitis specialists as an obscure and complicated field in ophthalmology that was supposed to be restricted to the happy few who had the knowledge, which in some countries was even prevented from being diffused. The effect was that ophthalmologists turned away from uveitis or were not correctly armed when they chose to take care of uveitis patients. The consequences of this situation often fell upon the patients. Since more than 15 years our group has been represented by the Society for Ophthalmo-Immunoinfectiology in Europe (SOIE), which has been working to alter this image of uveitis and ensure that the knowledge of the basics of uveitis reaches the practicing ophthalmologist. Our firm believe is that up to 70% of uveitis cases, especially anterior uveitis, can be taken care of by the practicing ophthalmologist following a structured approach in the appraisal of the uveitis case. Judging from the attendance obtained, the response to our approach in every country (where we organise courses) has been inversely proportional to the previous disinterest since we started publicizing it. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/159/58416 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58419 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Fluorescein and indocyanine green angiography for uveitis Herbort, CP In recent years enormous progress has been achieved in investigational procedures for uveitis. Imaging is one such example with the advent of new methods such as indocyanine green angiography, ultrasound biomicroscopy and optical coherence tomography to cite only the most important. This tremendous increase in precision and accuracy in the assessment of the level and degree of inflammation and its monitoring comes in parallel with the development of extremely potent and efficacious therapies. In view of these developments, our whole attitude in the appraisal and investigation of the uveitis patient has to be adapted and correctly reoriented integrating the recent developments and this is no different for ocular angiography. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/168/58419 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58421 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Tuberculous uveitis Abouammoh, M Al-Mezaine, HS In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patients with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/188/58421 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58423 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Differential diagnosis of retinal vasculitis Herbort, CP Tabbara, KF Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/202/58423 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58425 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Behçet's uveitis Tugal-Tutkun, I Behcet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient "Silk Road". The eye is the most commonly involved vital organ in Behηet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients with posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/219/58425 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58426 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Emergent infectious uveitis Khairallah, M Jelliti, B Jenzeri, S Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/225/58426 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58424 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Fuchs' uveitis: Failure to associate vitritis and disc hyperfluorescence with the disease is the major factor for misdiagnosis and diagnostic delay Bouchenaki, N Herbort, CP Purpose: Fuchs' uveitis is often diagnosed with substantial delay at the origin of deleterious consequences such as unnecessary treatment. The aim of the study was to analyse the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with the other clinical signs and evaluate their respective importance in the diagnosis of the disease. In particular, diagnostic delay and erroneous diagnoses were investigated. Patients and Methods: Patients seen in our centers between 1995 and 2008 with the diagnosis of Fuchs' uveitis were analysed. The data collected included age, initial and final visual acuities, clinical findings at presentation, mean diagnostic delay, erroneous diagnoses, laser flare photometry values, fundus and fluorescein angiography manifestations and ocular complications. Results: One hundred and five patients were included. The mean age at diagnosis was 34 years. Twelve patients (11.4%) had bilateral involvement. The mean diagnostic delay was 3.04 ± 4.30 years. The most frequent clinical signs were vitreous infiltration (97.40%), typical Fuchs' keratic precipitates (94.90%), crystalline lens opacities or cataract (47%), heterochromia (42.60%), ocular hypertension or glaucoma (12.80%). The mean laser flare photometry value at presentation was 9.85 ± 6.28 ph/ms. Thirty-nine patients (37.14%) had undergone fluorescein angiography showing disc hyperfluorescence in 97.7% and peripheral retinal vascular leakage in 13.6%. Conclusions: Fuchs' uveitis is significantly underdiagnosed likely because vitreous involvement was previously described but not commonly recognized as an association with Fuchs' uveitis in the clinician's mind and therefore has often been given a different diagnostic label. Moreover, the very frequent inflammatory signs on fluorescein angiography such as disc hyperfluorescence and more rarely peripheral retinal vascular leakage, which has not been typically associated with Fuchs' uveitis, appear to represent an additional factor leading to misdiagnosis. Such clinical findings need to be publicised in order to reduce misdiagnosis, and diagnostic delay. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/239/58424 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58422 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Inflammatory choroidal neovascularization Neri, P Lettieri, M Fortuna, C Manoni, M Giovannini, A Purpose and Methods: Choroidal neovascularization (CNV) can be a severe sight-threatening sequela, which can be secondary to both infectious and noninfectious uveitis. This review summarizes the different diseases associated with CNV, highlighting new treatment modalities and the possible strategies, which could be applied for the therapy of this occurrence. Results: Since CNV can often originate from posterior pole lesions and can be hard to identify, an accurate examination is mandatory in order to identify the correct diagnosis. In the majority of cases, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) enable the determination of the clinical characteristics of the CNV. An infectious disease should be looked for to include a suitable therapy when available. The treatment strategy for CNV secondary to noninfectious uveal inflammations should be directed at controlling the inflammatory process. Systemic corticosteroids with or without immunosuppressive agents are indicated even when the CNV occurs with apparently inactive uveitis: Chronic subclinical inflammation can be the basis for the pathogenesis of CNV. Additional therapies aimed directly at the neovascular process, such as the intravitreal anti-Vascular Endothelial Growth Factor (VEGF) agents, are recommended particularly when the therapy shows an insufficient response. Conclusion: CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant information about the choroidal status. Several therapeutic options have been considered, but no guidelines are provided at the moment. Moreover, the current data are still only based on case reports or small series. For such reasons, further trials are mandatory to validate the preliminary available results. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/245/58422 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58420 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmic disorders in adult lymphoma patients in Africa Omoti, AE Omoti, CE Momoh, RO Context: Ocular manifestations of lymphoma are rare events. Most reports of ocular involvement in lymphoma are case reports or reports of a few patients. Aims: To determine the ophthalmic disorders in adult, African, lymphoma patients. Settings and Design: A prospective study of ocular disorders in adult patients with lymphoma was conducted at the University of Benin Teaching Hospital, Benin City, Nigeria, between July 2004 and June 2007. Materials and Methods: The patients were interviewed and examined by the authors and the ocular findings recorded. Statistical Analysis: Data was analyzed on computer with the aid of the Instat GraghPad<sup>™</sup> v2.05a statistical package software. The mean, standard deviation, Mann-Whitney U-statistic and P value were calculated. Results: A total of 111 patients with hematological malignancies were seen over a period of three years of which 62 (55.85%) had lymphomas. Of these, 51(82.3%) were non-Hodgkin's lymphoma and 11(17.7%) were Hodgkin's lymphoma. Ocular disorders occurred in 16 patients (31.4%) with non-Hodgkin's lymphoma and none of the patients with Hodgkin's lymphoma (Mann-Whitney U-statistic is equal to 7.500, U' is equal to161.50, P , 0.0001). The ocular disorders due to non-Hodgkin's lymphoma were seen as - proptosis in six patients (11.8%), retinopathies in three (5.9%), conjunctival infiltration in three (5.9%), optic atrophy in two (3.9%), keratoconjunctivitis in one (two per cent), desquamating nodular lid lesions in one (two per cent), papilloedema in one (two per cent), and upper lid mass in one (two per cent). Four patients (6.5%) had monocular blindness. Conclusions: Ophthalmic disorders are relatively common in non-Hodgkin's lymphoma. Ophthalmic evaluation is needed in these patients for early identification and treatment of potentially blinding conditions. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/252/58420 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58418 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Riboflavin-ultraviolet a corneal cross-linking for keratoconus El-Raggal, TM Purpose: To evaluate the safety, efficacy of riboflavin-ultraviolet A irradiation (UVA) corneal cross-linking and present refractive changes induced by the treatment in cases of keratoconus. Materials and Methods: The study includes 15 eyes of 9 patients with keratoconus with an average keratometric (K) reading less than 54 D and minimal corneal thickness greater than 420 microns. The corneal epithelium was removed manually within the central 8.5 mm diameter area and the cornea was soaked with riboflavin eye drops (0.1% in 20% dextran t-500) for 30 minutes followed by exposure to UVA radiation (365 nm, 3 mW/cm<sup> 2</sup> ) for 30 minutes. During the follow-up period, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, slit lamp examination and topographic changes were recorded at the first week, first month, 3 and 6 months. Results: There was statistically significant improvement of UCVA from a preoperative mean of 0.11 ± 0.07 (range 0.05-0.3) to a postoperative mean of 0.15 ± 0.06 (range 0.1-0.3) (P < 0.05). None of the eyes lost lines of preoperative UCVA but 1 eye lost 1 line of preoperative BSCVA. The preoperative mean K of 49.97 ± 2.81 D (range 47.20-51.75) changed to 48.34 ± 2.64 D (range 45.75-50.40). This decrease in K readings was statistically significant (P < 0.05). All eyes developed minimal faint stromal haze that cleared in 14 eyes within 1 month. In only 1 eye, this resulted in a very faint corneal scar. Other sight threatening complications were not encountered in this series. Progression of the original disease was not seen in any of the treated eyes within 6 months of follow-up. Conclusion: Riboflavin-UVA corneal cross-linking is a safe and promising method for keratoconus. Larger studies with longer follow up are recommended. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/256/58418 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58417 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Efficacy of limbal-conjunctival autograft surgery with stem cells in pterygium treatment Abdalla, WM Purpose: To determine the efficacy of limbal-conjunctival autograft surgery with stem cells in the management of primary and recurrent pterygium and determine the best corrected visual acuity after surgery. Materials and Methods: Surgical excision of pterygium and limbal-conjunctival transplantation with stem cells was of 40 eyes (of 31 patients) with pterygium. Thirty one cases were primary and nine cases were recurrent pterygia. Graft margins were secured to the recipient site while stem cells aspect was sutured to the limbus. Results: After one year of follow-up, 37 of 40 (92.5%) eyes were free of recurrence. One of the three recurrent cases was aggressive (recurrence occurred two months after surgery) and the other two showed 2 mm corneal extension at 12 months follow-up. In 24 patients, out of 40 (60%), best corrected visual acuity improved more than two lines. Conclusion: Limbal-conjunctival autograft surgery, including stem cells, appears to be an effective surgical technique in preventing pterygium recurrence and it can also help in improving the best corrected visual acuity. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/260/58417 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58415 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Modified fasanella-servat for acquired ptosis: Case report and review of the literature Chaudhry, IA A 28-year-old man who had acquired ptosis of his left upper eyelid after a traffic accident did not benefit from standard levator advancement surgery. Patient had significant ptosis with moderate levator function. A modified Fasanella-Servat procedure under local anesthesia resulted in the desired correction of his left upper eyelid ptosis. A review of the Fasanella-Servat procedure for ptosis surgery is presented, as well as its modifications, along with its limitations. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/263/58415 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58414 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Mild myopic astigmatism corrected by accidental flap complication: A case report Fahed, DC Fahed, CD A 35-year-old female presented for laser in-situ keratomileusis (LASIK). Her preoperative eye exam was normal, with a preop refraction of OD -2.50 D Sph +1.25 D Cyl Χ175 and OS -2.75 D Sph +1.50 D Cyl Χ165 (cycloplegic and manifest), with 20/20 BCVA OU. The central pachymetry reading was 553 ΅m in the right eye. Preoperative topography was normal. At the start of the pendular microkeratome path, some resistance was felt, but the microkeratome continued along its path. Upon inspection of the flap, there was a central rectangle of intact epithelium with two mirror-image flaps on both sides. The flap was repositioned and LASIK was discontinued. The cornea healed with two faint thin linear vertical parallel scars at the edge of the pupil. Postoperative inspection of the blade revealed central blunting. One month postoperatively, the uncorrected visual acuity (UCVA) was 20/20. Manifest and cycloplegic refractions were plano. This is an interesting case of accidental flap complication resulting in the correction of mild myopic astigmatism. Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/266/58414 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:58412 2009-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Cataract surgery in patients with carotid cavernous fistula Jethani, J Medknow Publications 2009-10-01 http://www.meajo.org/text.asp?2009/16/4/269/58412 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61208 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Our eye is on the future Edward, DP Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/1/61208 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61226 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Iris depigmentation: An unusual complication of intralesional corticosteroid injection for capillary hemangioma Al-Mahdi, H Intralesional injection of corticosteroids has been used successfully in the treatment of adenexal hemangiomas, with advantages of easy administration, rapid action, repeatability, efficacy and safety. We report a case of an eight-month-old female infant who underwent intralesional corticosteroid injection for capillary hemangioma that had resulted in amblyopia of her left eye from ptosis. Two weeks after the injection, the hemangioma showed some regression but at that point iris depigmentation of the affected eye was noted. The iris depigmentation remained unchanged during her follow-up visit with significant regression of the hemangioma, associated ptosis and astigmatism. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/100/61226 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61227 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Circular anterior lens capsule rupture caused by blunt ocular trauma Dezhagah, H A 16 year old male experienced blunt ocular trauma causing rupture of the anterior lens capsule and mature cataract development. The trauma was due to a stone that impacted the left eye. In an otherwise clear lens, an anterior lens capsule defect formed post-trauma that progressed to a mature cataract over four months reducing distance vision from 20/125 to hand motion. The patient underwent phacoemulsification with posterior chamber intraocular lens implantation in the left eye. One year postoperatively, the vision in the left eye increased to 20/25 without correction. This is a rare case of cataract formation due to a defect in the anterior lens capsule caused by blunt ocular trauma. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/103/61227 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61212 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Keratoconus: Overview and update on treatment Espandar, L Meyer, J Keratoconus is a non-inflammatory, progressive thinning process of the cornea. It is a relatively common disorder of unknown etiology that can involve each layer of the cornea and often leads to high myopia and astigmatism. Computer-assisted corneal topography devices are valuable diagnostic tools for the diagnosis of subclinical keratoconus and for tracking the progression of the disease. The traditional conservative management of keratoconus begins with spectacle correction and contact lenses. Several newer, more invasive, treatments are currently available, especially for contact lens-intolerant patients. Intrastromal corneal ring segments can be used to reshape the abnormal cornea to improve the topographic abnormalities and visual acuity. Phakic intraocular lenses such as iris-fixated, angle-supported, posterior chamber implantable collamer and toric lenses are additional valuable options for the correction of refractive error. Corneal cross-linking is a relatively new method of stiffening the cornea to halt the progression of the disease. The future management of keratoconus will most likely incorporate multiple treatment modalities, both simultaneous and sequential, for the prevention and treatment of this disease. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/15/61212 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61213 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal collagen cross-linking Jovanovic, V Nikolic, L Lake, JC Kymionis, G Coskunseven, E Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of corneal tissue strengthening by using riboflavin as a photosensitizer and UVA to increase the formation of intra- and interfibrillar covalent bonds by photosensitized oxidation. Keratocyte apoptosis in the anterior segment of the corneal stroma all the way down to a depth of about 300 microns has been described and a demarcation line between the treated and untreated cornea has been clearly shown. It is important to ensure that the cytotoxic threshold for the endothelium has not been exceeded by strictly respecting the minimal corneal thickness. Confocal microscopy studies show that repopulation of keratocytes is already visible 1 month after the treatment, reaching its pre-operative quantity and quality in terms of functional morphology within 6 months after the treatment. The major indication for the use of CXL is to inhibit the progression of corneal ectasias, such as keratoconus and pellucid marginal degeneration. CXL may also be effective in the treatment and prophylaxis of iatrogenic keratectasia, resulting from excessively aggressive photoablation. This treatment has also been used to treat infectious corneal ulcers with apparent favorable results. Combination with other treatments, such as intracorneal ring segment implantation, limited topography-guided photoablation and conductive keratoplasty have been used with different levels of success. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/21/61213 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61214 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Deep anterior lamellar keratoplasty: Indications, surgical techniques and complications Karimian, F Feizi, S The concept of lamellar keratoplasty (LK) is not new. However, it had been abandoned and largely replaced by the time-honored technique of penetrating keratoplasty (PK) because LK is technically demanding, time consuming and gives suboptimal visual outcomes due to interface irregularity arising from manual lamellar dissection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as inherent advantages such as preservation of globe integrity and elimination of endothelial graft rejection have resulted in a re-introduction of LK as an acceptable alternative to con ventional PK. This review article describes the indications, different techniques, clinical outcomes and complications o f deep anterior LK. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/28/61214 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61209 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Cornea update: An overview of the topics presented in this issue Moshirfar, M Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/3/61209 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61215 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The use of glycerol-preserved corneas in the developing world Feilmeier, MR Tabin, GC Williams, L Oliva, M Corneal opacity is the third leading cause of blindness in the developing world and encompasses a wide variety of infectious, inflammatory and degenerative eye diseases. Most caes of corneal blindness are treatable with partial or full-thickness keratoplasty, provided adequate corneal tissue and surgical skill is available. However, access to sight-restoring keratoplasty in developing countries is limited by the lack of developed eye banking networks and a critical shortage of tissue suitable for transplantation. Beyond the developed world, corneal transplantation using fresh corneal tissue (FCT) is further hindered by unreliable storage and transportation facilities, unorganized distribution networks, the cost-prohibitive nature of imported tissue, unreliable compliance with medications and follow-up instructions and inadequate health and education services. Glycerol-preserved corneas overcome many of these limitations inherent to the use of FCT. As surgical innovation in lamellar corneal surgery expands the potential use of acellular corneal tissue, long-term preservation techniques are being revisited as a way to increase availability of corneal tissue to corneal surgeons throughout the developing world. Herein, we discuss the advantages of using and the applications for glycerol-preserved corneal tissue throughout the developing world. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/38/61215 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61216 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Day to day clinically relevant corneal elevation, thickness, and curvature parameters using the orbscan II scanning slit topographer and the pentacam scheimpflug imaging device Hashemi, H Mehravaran, S The introduction of different techniques and computerized devices into clinical ophthalmology has significantly improved our knowledge of the eyes, optics, and eye conditions. Today, corneal topography is performed with a wide range of devices that implement a variety of techniques. Advance computerized analysis systems provide us with simple and quick evaluation procedures, yet the sophisticated data and clinical information that is generated can only be interpreted with adequate knowledge of the system itself as well as the accepted normal ranges of various properties assessed with these systems. Two computerized topography systems that are in common use are the Orbscan (Bausch and Lomb Inc., Rochester, NY, USA) and the Pentacam (Oculus GmBH, Wetzlar, Germany). The Orbscan is a slit-scanning device and the Pentacam is Scheimpflug imaging device. In this review, we present a brief description of both technologies, the techniques implemented in each device and the acquisition process with each. This will be followed by a list of corneal parameters that need to be assessed in screening patients for refractive surgery. We will discuss how these parameters are displayed, how each parameter may serve as clinic criteria, and how data should be interpreted. We will also try to provide evidence regarding the accuracy of different measurements, and the comparability of the two devices. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/44/61216 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61210 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Endothelial keratoplasty: From DLEK to DMEK Fernandez, MM Afshari, NA The last decade has heralded a revolutionary shift in the treatment of corneal endothelial disease. Only 15 years ago, the only surgical treatment for pseudophakic bullous keratopathy and Fuchs dystrophy was penetrating keratoplasty (PK). Although used successfully for over a century, PK requires many months of refractive adjustments before the eye achieves visual stability. Starting with the advent of posterior lamellar keratoplasty in the late 1990s, a number of procedures have been developed, refined, and widely adopted, which have given patients faster recoveries and improved globe stability in comparison to traditional corneal transplantation. Each iteration of endothelial keratoplasty (EK) has involved the increasingly selective transplantation of corneal endothelial cells. Preliminary results of the most recent form of EK, Descemet's membrane EK, suggest that pure endothelial cell transplantation is on the horizon. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/5/61210 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61217 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Intraoperative and postoperative complications of laser in situ keratomileusis flap creation using intralase femtosecond laser and mechanical microkeratomes Espandar, L Meyer, J An essential step of laser in situ keratomileusis surgery is corneal flap creation, Femtosecond (FS)-assisted or mechanical microkeratome. Each type has rare intraoperative and postoperative complication rates. Several recent studies have identified risk factors and guidelines to help manage these complications. Fortunately, studies have shown no loss of best-corrected visual acuity (BCVA) after the management of intraoperative and postoperative complications in IntraLase FS and mechanical microkeratome. Refractive surgeons need to be aware of the types of complications that can occur, how to avoid them and how to manage them to ensure the best possible outcomes. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/56/61217 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61218 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
What is central toxic keratopathy syndrome if it is not diffuse lamellar keratitis grade IV? Hazin, R Daoud, YJ Khalifa, YM The Central Toxic Keratopathy (CTK) syndrome describes a rare, acute, self-limited, non-inflammatory process that yields central corneal opacification and significant hyperopic shift after refractive surgery. Despite being exceedingly rare, certain clinical features of CTK give the condition a striking resemblance to other more serious inflammatory conditions, including diffuse lamellar keratitis (DLK). As the authors demonstrate in this article, despite the overlapping clinical features, CTK is a disease process that is distinct from DLK and, therefore, in need of distinct management interventions. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/60/61218 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61219 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Intraocular lens power calculation after corneal refractive surgery Feiz, V Cataract surgery after corneal refractive surgery can be challenging for the ocular surgeon due to the difficulty with accurate intraocular lens (IOL) power determination and unexpected refractive surprises. As clinicians have done more work, a number of error sources have been determined. Furthermore, an increasing number of methods to avoid these refractive surprises have been proposed. The combination of this work has resulted in recommendations for the modification of standard IOL power calculations to improve outcomes. The following article includes a brief on, and by no means, inclusive, error sources and ways to compensate for them. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/63/61219 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61220 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Torsional mode phacoemulsification: Effective, safe cataract surgery technique of the future Gamil, MM Purpose: To compare various outcome measures using torsional mode and longitudinal mode in the phacoemulsification of cataract with different nuclear densities. Setting: Magrabi Eye Hospitals, Kingdom of Saudi Arabia. Design: A randomized comparative clinical study. Materials and Methods: This study includes 200 eyes of 156 patients (100 in the ultrasound longitudinal "US" group and 100 in the torsional group). All eyes received AcrySof<sup>®</sup> single piece intraocular lens (Alcon Surgical, Fort Worth, TX). The primary outcome measures were ultrasound time (UST), cumulative dissipated energy (CDE), and surgical complications. Postoperative outcome measures were the degree of corneal edema on the first postoperative day and final best corrected visual acuity (BCVA) and CCT (central corneal thickness). Results: The differences in UST and CDE between subgroups of nucleus hardness were statistically significant (P < 0.01). The UST and CDE consistently increased in eyes with higher grades of nucleus density. On day one, the mean BCVA was 0.61 ± 0.13 decimals in the ultrasound (US) group and 0.67 ± 0.11 decimals in the torsional group (significant P < 0.05).Corneal edema was significantly less in the torsional group (P < 0.05). At 30 days, the mean BCVA was 0.94 ± 0.22 decimals in the US group and 1.0 ± 0.12 decimals in the torsional group but this difference was not statistically different (P > 0.05). Conclusions: The torsional mode provides an effective and safe method for cataract removal with lower energy usage as compared to longitudinal traditional phacoemulsification. However, the final visual outcome was similar for both study groups. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/69/61220 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61221 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Point prevalence of pseudoexfoliation syndrome in patients scheduled for cataract surgery in eye camps in Yemen Al-Shaer, M Bamashmus, M Al-Barrag, A Purpose: To study the point prevalence of pseudoexfoliation syndrome (PXS) among Yemeni patients in different governorates with age-related cataract scheduled for surgery. Settings: Eye camps organized by the Nibras Health Society to perform cataract surgeries during the years 2002-2006. All patients aged 40 years and above were included in the study. Materials and Methods: A total of 2535 eyes of 2535 patients from 13 governorates, scheduled for cataract surgery in eye camps, were included. All eyes underwent complete eye examination before the surgery and were evaluated for the signs of pseudoexfoliation material in the pupil, iris and lens capsule on dilated slit lamp examination. Results: The study found 495 of the 2535 eyes (19.53%) with PXS with males more commonly affected than females (55.2 and 44.8%, respectively). The mean age of patients with PXS was 66.2 years while it was 64.6 years in non-PXS patients. The prevalence of pseudoexfoliation syndrome increased with age (10.1% in the age group of 41-50 years that increased to 28.8% in the age group of more than 81 years old). The rate of PXS detection in camps in 13 governorates ranged from 13.33 to 24.22% with an overall rate of 19.53%. The lowest rate was noticed in Sana'a and the highest in Al-Dhale governorate. Conclusion: This pilot study confirms that PXS was common in patients undergoing cataract surgery in Yemen with an increased detection rate with age. This study also highlights the prevalence of an ocular disease that is associated with systemic and ocular complications; however, further studies based on population studies are needed. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/74/61221 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61222 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Visual function of Egyptian children with low vision and the demographic determinants Mousa, A Aims: To determine whether the LV Prasad-Functional Vision Questionnaire (LVP-FVQ) could be used to assess self-reported visual function and quality of visual life in Egyptian school aged children. Materials and Methods: The LVP-FVQ was used to assess the quality of visual function in school-age children. All subjects were students at the time of assessment. Subjects underwent a visual function assessment that included distance and near visual acuity, contrast sensitivity, color vision and visual field examination where possible. Data analysis were for both descriptive and inference statistics. A P < 0.05 was considered statistically significant. Results: Fifty children aged 11.28 ± 3.5 years (range, 5 years to 18 years) with moderate-to-severe visual impairment most of their lives were enrolled. Twenty-two subjects (44%) had albinism, 18 (36%) subjects had hereditary retinal dystrophy, 6 (12%) subjects had cone dystrophy, 2 (4%) subjects had bilateral amblyopia and 2 (4%) subjects had congenital coloboma without other disabilities. The four most difficult tasks were related to the following daily activities alluded to in the questionnaire such as reading a textbook at arms length, copying from the blackboard, seeing somebody across the road and identifying colors. There was no statistically significant association between the demographic variables and the level of visual functioning, sex, age, type of school, family history or consanguinity (P > 0.05 for all variables). Conclusion: LVP-FVQ can be used to screen Egyptian children with visual impairment. Input and integration of the parents and the school teachers to evaluate the child s behavior at home and the school is essential to developing a balanced questionnaire. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/78/61222 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61223 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Challenges, Attitudes and Practices of the Spectacle Wearers in a Resource-Limited Economy Ayanniyi, AA Adepoju, FG Ayanniyi, RO Morgan, RE Purpose: To evaluate challenges, attitudes and practices among spectacle wearers to effect positive change when necessary, and determine positive change in a resource-limited economy. Materials and Methods: A multi-hospital descriptive, cross sectional survey of spectacle wearers was conducted between May 2007 and December 2008 in Nigeria. Results: A total of 214 wearers comprising 43.5% males and 56.5% females aged 18-84 years were surveyed. The majority of subjects (92.6%) had at least secondary education. The wearers' challenges included expensive spectacles (43.0%), falling/ scratched/broken lenses (29.4%) and fear that spectacles would damage the eyes (23.8%). The wearers' attitudes were comprised of consultations with 'road side dispensers' (7%) and permitting other individuals to select spectacle frames for them (26%). Care and maintaince practices included use of handkerchief, tissue paper, fingers and water to clean spectacles (49.5%) and placing spectacles inside spectacle cases (30.4%). There were no associations (P > 0.05) between gender or literacy levels and who selected the frames for the subjects, caregivers consulted for spectacles, and cleaning materials for spectacles. The placement of spectacles when not in use was significantly associated (P < 0.05) with the wearers' gender and literacy levels but not with the length of spectacle wear. Conclusion: Attitudes and practices requiring positive change crossed gender and educational levels among spectacle wearers. The cost of spectacles should be regulated and availability of standard eye care practices would reduce challenges including lens-related defects and quackery. During consultation with a recognized eye care professional, counseling of wearers on positive attitudes/practices as well as allaying fear of spectacle wear is required. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/83/61223 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61224 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Efficacy of garcinia kola 0.5% aqueous eye drops in patients with primary open-angle glaucoma or ocular hypertension Adefule-Ositelu, AO Adegbehingbe, BO Adefule, AK Adegbehingbe, OO Samaila, E Oladigbolu, K Purpose: To evaluate the intraocular pressure (IOP) lowering efficacy of Garcinia kola 0.5% aqueous solution eye drops in patients with newly diagnosed primary open-angle glaucoma or ocular hypertension (POAG/OH). Materials and Methods: A randomized, double-masked, multicenter, active-controlled prospective study. Patients who met the inclusion criteria were randomly assigned in equal numbers to receive Timolol 0.5% eye drops as a control medication (A = Group 1 eyes) or Garcinia kola 0.5% eye drops as the study medication (B = Group 2 eyes). All drops were instilled at 6 am and 6 pm daily. Goldman applanation tonometry was performed at 9 am, 12 pm and 3 pm at baseline, week-6, week-12 and week-24 visits. Voluntary and actively elicited reports of adverse events were documented. The mean change in IOP over 24 weeks was the primary outcome measure. Both groups were compared for statistically significant differences at all visits. A P < 0.05 was considered statistically significant. Results: A total of 178 patients were randomly assigned to G. kola and Timolol groups. At baseline there were no differences in mean IOP between groups, based on age, sex, or diagnosis. At the end of the study period (24<sup> th</sup> week), the mean (± SD) reduction in IOP was 12.93 ± 2.3 mmHg (47.8% ± 0.8% reduction) in G. Kola group and 13.09 ± 2.8 mm Hg (48.2% ± 1.03% reduction) in the Timolol group (P> 0.05). Adverse events were mild in nature with no statistically significant differences between groups (P > 0.05). Conclusions: Garcinia kola ophthalmic solution significantly reduces IOP as compared to baseline. The IOP lowering effect of both treatments was equivalent. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/88/61224 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61211 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Update on limbal stem cell transplantation Bakhtiari, P Djalilian, A Limbal epithelial stem cells are the primary source of corneal epithelial cell regeneration. Limbal stem cell deficiency (LSCD) can develop in traumatic, immunologic, or genetic diseases that affect the ocular surface. LSCD leads to conjunctivalization, with corneal vascularization and opacification and subsequent loss of vision. Limbal stem cell transplantation is a surgical treatment to address LSCD and restore a corneal epithelial phenotype. Based on the source of cells, limbal transplant can be autologous or allogenic. Many surgical techniques are defined according to the source of the stem cells and the carrier tissues that are used. More recently, ex vivo expanded bioengineered epithelial cells have been used to reconstruct the corneal surface using autologous cells to eliminate the risk of rejection. Before transplantation, a systematic exam of the lids, eyelashes, fornices, and aqueous tears is mandatory and every effort should be made to optimize ocular surface health and control inflammation to enhance the chances of graft survival. Postoperative care is also another major determinant of success. Any factor that destabilizes the ocular surface needs to be addressed. In addition, systemic and topical immunosuppressants are also needed in all allograft recipients. In addition to pre-operative and postoperative care and the surgery itself, the etiology of LSCD also has an impact on the outcome. The prognosis of inflammatory diseases such as Stevens-Johnson syndrome is the worst among disorders causing LSCD. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/9/61211 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:61225 2010-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal optical quality following sub 1.8 mm micro-incision cataract surgery vs. 2.2 mm mini-incision coaxial phacoemulsification Alio, JL Elkady, B Ortiz, D Purpose: To study and compare the effects of the micro-incision cataract surgery (MICS-sub 1.8 mm) and mini-incision coaxial phacoemulsification (2.2 mm) on the optical quality of the cornea characterized in terms of corneal aberrations. Materials and Methods: Fifty eyes underwent MICS and 50 mini-incision phacoemulsification, by the same surgeon. Both types of cataract surgery were performed using low ultrasound power and through a clear corneal incision, placed on the steepest corneal meridian ranging from 1.6 to 1.8 in MICS (Group I) and from 2.12 to 2.3 mm in mini-incision coaxial phacoemulsification (Group II). Seidel and Zernike aberration coefficients and RMS values were obtained for a 6-mm pupil preoperatively and one month after surgery. Results: The corneal astigmatism did not show statistically significant changes in either of the two groups: (MICS: -0.73 ± 0.63, -0.65 ± 0.53 D, P = 0.25), (mini-incision phacoemulsification; -1.21 ± 1.52, -1.00 ± 1.19 D, P = 0.12). The total RMS remained unchanged after MICS (1.77 ± 1.7, 1.65 ± 1.3 µm, P = 0.18) and mini-incision phacoemulsification (2.00 ± 1.87, 2.09 ± 1.8 µm, P = 0.41). Statistically significant changes were found for coma (P = 0.004) and higher-order aberrations (P < 0.001), showing MICS significantly less changes in cornea. Conclusions: Both MICS and mini-incision phacoemulsification do not degrade the optical quality of the cornea. Both surgeries do not induce a modification of the corneal astigmatism, even in the axis. It seems that 2 mm is the limit around which no optical changes are induced by cataract surgery in the human cornea. Medknow Publications 2010-01-01 http://www.meajo.org/text.asp?2010/17/1/94/61225 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63068 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Oculoplastics and pediatric ophthalmology: An update Chaudhry, IA Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/111/63068 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63069 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Noncosmetic periocular therapeutic applications of botulinum toxin Kaynak-Hekimhan, P Botulinum toxin blocks acetylcholine release at the neuromuscular junction. The drug which was initially found to be useful in the treatment of strabismus has been extremely effective in the treatment of variety of conditions, both cosmetic and noncosmetic. Some of the noncosmetic uses of botulinum toxin applications include treatment of spastic facial dystonias, temporary treatment of idiopathic or thyroid dysfunction-induced upper eyelid retraction, suppression of undesired hyperlacrimation, induction of temporary ptosis by chemodenervation in facial paralysis, and correction of lower eyelid spastic entropion. Additional periocular uses include control of synchronic eyelid and extraocular muscle movements after aberrant regeneration of cranial nerve palsies. Cosmetic effects of botulinum toxin were discovered accidentally during treatments of facial dystonias. Some of the emerging nonperiocular application for the drug includes treatment of hyperhidrosis, migraine, tension-type headaches, and paralytic spasticity. Some of the undesired side effects of periocular applications of botulinum toxin inlcude ecchymosis, rash, hematoma, headache, flu-like symptoms, nausea, dizziness, loss of facial expression, lower eyelid laxity, dermatochalasis, ectropion, epiphora, eyebrow and eyelid ptosis, lagophthalmos, keratitis sicca, and diplopia. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/113/63069 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63071 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Periocular capillary hemangiomas: Indications and options for treatment Bang, GM Setabutr, P Capillary hemangiomas are the most common periocular and orbital tumors of childhood that typically arise in infancy. Though the diagnosis is frequently made on clinical examination, various diagnostic modalities may be helpful in initial evaluation and follow-up. Tests may be necessary in diagnosing suspect cases or aid in the differentiation of potential malignant tumors. In the vast majority of cases these tumors undergo spontaneous involution without sequelae. However, some periocular and orbital capillary hemangiomas require intervention to prevent serious complications. Other tumors require treatment to lessen the surgical burden for cosmetic repair. When treatment is necessary, there are a number of therapeutic options available. As there is no standard, potential risks and benefits must be discussed with the family and treatment should be specific in each case. A complete understanding of the natural history of the tumor, indications for treatment, and response to different therapies is imperative in managing this common lesion. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/121/63071 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63073 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Current techniques in surgical correction of congenital ptosis Allard, FD Durairaj, VD Ptosis refers to vertical narrowing of the palpebral fissure secondary to drooping of the upper eyelid to a lower than normal position. Ptosis is considered congenital if present at birth or if it is diagnosed within the first year of life. Correction of congenital ptosis is one of the most difficult challenges ophthalmologists face. Multiple surgical procedures are available including, frontalis sling, levator advancement, Whitnall sling, frontalis muscle flap, and Mullerectomy. Selection of one technique over another depends on the consideration of several factors including the surgeon experience, the degree of ptosis in the patient, as well as the degree of levator muscle function. Current recommendations for the correction of congential ptosis vary based on clinical presentation. Advantages and disadvantages of each of these procedures are presented with recommendations to avoid complications. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/129/63073 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63074 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Understanding pediatric bacterial preseptal and orbital cellulitis Gonzalez, MO Durairaj, VD Pediatric preseptal and orbital cellulitis are infectious disorders that result in periorbital inflammation. Preseptal cellulitis is often associated with breaches in the skin barrier whereas orbital cellulitis is commonly associated with paranasal sinusitis. Orbital cellulitis may be associated with subperiosteal abscess. It is important to distinguish between preseptal from orbital cellulitis. Clinical examination and diagnostic imaging are useful in determining appropriate management. Patients are usually treated with broad spectrum antibiotics and surgery when indicated. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/134/63074 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63076 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Indirect orbital floor fractures: A meta-analysis Gonzalez, MO Durairaj, VD Orbit fractures are common in the context of orbital trauma. Fractures of the orbital floor without orbital rim involvement are known as indirect orbital floor fractures, pure internal floor fractures, and orbital blowout fractures. In this paper, we have reported a meta-analysis of orbital floor fractures focusing on indications and timing of surgical repair, outcomes, and complications. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/138/63076 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63078 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Facial nerve palsy: Providing eye comfort and cosmesis Alsuhaibani, AH Development of facial nerve palsy (FNP) may lead to dramatic change in the patient's facial function, expression, and emotions. The ophthalmologist may play an important role in the initial evaluation, and the long-term management of patients with new-onset of FNP. In patients with expected temporary facial weakness, no efforts should be wasted to ensure proper corneal protection. Patients with permanent functional deficit may require combination of surgical procedures tailored to the patient's clinical findings that may require good eye comfort and cosmesis. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/142/63078 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63080 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Plus disease: Why is it important in retinopathy of prematurity? Solarte, CE Awad, AH Wilson, CM Ells, A Retinopathy of prematurity (ROP) is one of the leading causes of preventable blindness in childhood. Early posterior pole vascular signs of severe ROP have been studied since the first description of the disease. The progressive changes that take place in the posterior pole vessels of an extremely premature baby occur in a predictable fashion soon after birth. These vascular changes are described as plus disease and are defined as abnormal dilation and tortousity of the blood vessels during ROP that may go on to total retinal detachment. The ophthalmological community now has a better understanding of the pathology and cascade of events taking place in the posterior pole of an eye with active ROP. Despite many years of scientific work on plus disease, there continue to be many challenges in defining the severity and quantification of the vascular changes. It is believed that understanding of the vascular phenomenons in patients with ROP will help in designing new treatment strategies that will help in salvaging many of the eyes with severe ROP. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/148/63080 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63082 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Congenital anophthalmia: A review of dealing with volume Bernardino, R Background : Anophthalmia in childhood whether congenital or acquired is not just a question of cosmesis. Loss of an eye can effect the maturation of the soft tissues and bony structure surrounding the affected orbit. Therefore, a comprehensive approach including medical and surgical interventions is required to rehabilitate a child early in life. Materials and Methods : A literature survey of the past 40 years on the topic of congenital anophthalmia with focus on medical and surgical volume augmentation of the orbit was conducted. Results : Newer technologies including hydrogel implants and saline-filled tissue expanders have allowed for more rapid expansion of the pediatric orbit often with minimally invasive surgical procedures. However, traditional approaches including conformer therapy are still the primary intervention in these complicated cases. Conclusion : Anophthalmia in childhood requires a close interaction between ophthalmologist and ocularist as well as a motivated patient and family. With early intervention a good cosmetic outcome with periocular symmetry is obtainable. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/156/63082 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63083 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Reconstruction of large upper eyelid defect with Two composite lid margin grafts Hafez, A Purpose: To evaluate the results of reconstruction of large defects in the upper lid using two composite contra-lateral eyelid margin grafts. Methods: This is an interventional case series in which a large full thickness defect of the upper lid was reconstructed in 7 patients using two composite eyelid margin grafts and myocutaneous advancement. The grafts were taken from both eyelids of the contra lateral eye and the final outcome was evaluated. Results: Cosmetic results were achieved in both donor and recipient eyes satisfying to all patients; no graft sloughing was seen. Transient edema, punctate epithelial erosions, lid notching, madarosis and ptosis were seen in the early postoperative period. Conclusion: Reconstruction of a large defect in the upper lid with two composite eyelid-margin grafts is an easy, safe, effective technique with minimal complications. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/161/63083 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63081 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular disorders in adult leukemia patients in Nigeria Omoti, AE Omoti, CE Momoh, RO Context: Leukemias may present with, or be associated with ocular disorders. Aims: To determine the rates of ophthalmic disorders in adult patients with leukemia. Settings and Design: A prospective study of ocular disorders in adult patients with leukemia at the University of Benin Teaching Hospital, Benin City, Nigeria, between July 2004 and June 2008 was conducted. Methods and Materials: The patients were interviewed and examined by the authors and the ocular findings were recorded. Statistical analysis was performed using Instat GraphPad™ v2.05a statistical package software. The means, standard deviation, and the Kruskal-Wallis non parametric test were performed. Results: Forty-seven patients with leukemias were seen. Nineteen patients (40.4%) had CLL, 14(29.8%) had CML, 9(19.1%) had AML and 5(10.6%) had ALL. Seven patients (14.9%) had ocular disorders due to leukemia. The ocular disorders due to the leukemia were proptosis in two patients (4.3%), retinopathy in one patient (2.1%), conjunctival infiltration in one patient (2.1%), periorbital edema in one patient (2.1%), retinal detachment in one patient (2.1%), and subconjunctival hemorrhage in one patient (2.1%). There was no significant difference in rate of the ocular disorders in the various types of leukemia (Kruskal-Wallis KW= 4.019; corrected for ties. P=0.2595). One patient (2.1%) was blind from bilateral exudative retinal detachment while 1 patient (2.1%) had monocular blindness from mature cataract. Conclusions: Ophthalmic disorders that are potentially blinding occur in leukemias. Ophthalmic evaluation is needed in these patients for early identification and treatment of blinding conditions. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/165/63081 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63079 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Graves opthalmopathy and psychoendocrinopathies Ghanem, AA Amr, MA Araafa, LF Purpose: To assess the psychiatric and endocrinological changes in patients with Graves ophthalmopathy (GO). Design: A prospective, controlled, University Hospital based study Subjects and Methods: The current study comprised 60 patients diagnosed with GO at Mansoura Ophthalmic Center. Thirty five patients of them with moderate to severe GO formed the study group and twenty five patients with negligible to very mild GO formed the control group in the euthyroid state. The study group was further subdivided based on their predominant clinical signs into a proptosis subgroup and a muscle restriction subgroup . Psychiatric changes were assessed with the Middlesex Hospital Questionnaire (MHQ). Biochemical analyses included serum-free thyroxine and thyroid-stimulating hormone (TSH) concentrations, TSH receptor antibody (TRAb) activity and anti-thyroglobulin particle agglutination (TGPA) and antithyroid microsomal particle agglutination (MCPA). Results: The proptosis group reported significantly higher scores on anxiety, depression, and phobia than the muscle restriction group (P<0.0001). The proptosis and muscle restriction subgroups reported significantly higher scores on all subscales compared to the control group (P < 0.05). The scale scores of depression and phobia showed a positive correlation with scores of anxiety (P<0.0001). The serum TRAb activity showed a significant correlation with anxiety, phobia and hysteria (P < 0.0001). Conclusion: The psychiatric aspect of GO should be evaluated during routine follow-up and should be considered when making management decisions. Thyroid specific antibodies may be useful in confirming the diagnosis of GO. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/169/63079 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63077 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Role of new magnetic resonance imaging modalities in diagnosis of orbital masses: A clinicopathologic correlation Roshdy, N Shahin, M Kishk, H El-Khouly, S Mousa, A Elsalekh, I Purpose: To evaluate the role of diffusion-weighted magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) in the diagnosis of different orbital masses and their advantages over conventional MRI. Materials and Methods: The study included 20 patients presenting with proptosis. Every patient was subjected to thorough clinical examination, conventional MRI "T1 weighted, T2 weighted, and postcontrast T1 weighted if needed," diffusion-weighted MRI, and proton MRS. Orbitotomy was performed, the orbital mass was excised, and histopathological examination was performed. Results: Diffusion-weighted MRI could differentiate between benign lesions and malignant tumors in 70% of cases; however, overlap occurred in 30% of cases with benign tumors showing restricted diffusion whereas proton MRS could differentiate between benign and malignant tumors in 90% of cases. Conclusion: Diffusion-weighted MRI and proton MRS can potentially increase the accuracy of diagnosis of orbital masses through in vivo tissue characterization. Magnetic resonance spectroscopy seems to be the more accurate modality. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/175/63077 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63075 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Management of bilateral congenital lacrimal punctal and canalicular atresia and congenital fistula of the lacrimal sac Shah, S Shah, M Khandekar, R An 8-year-old girl presented with complaints of bilateral epiphora since birth. The patient had congenital punctal and canalicular atresia combined with congenital fistula. She was treated successfully with surgery. A review of the literature indicated very few reports of surgical treatment of such cases. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/180/63075 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63072 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Subretinal worm and repeat laser photocoagulation Natesh, S Harsha, K Nair, U Nair, K Diffuse unilateral subacute neuroretinitis (DUSN) can be a diagnostic dilemma. Laser photocoagulation of the subretinal worm is an effective treatment for eradication. Early laser photocoagulation has been advocated. We report a case of a middle aged man who presented with decreased vision and a sub retinal macular worm that required two laser sessions for complete eradication of the worm. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/183/63072 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:63070 2010-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Spontaneous corneal perforation in ocular rosacea Al, AK Al, ZW Rosacea is a dermatologic condition that affects the midfacial region. Ocular rosacea is most frequently diagnosed when cutaneous signs and symptoms are also present. Ocular manifestations are essentially confined to the eyelids and ocular surface. Ocular involvement ranges from minor irritation, dryness, and blurry vision to potentially severe ocular surface disruption including corneal ulcers, vascularization and rarely perforation. We present a 49-year-old Saudi Arabian female with the diagnosis of rosacea who presented with a peripheral corneal performation. The perforation was successfully managed by surgical repair, oral doxycycline and topical steroid. The final best corrected visual acuity was 20/30 after treatment. Early referral to an ophthalmologist and careful long-term follow-up are recommended. Medknow Publications 2010-04-01 http://www.meajo.org/text.asp?2010/17/2/186/63070 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65485 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Oncology update Gunduz, K Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/189/65485 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65486 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Vascular tumors of the retina and choroid: Diagnosis and treatment Turell, ME Singh, AD The vascular tumors of the retina and choroid comprise a diverse group of congenital and acquired lesions. The major vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, retinal vasoproliferative tumor, and racemose hemangiomatosis of the retina or Wyburn-Mason syndrome. Choroidal vascular tumors include circumscribed choroidal hemangioma and diffuse choroidal hemangioma. While classified as benign, visual symptoms secondary to exudative retinal detachment and a variety of other mechanisms are common and are a major source of long-term visual disability. While many therapeutic modalities exist, treatment of symptomatic cases can be challenging. Of particular importance, many of the vascular tumors of the retina and choroid have significant associations with systemic disease. As ocular symptoms are often the most common presenting disease manifestation, the ophthalmologist plays an important role in accurate and early diagnosis. The ability to initiate prompt screening and treatment in appropriate cases is critical. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/191/65486 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65489 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions Materin, MA Raducu, R Bianciotto, C Shields, CL Purpose : To establish the characteristics of secondary retinal and retinal pigment epithelial (RPE) changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography (OCT) and fundus autofluorescence (FAF). Materials and Methods : PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings. Results : The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as atrophy, degeneration, and photoreceptor loss in the neurosensory retina. Conclusions : Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT-evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presence of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/201/65489 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65492 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Spontaneously resolving periocular erythema and ciliary madarosis following intra-arterial chemotherapy for retinoblastoma Marr, B Gobin, PY Dunkel, IJ Brodie, SE Abramson, DH Purpose and Design: To describe an unusual clinical finding seen in children undergoing intra-arterial chemotherapy for retinoblastoma. Materials and Methods: A retrospective review of 69 eyes of 63 patients receiving intra-arterial chemotherapy over a 3-year period. Charts and photographs of 69 consecutive cases were reviewed, and data were collected on patients with clinical evidence of a hyperemic cutaneous periocular abnormality following the procedure. Results: A blanching erythematous and edematous patch was noted in the periocular region in 16% (11 of 69) of the children who received intraarterial chemotherapy. The plaque extended into the region of the supertrochlear and medial marginal artery distribution on the ipsilateral side of the intra-arterial chemotherapy. All patches of erythema spontaneously resolved within 3 months following completion of the intra-arterial chemotherapy. Conclusion: Periocular erythema and swelling is a self-limited clinical finding associated with intra-arterial chemotherapy in a small number of patients. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/207/65492 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65494 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Exoresection and endoresection for uveal melanoma Gunduz, K Bechrakis, NE Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. There are two surgical resection techniques: Transscleral resection or "Exoresection" via a partial lamellar sclerouvectomy and "Endoresection" via a pars plana vitrectomy. While exoresection is more applicable to anteriorly located tumors with ciliary body and/or iris involvement, endoresection is more suitable for posteriorly located tumor without ciliary body involvement. Both approaches are suitable for large tumors with >8 mm in thickness. In general, eyes containing these large tumors have a very dismal prognosis regarding long-term visual function, eye retention, and irradiation-induced side effects. By removing the tumor burden from the eye, histopathologic and cytogenetic information of the tumor is available and complications associated with the so-called toxic tumor syndrome are avoided. However, both types of surgical resection are challenging surgical procedures, bearing the risk of early and late postoperative complications. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/210/65494 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65498 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Molecular pathology of retinoblastoma Kandalam, M Mitra, M Subramanian, K Biswas, J Retinoblastoma (RB) is an embryonic neoplasm of retinal origin. For many years, scientists have sought the fundamental origins of tumorigenesis, with the ultimate hope of discovering a cure. Indeed, these efforts have led to a significant understanding that multiple molecular and genetic aberrations, such as uncontrolled proliferation and the inhibition of apoptosis that contribute to the canonical characteristics of tumor biology. Despite these advances, a thorough understanding, such as the precise cells, which are the targets of neoplastic transformation, especially in solid tumors, is currently lacking. The focus of this review is to emphasize the molecular defects involved in the RB tumor progression and mechanisms associated with inhibition of tumor cell apoptotic processes. This review also discusses the importance of target molecules characterization and their potential therapeutic or prognostic use in RB disease. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/217/65498 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65501 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Idiopathic juxtafoveolar retinal telangiectasis: A current review Nowilaty, SR Al-Shamsi, HN Al-Khars, W Idiopathic juxtafoveolar retinal telangiectasis (IJFT), also known as parafoveal telangiectasis or idiopathic macular telangiectasia, refers to a heterogeneous group of well-recognized clinical entities characterized by telangiectatic alterations of the juxtafoveolar capillary network of one or both eyes, but which differ in appearance, presumed pathogenesis, and management strategies. Classically, three groups of IJFT are identified. Group I is unilateral easily visible telangiectasis occurring predominantly in males, and causing visual loss as a result of macular edema. Group II, the most common, is bilateral occurring in both middle-aged men and women, and presenting with telangiectasis that is more difficult to detect on biomicroscopy, but with characteristic and diagnostic angiographic and optical coherence tomography features. Vision loss is due to retinal atrophy, not exudation, and subretinal neovascularization is common. Group III is very rare characterized predominantly by progressive obliteration of the perifoveal capillary network, occurring usually in association with a medical or neurologic disease. This paper presents a current review of juxtafoveolar retinal telangiectasis, reviewing the classification of these entities and focusing primarily on the two most common types encountered in clinical practice, i.e., groups I and II, describing their clinical features, histopathology, natural history, complications, latest results from imaging modalities and functional studies, differential diagnosis, and treatment modalities. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/224/65501 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65488 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Characteristics of optic disc melanocytomas presenting with visual dysfunction Al-Rashaed, S Abboud, EB Nowilaty, SR Objective and Design: A retrospective review study was designed to describe five cases of optic disc melanocytomas with tumor-related visual impairment. Participants: Five patients with optic disc melanocytoma presented with visual complaints to a tertiary eye hospital in Saudi Arabia. Materials and Methods: Demographic and clinical data were analyzed, including the results of ocular examination, lesion laterality, best-corrected Snellen visual acuity, pupillary reflex, visual field testing, color fundus photography, fundus fluorescein angiography, and ophthalmic ultrasound. Results: Visual dysfunction secondary to optic disc melanocytoma was identified. Case 1 had macular star edema with mild tumor enlargement, Case 2 had optic atrophy, Case 3 had juxtapapillary choroidal neovascular membrane with macular involvement, Case 4 had optic disc swelling with an enlarged blind spot, and Case 5 had a large altitudinal visual field defect. Conclusion: Although melanocytomas of the optic disc tend to have a benign behavior with slow evolution and stable vision, they may adversely affect visual function through a variety of mechanisms. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/242/65488 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65491 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
The burden and spectrum of vitreo-retinal diseases among ophthalmic outpatients in a resource-deficient tertiary eye care setting in South-Eastern Nigeria Eze, BI Uche, JN Shiweobi, JO Purpose: This study was designed to determine the rate and pattern of vitreo-retinal diseases at a tertiary eye care center in South-eastern Nigeria. Materials and Methods: The outpatient register at the Eye Clinic of the University of Nigeria Teaching Hospital, Enugu, was retrospectively examined to identify all new patients registered between January 2004 and December 2008. A chart review of subjects with vitreo-retinal disease was conducted to record relevant demographic and clinical data including the needs for vitreo-retinal care. Descriptive and analytical statistics were performed. A P-value <0.001 (one degree of freedom) was considered statistically significant. Results: Of the 8,239 new patients reported during the period, 326 subjects (males- 59.3%; females- 40.7%; sex ratio = 1.1:1) aged 49.3 ± 16.8 years (range 3-82 years) had vitreo-retinal disease. The rate of vitreo-retinal disease was 3.9%. The rate was higher in subjects above 40 years old (P < 0.001), but did not differ between sexes (P = 0.469). Diabetic retinopathy (24.9%), hypertensive retinopathy (13.3%), and age-related macular degeneration (10.7%) were the leading vitreo-retinal diseases. Blindness from vitreo-retinal disease was bilateral in 6.1% of subjects and unilateral in 17.5% of subjects. The common co-morbidities were ocular conditions such as refractive error (19.8%), cataract (14.2%), and glaucoma (10.4%); and systemic conditions such as diabetes mellitus (14.6%) and hypertension (13.2%). Conclusions: The rate of vitreo-retinal diseases among new ophthalmic outpatients at UNTH, Enugu, is 3.9%. Retinal vascular disorders and age-related maculopathy are the leading retinal diseases. At UNTH, resource needs for vitreo-retinal care are urgent including retinal photography/angiography, laser photocoagulation, intra-vitreal pharmacotherapy, and vitreo-retinal surgery. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/246/65491 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65496 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
A prospective, randomized comparison of intravitreal triamcinolone acetonide versus intravitreal bevacizumab (avastin) in diffuse diabetic macular edema Shahin, MM El-Lakkany, RS Purpose: To compare the functional and anatomical outcomes following intravitreal triamcinolone acetonide vs. intravitreal bevacizumab (Avastin) treatment for diffuse diabetic macular edema. Materials and Methods: In this prospective, randomized study, subjects were divided into two groups: 24 eyes that received intravitreal injection of 4 mg/0.1 mL triamcinolone acetonide (IVTA group) and 24 eyes received intravitreal injection of 1.25 mg/0.05 mL bevacizumab (IVB group). Changes in best corrected visual acuity (BCVA), intraocular pressure (IOP), baseline fluorescein angiography and optical coherence tomography measurements were evaluated in both groups. Follow-up visits out to three months from baseline are reported. Results: One month after treatment, baseline foveal thickness decreased from 452 μ to 299 μ in the IVTA group and from 292 μ to 270 μ in the IVB group. BCVA increased by two or more lines in 58.3% of eyes in the IVTA group and there was no similar improvement in the IVB group. In the IVTA group, a transient increase in IOP (27-43 mmHg) occurred in four cases (16.7%), which was successfully controlled with topical medications. There were no complications in the IVB group. Conclusion: Short term outcomes indicate that intravitreal injection of bevacizumab was not associated with surgical complications compared to triamcinolone acetonide. Triamcinolone acetonide appears to be more effective treatment for diabetic macular edema than bevacizumab. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/250/65496 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65499 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Non-foveal macular holes after PPV for macular pucker El-Toukhy, HM Swelam, A Purpose: To describe six patients (six eyes) who developed an eccentric macular hole after surgery for idiopathic epimacular proliferation. Materials and Methods: Review of records from six patients who developed eccentric macular holes postoperatively following vitrectomy in 107 consecutive cases with peeling of the epimacular proliferation and internal limiting membrane (ILM) from June 2004 to January 2009, Results: Eccentric macular holes were developed from nine days to eight months (mean, 3.1 months) after epimacular proliferation peeling. The ILM was peeled in addition to the epimacular proliferation in five of the six cases. Of the six eccentric macular holes, four were located temporal to the fovea, one was located superior to the fovea, and one was located nasal to the fovea. Final visual acuities after a mean follow-up period of 17.3 months were 20/20 in two eyes, 20/25 in one eye, 20/40 in two eyes, and 5/200 in one eye. The eye with the eccentric macular hole nasal to the fovea had the poorest final visual acuity of 5/200. Conclusion: Eccentric macular holes occurring after vitrectomy to remove epimacular proliferation is an uncommon postoperative finding. Various explanations have been suggested for the etiology of these holes, but there is no consensus. We suggested that the ILM tear should be initiated with a diamond dusted knife to reduce the likelihood of injury to the underlying Muller cells that may contribute to the formation of eccentric macular holes. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/254/65499 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65502 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence and determinants of diabetic retinopathy in Al Hasa region of Saudi Arabia: primary health care centre based cross-sectional survey, 2007-2009 Khan, AR Wiseberg, JA Khan, SA Purpose: To evaluate the prevalence of diabetic retinopathy (DR) in the urban and rural areas of Al Hasa region of Saudi Arabia and to determine risk factors related to DR. Materials and Methods: This study was conducted on patient attending primary health care centers between July 2007 and June 2009. A retrospective chart review was conducted on subjects with diabetes mellitus greater than 18 years old. Ophthalmologists examined DR status through dilated pupils by using direct, indirect, and slit lamp bio-microscopy. Frequencies, percentage, and their 95% confidence intervals (CIs) were calculated. Odd's ratio was used to associate DR with possible risk factors. A P value less than 0.05 was considered statistically significant. Results: The prevalence of DR among 473 diabetic subjects was 30% (95% CI: 25.80-34.20). The odd ratios (ORs) of DR among diabetic residing in an urban area was significantly higher than diabetics residing in rural areas [OR = 1.94 (95% CI of OR 0.82-2.89)]. DR was associated to the duration of diabetes (adjusted OR = 1.70), uncontrolled blood sugar level (adjusted OR = 1.96), hyperlipidemia (adjusted OR = 2.04), and hypercholesterolemia (adjusted OR = 2.80). Conclusions: DR appears to be a public health problem in the Al Hasa district of Saudi Arabia, and a planned approach is required to avoid severe visual impairment in patients with diabetes mellitus. Primary prevention and early detection could be implemented through primary health centers and non-ophthalmologists. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/257/65502 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65500 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity Ahmed, AE Channa, R Durrani, J Ali, A Ahmad, K Objective: This study was designed to present our early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity (ROP) at a single institution over a 13-month-period. Methods: A retrospective case series of eight children with ROP who received intravitreal bevacizumab combined with laser treatment between June 2007 and July 2008 were reported. A chart review was conducted to evaluate if stability of the ROP lesion had been achieved. Main information collected included data on demographics, gestational age, birth weight, length of stay in neonatal intensive care unit, and stage of ROP. Results: Fifteen eyes of eight subjects were treated. One eye did not receive any treatment due to complete retinal detachment. The median age at treatment was 8 weeks (range, 6 weeks to 1 year). The most common stage of ROP was 3+. All eyes remained stable at 1 year or later after treatment. Conclusion: Intravitreal bevacizumab in conjunction with laser treatment had promising results at our institution. We recommend prospective, randomized, controlled clinical trials to compare the effect of laser treatment alone, of bevacizumab treatment alone (at different doses), and of combined bevacizumab and laser treatment. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/264/65500 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65487 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Small choroidal melanoma with monosomy 3 Ghassemi, F Shields, CL Materin, MA Shields, JA Purpose: To report a patient with small juxtapapillary choroidal melanoma with chromosome 3 monosomy treated with I<sup> 125</sup> plaque and transpupillary thermotherapy (TTT). A 64-year-old Caucasian male presented with painless blurred vision of the left eye. Ocular examination disclosed a small juxtapapillary choroidal melanocytic tumor with overlying subretinal fluid and orange pigment. Ultrasound showed an elevated choroidal mass of 2 mm thickness with low reflectivity on A-scan and hollowness on B scan, consistent with a small choroidal melanoma. The patient was treated with plaque I<sup> 125</sup> radiotherapy combined with one session of TTT. Genetic testing of the tumor cells obtained by fine needle aspiration biopsy showed chromosome 3 monosomy. At 1 year after treatment, the tumor was regressed with resolution of subretinal fluid and 20/40 visual acuity. A small choroidal melanoma can manifest monosomy of chromosome 3, a known predictive factor for the development of systemic metastasis. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/268/65487 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65490 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Idiopathic choroidal neovascularisation as the inaugural sign of multiple evanescent white dot syndrome Papadia, M Herbort, CP We report a case of multiple evanescent white dot syndrome (MEWDS) that presented with putative idiopathic choroidal neovascularisation (ICNV) before showing angiographic signs typical of MEWDS. A 16-year-old male presented with unilateral metamorphopsias and visual loss in his left eye. ICNV with subretinal hemorrhage was diagnosed and treated with intravitreal Avastin<sup> ®</sup> . Fifteen days later, regression of choriodal neovascularization (CNV) was documented together with the appearance of fluorescein angiography (FA) and indocyanine green angiography (ICGA) signs typical for MEWDS, that included faint mottled FA hyperfluorescence in the mid-peripheral fundus, irregularly shaped mid-peripheral ICGA dark areas in the intermediate angiographic phase that were clearly delineated in the late phase as well as peripapillary hypofluorescence. Fundus examination appeared completely normal during the follow-up except for the CNV hemorrhage noted at the initial visit. This case demonstrates the need to consider ICNV as a diagnosis of exclusion until inflammatory causes have been eliminated. In this case, the underlying occult inflammatory condition would have been missed without the ICGA data that clearly showed signs of MEWDS that was supported by FA findings. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/270/65490 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65493 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Isolated cilioretinal artery occlusion as an initial manifestation of polycythemia vera Elasri, F Souhail, H Reda, K Iferkhass, S Idrissi, A Naoumi, A Oubaaz, A Isolated cilioretinal artery occlusion is a rarely reported initial manifestation of polycythemia vera. In this study, we reported a case of a 65-year-old man with polycythemia vera with cilioretinal artery occlusion as an initial manifestation. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/275/65493 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65495 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Successful surgical management of optic disc pit maculopathy without internal membrane peeling Diab, F Al-Sabah, K Al-Mujaini, A Optic disc pit is an excavation of the optic nerve head usually seen in association with other abnormalities of the optic nerve, peripapillary retina, or posterior vitreous detachment. In 50% the cases, it might be associated with serous macular detachment. The prevailing theory that explains this disorder is that subretinal fluid which is derived from liquefied vitreous passes through the optic disc pit and elevates the macula. In this study, we report a case of serous macular detachment complicating optic disc pit in a young male patient treated surgically without internal limiting membrane peeling and showed dramatic improvement of vision after 1 year. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/278/65495 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:65497 2010-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Erectile dysfunction following intravitreal bevacizumab Yohendran, J Chauhan, D Despite initial concerns regarding systemic complications, the use of intravitreal antivascular endothelial growth factor (anti-VEGF) agents for ocular disease is rapidly expanding worldwide, in terms of both the number of patients injected and its indications. To our knowledge, there are no cases in the literature reporting erectile dysfunction following the use of intravitreal bevacizumab. We postulate an organic mechanism for impaired erectile function due to systemically absorbed intravitreal bevacizumab. We describe a case of erectile dysfunction following intravitreal bevacizumab administration. Color fundus photos, fluorescein angiogram and optical coherence tomography images are presented. A 40-year-old male underwent intravitreal bevacizumab therapy for macular edema secondary to a branch retinal vein occlusion. He subsequently developed transient erectile dysfunction after each of his two bevacizumab injections. His only comorbidity was mild hypertension. Erectile dysfunction may be a side effect of intravitreal bevacizumab. The erectile dysfunction could be organic and/or psychogenic in etiology. Medknow Publications 2010-07-01 http://www.meajo.org/text.asp?2010/17/3/281/65497 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71583 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Childhood visual impairment and other challenges in the Middle East and African region Edward, DP Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/285/71583 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71585 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Ab interno trabeculectomy Pantcheva, MB Kahook, MY Anterior chamber drainage angle surgery, namely trabeculotomy and goniotomy, has been commonly utilized in children for many years. Its' reported success has ranged between 68% and 100% in infants and young children with congenital glaucoma. However, the long-term success of these procedures has been limited in adults presumably due to the formation of anterior synechiae (AS) in the postoperative phase. Recently, ab interno trabeculectomy with the Trabectome™ has emerged as a novel surgical approach to effectively and selectively remove and ablate the trabecular meshwork and the inner wall of the Schlemm's canal in an attempt to avoid AS formation or other forms of wound healing with resultant closure of the cleft. This procedure seems to have an appealing safety profile with respect to early hypotony or infection if compared to trabeculectomy or glaucoma drainage device implantation. This might be advantageous in some of the impoverish regions of the Middle East and Africa where patients experience difficulties keeping up with their postoperative visits. It is important to note that no randomized trial comparing the Trabectome to other glaucoma procedures appears to have been published to date. Trabectome surgery is not a panacea, however, and it is associated with early postoperative intraocular pressure spikes that may require additional glaucoma surgery as well as a high incidence of hyphema. Reported results show that postoperative intraocular pressure (IOP) remains, at best, in the mid-teen range making it undesirable in patients with low-target IOP goals. A major advantage of Trabectome surgery is that it does not preclude further glaucoma surgery involving the conjunctiva, such as a trabeculectomy or drainage device implantation. As prospective randomized long-term clinical data become available, we will be better positioned to elucidate the exact role of this technique in the glaucoma surgical armamentarium. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/287/71585 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71588 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Adalimumab (Humira <sup>TM</sup> ) in ophthalmology: A review of the literature Neri, P Lettieri, M Fortuna, C Zucchi, M Manoni, M Celani, S Giovannini, A Tumor Necrosis Factor alpha (TNF-α) is a pleiotropic cytokine which plays a primary role in the induction of inflammation in autoimmune diseases. The newest anti-TNF-α agent is adalimumab (Humira, Abbott Pharmaceutical Inc.), a human-derived antibody. This review summarizes the characteristics of adalimumab, highlighting its clinical use in systemic and ocular inflammatory disorders, and the possible therapeutic strategies. Adalimumab has been successfully used for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriasis arthritis. More recently, adalimumab has shown promising qualities in controlling intraocular inflammations, even though this has been used prevalently as a rescue therapy for unresponsive cases. This biologic agent was also used in pediatric cases, showing a good safety and efficacy profile. Albeit no direct comparison with other biologics has been done, and adalimumab seems to be equivalent to the other anti-TNF-α, the switching to adalimumab can offer a better uveitic control. Adalimumab is a promising drug for the treatment of uveitis, even though further studies are needed on its application as a primary therapy in uveitis. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/290/71588 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71590 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Refractive error and visual functions in children with special needs compared with the first grade school students in Oman Vora, U Khandekar, R Natrajan, S Al-Hadrami, K Background: We evaluated the refractive status and visual function of children with special needs (other handicap) in 2010 and compared them with healthy 1 <sup>st</sup> grade school students in Oman. Materials and Methods: This was a cohort study. Optometrists recorded vision using a logarithm of minimum angle of resolution (LogMAR) chart. Preferential looking method was used for testing 31 children. Cycloplegic refraction was performed on all children. Contrast sensitivity was tested using 2.5%, 10%, and 100% contrast charts. Ocular movement, alignment, and anterior segment were also assessed. A pediatrician reviewed the health records of all the children at the time of their enrollment in this study to determine if the child had been diagnosed with a systemic condition or syndromes. The visual functions were assessed by study investigators. We estimated the rates and the risk of different visual function defects in children with special needs. Result: The prevalence of refractive error in 70 children (4.7 ± 0.8 years) with special needs (group 1) and 175 normal healthy first grade students (group 2) were 58.5% and 2.9%, respectively. The risk of refractive error was significantly higher in children with special needs [relative risk, 48.1 (95% confidence interval, 17.54-131.8)]. Hyperopia (>1.00 D), myopia (≥ 1.00D) and astigmatism (≥ ±1.00 D) were found in 18.6%, 24.3%, and 27.1%, respectively, in group 1. Six children in this group had defective near vision. Sixteen (80%) children with Down syndrome had refractive error. Seven (50%) children with developmental disorder showed decreased contrast sensitivity. Conclusion: Prevalence of uncorrected refractive error was much higher in children with special needs. Prevalence of strabismus, nystagmus, and reduced contrast sensitivity was also higher in children with special needs. Early vision screening, visual function assessment, correction of refractive error, and frequent follow-up are recommended. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/297/71590 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71592 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Case-control studies and risk factors for cataract in two population studies in Nigeria Echebiri, SI Myers, SN Purpose: The aim of this study was to determine and investigate the risks associated with cataract in South Western and North Central Nigeria. Materials and Methods: A hospital-based, case-control study was conducted in Lagos (Lagos group), South Western Nigeria, and Kano (Kano group), North Central Nigeria. In this study, 530 subjects with visually impairing cataracts (study group) and 530 age- and sex-matched controls (control group) were recruited from patients aged 40 to 89 years attending the ophthalmology clinics at the same hospital. All subjects were examined for the presence/absence of cataract and interviewed about their educational achievements, diarrhea/dehydration crises, urban/rural residence, and ophthalmological conditions. A standardized questionnaire was administered to all subjects. Logistic regression analysis with age adjustment, literacy, outdoor work, body mass index, crowding, regular vegetable intake, heavy alcohol, and cigarette intake was performed. P < 0.05 was considered statistically significant. Results: Using multivariate regression analysis, after adjustment for age and other demographics factors, low education and no education [adjusted odds ratios (OR) = 2.42 for the Lagos group and 4.10 for Kano group] and a positive history of diarrhea or dehydration crises (adjusted OR = 1.31 for the Lagos group and 2.12 for Kano group) were associated with an increased risk for cataract. Senile cataracts were more common among the Fulani ethnic group (adjusted OR = 2.21) of North Central Nigeria. However, rural or urban residence did not reveal any positive risk for cataract. Conclusion: The risk of cataract in North Central Nigeria is similar to that in South Western Nigeria. Cataracts were strongly associated with increasing age,with peak age of 55 years and were more common in those with lower education, severe diarrhea and among the members of Fulani in North Central Nigeria. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/303/71592 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71594 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Perception and attitude of people toward onchocerciasis (river blindness) in south western Nigeria Adeoye, AO Ashaye, AO Onakpoya, OH Background: Onchocerciasis (river blindness) is a major cause of bilateral blindness with devastating socioeconomic consequences. Since Nigeria is the most heavily onchocerciasis endemic country in the world, the information on people's knowledge about this disease is significant. This could influence their response to current preventive measures of the African Programme for Onchocerciasis Control. Aim: This study was designed to estimate the level of knowledge and attitudes of rural/semi-urban communities in Ife North Local Government Area of Osun State toward onchocerciasis. Materials and Methods: Cluster random sampling was used to select 500 adults for the study. Semi-structured questionnaires were administered to subjects. Data on knowledge of the local name, cause, mode of transmission, manifestation, severity, treatment, and prevention of onchocerciasis were collected and analysed. Statistical analysis included frequency distribution of the responses and a Chi-square test for comparison of variables with the P value for statistical significance set at 0.05. Results: Onchocerciasis was well known by its local name among 458 (91.6%) of the respondents. Only seven (1.4%) knew that it affects both the eyes and skin. The cause was commonly attributed to impure blood by 114 (22.8%), whereas transmission was thought to be through fomites by 161 (32.2%). Only 12 (2.4%) respondents attributed the disease to blackfly bites. The level of education and the association of onchocerciasis with a river were significantly associated (P = 0.001). Subcutaneous nodules were felt to contain water (85.4%), baby worms (3.2%), and fat (0.6%). There was a negative attitude toward sufferers of the disease. Conclusion: Adequate information transfer in simple local dialect by trained personnel to the communities at risk of onchocerciasis is essential for better uptake of all aspects of the onchocerciasis control programme. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/310/71594 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71596 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Incidence and complications of traditional eye medications in Nigeria in a teaching hospital Ukponmwan, CU Momoh, N Purpose: The aim of this study was to determine the types and nature of traditional eye medications (TEMs), their sources, and the ocular complications that may arise from use in a teaching hospital in Nigeria. Materials and Methods: A prospective study of consecutive subjects who used TEM before presentation to the Eye Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria between July 1, 2004 and June 30, 2008. P < 0.05 was considered statistically significant. Results: A total of 113 subjects were evaluated of which 64 were males (56.6%), females (43.4%) were females. There was no significant difference in the number of males and females (P > 0.05). Rural dwellers were more likely to use TEM than urban dwellers (P < 0.0001). The mean age of the subjects was 47.9 ΁ 22.3 years (range, 4-90 years). The most common traditional medication was derived from plant extracts (54.9%) followed by concoctions (21.2%). Complications occurred in 54.8% of the subjects. Ocular complications included corneal opacities in 13.35% of subjects, staphyloma in 9%, and corneal ulcers in 8%. Other complications were panophthalmitis, endophthalmitis, uveitis, cataract, and bullous keratopathy. Eleven subjects underwent evisceration or enucleation of the affected eye. There was no significant difference in the type of medication used and ocular complications (P = 0.956). Sources of TEM were self-medication in 38.9% of subjects, relatives in 27.4%, and traditional healers in 17.7%. Conclusion: The use of TEM is a common practice that could be harmful and lead to blindness. Proper health education of the public and traditional healers can reduce the prevalence of preventable blindness. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/315/71596 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71597 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Computerized motion sensitivity screening tests in a multicountry rural onchocercal community survey in Africa Babalola, OE Umeh, RE Mahmoud, AO Purpose: To determine whether the Wu-Jones Motion Sensitivity Screening Test (MSST) accurately reflects the burden of optic nerve disease in several onchoendemic communities in Africa. Materials and Methods: The MSST was used to evaluate subjects in the communities of Raja in Sudan, Bushenyi in Uganda, Morogoro in Tanzania, and Ikon, Olomboro, and Gembu in Nigeria. Motion sensitivity was expressed as a percentage of motion detected in the individual eye, and this was averaged for the community. A perfectly normal eye would detect all motion and score 100%. Results: In this study, 3858 eyes of 2072 subjects were tested. The test was completed in 76% of respondents. Acceptability was high. Average test time was 120.4 s. The overall mean motion sensitivity of all eyes tested was 88.49%, ±17.49. Using a cutoff level of 50%, 6.4% of all subjects tested were subnormal. The highest proportion of subnormals recorded was in Morogoro at 12.7%. Severe defects in a community best correlated with optic nerve disease prevalence, while the proportion of the defect from a higher cutoff level best correlated with overall ocular morbidity. A repeat examination in the next 5 years following ivermectin treatment will show the influence, if any, on community-wide MSST performance. Conclusion: A wide range in community scores reflected disease diversity. The MSST appears to be a useful test in community-wide screening and diagnosis as it reflects the general level of ocular pathology and specifically, optic nerve disease. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/320/71597 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71599 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmic manifestations of leukemia in a tertiary hospital population of adult Nigerian Africans Eze, BI Ibegbulam, GO Ocheni, S Purpose: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria Teaching Hospital (UNTH), Enugu, south-eastern, Nigeria. Materials and Methods: This prospective, observational case series surveyed adult leukemia patients presenting at UNTH's departments of Hematology/Immunology and Ophthalmology from July 2003 to August 2008. The demographic profile, clinical data from for each individual in the cohort were statistically collated and analyzed. A P <0.05 was considered as statistically significant. Results: There were 72 participants (45 males and 27 females), aged 32.7 ± 9.8 years (range, 18 years to 72 years). Leukemic ophthalmopathy was present in 77.8% of subjects. The leading ophthalmic manifestations of leukemia were retinal vascular abnormalities in 50.0% of subjects, conjunctival pallor in 27.8% of subjects, sub-conjunctival hemorrhage in 19.4% of subjects, and retinal hemorrhage in 16.7% of subjects. Ocular co-morbidity was present in 47.2% of subjects. Vision loss occurred in 37.5% of subjects, of which 32.1% was leukemia related, and the remaining due to ocular co-morbidity. Leukemic ophthalmopathy was more prevalent in chronic leukemia (P <0.05), frequently affected the ocular posterior segment (P < 0.05), and often resulted from secondary hematologic complications (P <0.05). There was no gender difference in the prevalence of leukemia (P = 0.0822) or leukemic ophthalmopathy (P = 0.6624). Conclusion: The prevalence of leukemic ophthalmopathy in Enugu is high. It is often associated with significant ocular co-morbidity and vision loss. These have implications for clinicians involved in leukemia management. Early diagnosis and regular ophthalmic examinations are recommended to optimize treatment outcomes. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/325/71599 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71601 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Tracing children with blindness and visual impairment using the key informant survey in a district of north-western Nigeria Muhammad, N Maishanu, NM Jabo, AM Rabiu, MM Purpose: To identify children with irreversible blindness in a district of northern Nigeria for enrolment into an inclusive education pilot project. Materials and Methods: Using key informants (KIs) working and residing within the communities, children with blindness and visual impairment in Gwadabawa local government area (LGA) were identified and then examined by a team of ophthalmologists/optometrists. Data analysis was performed manually using simple percentages and proportions. Results: Sixty children were reported with visual problems by parents/guardians of whom 58 (97%) were examined. Twenty children (35%) were blind, 17 (29%) were irreversibly blind, and 9 (16%) had low vision (<6/18 to 3/60) with presenting vision. The major causes of childhood blindness were corneal opacity/phthisis bulbi (75%), and cataract (15%). The cause of irreversible blindness in these children was largely preventable (80%) as it was due to childhood-related illnesses, such as vitamin A deficiency and measles. Conclusions: The major causes of childhood blindness in the study area were avoidable and the use of KI survey in this study provided an opportunity for service delivery. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/330/71601 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71603 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Psychosocial characteristics of totally blind people in a Nigerian city Ademola-Popoola, DS Tunde-Ayinmode, MF Akande, TM Purpose: To characterize the demographic and psychosocial problems of a group of blind people as a way of attracting more attention to and providing data that can improve the psychosocial care of the visually impaired. Materials and Method: A cross-sectional descriptive study of a population of totally blind people in Ilorin, Nigeria using a self-report questionnaire (SRQ). The questionnaire was verbally administered by the study personnel in the local language. Simple frequency tables were obtained and the Chi-square test was performed to determine significant differences between variables. P-value <0.05 was considered statistically significant. Results: Sixty one blind patients consented to participate. Most participants were engaged in street begging for their livelihood. Most subjects desired a job change, signifying dissatisfaction with the present occupation. Up to 80% of the cohort was married and had spouses who were also blind in at least one eye. Approximately two-thirds had five or more children and majority lived with family members who were responsible for taking care of their personal hygiene, cooking and mobility. The majority developed blindness in childhood and 16% had a family history of blindness and 77% had never used conventional eye care, with corneal disease being the most frequent cause of blindness. Many feared that their children may also become blind. Thirty-one (51%) scored ≥5 on SRQ and were classified as probable cases of psychological disorder. Conclusion: Blindness in a majority of cases that started in childhood was probably preventable. Inaccessibility to or failure of the formal rehabilitation and social welfare systems may have caused this psychosocial dilemma. The high level of social and family interaction provides opportunity for organized preventive ophthalmology, community health care services and psychosocial care. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/335/71603 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71606 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
A forecast of ophthalmology practice trends in Saudi Arabia: A survey of junior residents Alwadani, F Alrushood, A Altokhy, H Alasbali, T Purpose: The aim of this study is to identify the trends in practice pattern among current ophthalmology residents in Saudi Arabia. Materials and Methods: Ophthalmology residents in Saudi Arabia responded anonymously to a written survey between November 2007 and February 2008. The survey contained questions on demographic information, medical education, residency training, career goals and factors influencing their career choice. The data were categorized by gender. The influence of gender on outcome was assessed in a univariate fashion using the Chi-square or Fisher exact test when appropriate. A P-value of 0.05 or less was considered statistically significant for all analyses. Results: A total of 68 out of 85 residents (80%) responded to the survey. Over one-half of the residents preferred to pursue a fellowship within Saudi Arabia (53%), while others (25%) planned to train in North America. The majority of respondents wished to practice in an urban setting (63%). Anterior segment was the most desired subspecialty, while general ophthalmology and glaucoma were not a popular choice. Most residents were interested in refractive surgery (77%) and research (75%). The main factor influencing the decision to pursue ophthalmology was the ability to combine medicine and surgery (97%), while a positive elective experience was also an important factor, particularly for female respondents (91% vs. 57%; P < 0.001). Conclusion: Concerted efforts are required to encourage adoption to ophthalmic practice in public institutions rather than in private practice. In addition training in underrepresented subspecilaties should be encouraged to ensure adequate ophthalmic care for all citizens of Saudi Arabia. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/343/71606 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71605 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospital-based cohort in "Yemen" Bamashmus, MA Saleh, MF Awadalla, MA Background: To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) were not performed in patients who presented for refractive surgery consultation. Materials and Methods: A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. Results: In this cohort, 1,660 (79.4%) patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 (21%) patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters (19%), keratoconus (18%), suboptimal central corneal thickness (15%), cataract (12%) and keratoconus suspect (forme fruste keratoconus) (10%). Conclusion: Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/349/71605 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71604 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
The effects of blunt trauma and cataract surgery on corneal endothelial cell density Yeniad, B Corum, I Ozgun, C Purpose: This study was designed to investigate the effects of trauma and cataract surgery on corneal endothelial cell density (ECD) in patients with a traumatic cataract due to blunt trauma without globe laceration. Materials and Methods: In this prospective study, 31 subjects with traumatic cataract (traumatic cataract group) and 30 subjects with a senile cataract (control group) were enrolled. The subjects with traumatic cataract were subdivided into two groups: uncomplicated surgery subgroup (n = 19) in which subjects underwent standard phacoemulsification with intraocular lens implantation and complicated surgery subgroup (n = 12) in which subjects underwent cataract surgery other than standard phacoemulsification. The ECD of the traumatic cataract group and the control group was compared preoperatively and at 3 months or later postoperatively. A P value less than 0.05 was considered statistically significant. Results: The ECD in the eyes with traumatic cataract was 13.1% lower than that for healthy eyes preoperatively (P = 0.043). Postsurgical ECD decreased by 16.7% in complicated surgery subgroup and 11.9% in uncomplicated surgery subgroup (P = 0.049) after 3 months postoperatively. The ECD decreased by 10.8% in the control group (P = 0.489). Conclusions: Patients with cataracts due to blunt trauma had a decreased endothelial cell count, which was significantly aggravated by cataract surgery. The loss of corneal endothelium cells due to surgery depends on the surgical approach. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/354/71604 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71602 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery in cases with cataract and posterior segment diseases Yazici, AT Kara, N Bozkurt, E Cakir, M Goker, H Demirok, A Yilmaz, OF Background: Combined cataract surgery and transconjunctival sutureless vitrectomy are a good option in patients with cataract and vitreoretinal diseases. Aim: To evaluate the effectiveness, outcomes, and complications of combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery. Settings and Design: A retrospective case series was conducted at the Beyoglu Eye Education and Research Hospital. Materials and Methods: In this study, 28 eyes of 28 patients underwent combined 23-gauge transconjunctival sutureless vitrectomy and phacoemulsification and IOL implantation for cataract and various posterior segment diseases. The outcome measures included, visual acuity, intraocular pressure changes, and anatomical success were evaluated. Results: The mean follow-up was 4.8 months (range, 3-15 months). Mean overall preoperative visual acuity was 20/333, and final acuity was 20/95 (P < 0.001). Mean intraocular pressure (IOP) on the preoperative and first postoperative day was 15.6 ± 7.5 and 13.8 ± 3.3 mmHg, respectively (P > 0.05). Three eyes (10.7%) had postoperative hypotony (<6 mmHg)that all recovered spontaneously within the first postoperative week. Three eyes (10.7%) required laser treatment for iatrogenic retinal tears. Anatomical success was obtained in all cases. No serious complications such as endophthalmitis were observed during the follow-up period. Conclusion: Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in patients with significant lens opacities and vitreoretinal pathology. Although the anatomic and visual outcomes were satisfactory, the outcomes depended mainly on underlying vitreoretinal pathology. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/359/71602 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71600 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal crosslinking for keratoconus in Iranian patients: Outcomes at 1 year following treatment Saffarian, L Khakshoor, H Zarei-Ghanavati, M Esmaily, H Aim and Design: A retrospective, nonrandomized, single-center clinical study was designed to evaluate the outcomes of corneal collagen crosslinking (CXL) for progressive keratoconus in Iranian patients 12 months after CXL. Settings: This study was carried out at Navid Didegan Eye Center, a private clinic, Mashhad, Iran. Materials and Methods: Ninety-two eyes of 53 subjects with progressive keratoconus were evaluated in this study. All eyes completed 1-year follow-up. The outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), sphere and cylinder refraction, keratometry, and corneal thickness. Comparison of baseline and 1-year postoperative data is reported in this study. The Wilcoxon signed-ranked and Student's t-tests were used for statistical analyses. P < 0.05 was statistically significant. Results: The mean age was 21.5 ± 3.4 years (range, 16 -30 years). Thirty-one (58.5%) of the subjects were men and 22 (41.5%) were women. Mean baseline UCVA and BSCVA were 0.61 ± 0.31 and 0.06 ± 0.12 logarithm of minimal angle of resolution (logMAR), respectively. One year postoperatively UCVA was 0.31 ± 0.25 logMAR and BSCVA was 0.0 ± 0.01 logMAR. UCVA and BSCVA were statistically higher postoperatively (P < 0.001, both parameters). The mean astigmatism decreased by 0.78 ± 1.49 diopter (D) with significant variation during the follow-up period (P < 0.001). Mean baseline simulated keratometry (SIM K) was 46.94 ± 2.37 D and decreased to 46.0 ± 2.33 D on year postoperatively (P < 0.001). Conclusion: Corneal CXL seems to be efficient in stabilization of progressive keratoconus progression in Iranian patients at 1 year of followup. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/365/71600 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71598 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Mitomycin-C needle bleb revision in congenital glaucoma Mohamed, ET Purpose and Settings: This study was designed to evaluate the efficacy and safety of mitomycin-C (MMC) augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital. Patients and Methods: A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 ± 3.4 years (range, 1-12 years). Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC (0.04 mg/mL) and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous outflow. Results: Follow-up ranged from 6 to 20 months (mean, 9.23 ± 5.25 months). One needling revision was performed in 22 eyes (73.3%) and eight eyes (26.7%) received two needle revisions. The mean intraocular pressure (IOP) decreased from 26.9 ± 2.85 mmHg (range, 21-34 mmHg) before surgery to 15.63 ± 3.15 mmHg (range, 10-24 mmHg) at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye. Conclusion: MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/369/71598 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71595 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Malignant nodular hidradenoma of the eyelid: A rare sweat gland tumor Al, BA Reddy, SS Reddy, MA We report a case of malignant nodular hidradenoma in a middle-aged man, who presented with a nodular swelling in the eyelid. The tumor was similar to its benign counterpart but had additional features such as surface ulceration, numerous mitiotic figures, and an infiltrative growth pattern. Malignant forms of hidradenomas are unusual and the possibility this variant should be considered in the differential diagnosis of eyelid tumors. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/374/71595 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71593 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Transcorneal tube erosion of an Ahmed valve implant in an adult Al-Shahwan, S Ahmed valve implants are currently used to manage high-risk complicated adults and pediatric glaucoma when standard filtration surgery is unsuccessful. Despite its success, the Ahmed valve shunt has significant complications particularly in the anterior segment. We report an unusual case of transcorneal tube erosion of an Ahmed valve implant in an adult that resulted from long-standing tube-corneal touch. Periodic observation of tube position is recommended. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/377/71593 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71591 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Progressive posterior lenticonus in a patient with alport syndrome Al-Mahmood, AM Al-Swailem, SA Al-Khalaf, A Al-Binali, GY We report a rare case of Alport syndrome with progressive posterior lenticonus. A 24-year-old male presented to our tertiary eye care center with history of poor vision. At initial presentation, the patient had bilateral anterior lenticonus, posterior subcapsular cataract, and renal failure. The patient was diagnosed with Alport syndrome based on a positive family history of the disease and clinical findings. Further examination revealed progressive posterior lenticonus that was not present initially. The presence of such finding is important because it influences the surgical approach to avoid complications during cataract surgery. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/379/71591 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71589 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Acute ocular complications from self-administered topical Kermes Al-Ghadeer, HA To report severe ocular complications and their management after self-administered topical kermes dye eye drops. A case report of a 55-year-old man who suffered severe ocular surface damage after application of topical kermes eye drops to his left eye. Active compounds of the kermes eye drops were studied for their composition. Patient reported decreased vision in the affected eye and the external eye examination revealed complete corneal abrasion, cicatrization of the conjunctiva, and symblepharon formation. The patient required immediate cleansing of the ocular surface along with irrigation. He was treated with topical corticosteroids and frequent lubrication. Gas chromatography/mass spectrometry analysis of the retrieved topical material revealed the presence of acid. The patient's visual acuity improved from 20/200 before treatment to 20/25 after treatment.Topically administered kermes eye drops may cause severe ocular injuries. Public education, early recognition of such injuries, and timely intervention may prevent permanent damage to the ocular adnexae. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/382/71589 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71587 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection Hill, JJ We report a case of conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection after phacoemulsification surgery. This case report highlights a serious complication of the inadvertent use of methylprednisolone as a subconjunctival agent. To report a case of conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection after phacoemulsification. Case report a single case presenting to a tertiary ophthalmic unit. An 82-year-old patient underwent uncomplicated phacoemulsification in the right eye. Postoperatively, she was given a subconjunctival injection of methylprednisolone. Two weeks later, she presented with a painful ulcerated lesion of the conjunctiva proximal to the injection site. The ulcerated lesion was surgically excised and she made a complete recovery.In this reported case, methylprednisolone was used in error with significant resultant morbidity. This preparation is not registered for the off label use in ophthalmology, and this case report highlights the danger of its inadvertent use as a subconjuctival agent. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/385/71587 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71586 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Intravitreal avastin for choroidal neovascularization associated with stargardt-like retinal abnormalities in pseudoxanthoma elasticum Querques, G Bux, AV Prascina, F Noci, ND The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE), showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal choroidal neovascularization (CNV) of the right eye (RE). A 57-year-old woman with diagnosis of angioid streaks, retinal flecks, and chorioretinal Stargardt-like atrophy due to PXE was referred to our department for sudden decreased vision in her RE (20/160). Upon a complete ophthalmologic examination, including fluorescein angiography (FA), and optical coherence tomography (OCT), the patient was diagnosed with subfoveal CNV of the RE. Owing to the subfoveal localization of the CNV, the patient was submitted to intravitreal bevacizumab injection. At the 1-month follow-up, visual acuity (VA) improved (20/40), and FA and OCT revealed the CNV closure. Twelve months after the treatment, the patient's VA remained stable with no recurrence of active CNV. On the basis of our findings, a single intravitreal bevacizumab injection seems to induce total regression of CNV complicating PXE, in a patient showing Stargardt-like retinal abnormalities. Further investigations are required to confirm our results. Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/387/71586 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71582 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmic disorders in adult lymphoma patients Javed, AM Honavar, S Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/390/71582 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:71584 2010-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Authors' reply Omoti, AE Omoti, CE Momoh, RO Medknow Publications 2010-10-01 http://www.meajo.org/text.asp?2010/17/4/390/71584 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75875 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmic genetics: Moving forward Abu-Amero, KK Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/1/75875 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75880 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Leber's hereditary optic neuropathy: The mitochondrial connection revisited Abu-Amero, KK Our current understanding of Leber's hereditary optic neuropathy (LHON)-mitochondrial connection falls short of comprehensive. Twenty years of intensive investigation have yielded a wealth of information about mitochondria, the mitochondrial genome, the metabolism of the optic nerve and other structures, and the phenotypic variability of classic LHON. However, we still cannot completely explain how primary LHON mutations injure the optic nerve or why the optic nerve is particularly at risk. We cannot explain the incomplete penetrance or the male predominance of LHON, the typical onset in young adult life without warning, or the synchronicity of visual loss. Moreover, primary LHON mutations clearly are not present in every family with the LHON phenotype (including multigenerational maternal inheritance), and they are present in only a minority of individuals who have the LHON optic neuropathy phenotype without a family history. All lines of evidence point to abnormalities of the mitochondria as the direct or indirect cause of LHON. Therefore, the mitochondria-LHON connection needs to be revisited and examined closely. This review will attempt to do that and provide an update on various aspects of LHON. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/17/75880 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75876 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The genetics of keratoconus Nowak, DM Gajecka, M Keratoconus (KTCN) is non-inflammatory thinning and anterior protrusion of the cornea that results in steepening and distortion of the cornea, altered refractive error, and decreased vision. Keratoconus is a complex condition of multifactorial etiology. Both genetic and environmental factors are associated with KTCN. Evidence of genetic etiology includes familial inheritance, discordance between dizygotic twins, and association with other known genetic disorders. Several loci responsible for a familial form of KTCN have been mapped; however, no mutations in any genes have been identified for any of these loci. This article focuses on the genetic aspects. In addition, bioinformatics methods applied in KTCN gene identification process are discussed. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/2/75876 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75881 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Genetic diagnostic methods for inherited eye diseases Gabriel, LA Traboulsi, EI Accurate molecular diagnosis of genetic eye diseases has proven to be of great importance because of the prognostic and therapeutic value of an accurate ascertainment of the underlying genetic mutation. Efforts continue in diagnostic laboratories to develop strategies that allow the discovery of responsible gene/mutations in the individual patient using the least number of assays and economizing on the expenses and time involved in the process. Once the ophthalmologist has made the best possible clinical diagnosis, blood samples are obtained for genetic testing. In this paper we will review the basic laboratory methods utilized to identify the chromosomal or mutational etiology of genetic diseases that affect the eye. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/24/75881 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75882 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Genetics and genomics of pseudoexfoliation syndrome/glaucoma Schlotzer-Schrehardt, U Pseudoexfoliation (PEX) syndrome, one of the most common causes of glaucoma, represents a complex, multifactorial, late-onset disease of worldwide significance. The etiopathogenesis involves both genetic and non-genetic factors. The PEX-specific tissue alterations are caused by a generalized fibrotic matrix process, which has been characterized as a stress-induced elastosis associated with the excessive production and abnormal cross-linking of elastic microfibrils into fibrillar PEX aggregates. The identification of lysyl oxidase-like 1 (LOXL1) as a major genetic risk factor for PEX syndrome and PEX glaucoma further supports a role of elastogenesis and elastosis in the pathophysiology of PEX, as LOXL1 is a pivotal cross-linking enzyme in elastic fiber formation and stabilization. The available data suggest that LOXL1 is markedly dysregulated depending on the stage of the fibrotic process. While transient upregulation of LOXL1 during the early stages of PEX fibrogenesis participates in the formation and aggregation of abnormal PEX fiber deposits, the decreased expression of LOXL1 during the advanced stages of the disease may affect elastin metabolism and promote elastotic processes, e.g. in the lamina cribrosa, predisposing to glaucoma development. However, in view of the low penetrance of the PEX-associated risk variants of LOXL1, other genetic and/or environmental factors must contribute to the risk of developing the PEX phenotype. Some evidence exists for the contribution of additional genes with relatively small effects, e.g. clusterin (CLU), contactin-associated protein-like 2 (CNTNAP2), apolipoprotein E (APOE), glutathione S-transferases (GSTs), and tumor necrosis factor-alpha (TNFA), in certain study populations. Several environmental conditions associated with PEX, such as oxidative stress as well as pro-fibrotic cytokines and growth factors, can regulate expression of LOXL1 and elastic proteins in vitro and may therefore act as co-modulating external factors. Ultimately, both detection and functional characterization of yet unidentified genetic and non-genetic factors may lead to the development of more precise screening tools for the risk of PEX glaucoma. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/30/75882 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75883 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Preoperative subconjunctival injection of mitomycin C versus intraoperative topical application as an adjunctive treatment for surgical removal of primary pterygium Ghoneim, EM Gab-Allah, AA Kamal, MZ Purpose : To compare the efficacy of preoperative local injection of mitomycin C (MMC) to intraoperative application of MMC in the prevention of pterygium recurrence after surgical removal. Materials and Methods : Seventy eyes of 70 patients with primary pterygia were randomly allocated to two groups. The first group (Group A, 35 eyes) received 0.1 ml of 0.15 mg/ml of subconjunctival MMC injected into the head of the pterygium 24 h before surgical excision with the bare sclera technique. The second group (Group B 35 eyes) underwent surgical removal with the bare sclera technique with intraoperative application of MMC (0.15 mg/ml) over bare sclera for 3 min. The study was performed between March 2007 and December 2008, and follow up was performed for 1 year postoperatively. Differences between frequencies in both groups were compared by the Chi-square test or Fisher exact test. Differences between means in both groups were compared by Student's t-test. P < 0.05 was considered significant. Results : The rate of pterygium recurrence was 5.70% in Group A and 8.57% in Group B at 1 year postoperatively (P>0.05). Postoperatively, scleral thinning occurred in one eye in each group that resolved by 5 months postoperatively. No serious postoperative complications occurred in either group. Conclusion : Preoperative local injection of 0.15 mg/ml MMC is as effective as intraoperative topical application of 0.15 mg/ml MMC for preventing pterygium recurrence after surgical removal. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/37/75883 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75884 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Change in quality of life after medical and surgical treatment of graves' ophthalmopathy Kashkouli, MB Heidari, I Pakdel, F Jam, S Honarbakhsh, Y Mirarmandehi, B Purpose : To assess the changes in quality of life (QOL) of patients after treatment of their Graves' ophthalmopathy (GO). Materials and Methods : In this prospective, cross-sectional study, the GO-QOL questionnaire was completed by 67 subjects before and at least 6 months after steroid treatment (61 subjects, group 1) or optic neuropathy orbital decompression (6 subjects, group 2). Visual, psychosocial, education and counseling scores (higher score = better health), GO severity and clinical activity scores and minimal clinically important difference (MCID) were recorded and analyzed for correlation and statistical significance. A P-value <0.05 was considered statistically significant. Results : The mean age of patient enrolled in the study was 38.3 years, with 43 females (64.2%). The mean duration of thyroid dysfunction and GO were 40.1 and 26.5 months, respectively. Two treatment groups were similar for all the variables (0.06 < P < 0.9), except for higher mean age in the orbital decompression group (45.2 versus 37.7 years) (P = 0.03). Mean severity, activity, visual function and psychosocial function scores significantly improved in group 1 (steroid group) (P < 0.05, all cases). A significant improvement in clinical activity score and psychosocial scores occurred in group 2 (decompression group) (P < 0.05). MCID was achieved in two-thirds of the patients, with no significant difference between groups (P > 0.05). There was no significant effect of duration of thyroid disease and GO and severity and activity of GO on QOL scores either before or after treatment (P > 0.05, all cases). Conclusion : Steroid treatment and orbital decompression significantly improve the QOL in GO. Duration, severity and activity of GO did not have a significant impact on the QOL. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/42/75884 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75886 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
A clinicopathologic study of excised conjunctival lesions Purpose : This study was aimed at to determine the frequency of excised conjunctival lesions in a patient population treated over a 10-year period. Materials and Methods : The data of all excised conjunctival lesions with tissue diagnoses from 1998 to 2008 in the pathology department were analyzed. Results : The patient group comprised 192 conjunctival specimens; 106 (55.2%) obtained from male patients and 86 (44.8 %) from female patients. The age range was 75 years with a mean age of 27.07 ± 17 years. The most frequent excised lesions were pyogenic granulomas, which represented 30.7% (59 cases). Pigmented epithelial tumors were the second most common benign conjunctival lesions (44 cases, 22.9%). Out of these cases, compound nevus represented 86.4% (38 cases) and junctional nevus represented 6.8% (3 cases). Primary acquired melanosis and subepithelial nevus were reported in two cases (4.5%) and one case (2.3%), respectively. Cystic lesions represented 12% (23 cases). These were mostly ductal retention cysts in 16 cases (70%), occupying the fornix in eight cases. Ocular surface squamous neoplasia (OSSN) was detected in 21 cases (10.9%) significantly affecting an older age group as compared to other lesions (mean age 45.9 ± 16.7). Other less frequent lesions included papilloma (10 cases, 2.5%), dermolipoma (8 cases, 4.2%), solid dermoid (3 cases, 1.6%), hemangioma (15 cases, 7.8%), and benign reactive lymphoid hyperplasia (four cases, 2.1%). Conclusion : Benign lesions were the most frequent histologically diagnosed conjunctival lesions. The true malignant lesions were lower than what has been described in many reports. The significant proportion of precancerous OSSN can be attributed to sun exposure and ultraviolet light in Egypt. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/48/75886 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75888 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Management of intraoperative miosis during pediatric cataract surgery using healon 5 Jhanji, V Sharma, N Vajpayee, RB Purpose : We describe a technique for achieving pupillary dilatation in order to manage and counteract intraoperative miosis during pediatric cataract surgery using viscoadaptive viscoelastic (sodium hyaluronate 2.3%). Materials and Methods : The technique of viscomydriasis was used in six eyes with pediatric cataracts with intraoperative pupillary miosis. Results : Pupillary dilatation was achieved and maintained in all eyes throughout cataract surgery. All the surgical steps including anterior and posterior capsulorrhexis and aspiration were performed successfully. Conclusions : Viscomydriasis is a simple and effective technique for the management of intraoperative pupillary miosis during cataract surgery in pediatric eyes. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/55/75888 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75889 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The effects of riboflavin/ultraviolet: A corneal cross-linking on the signs and symptoms of bullous keratopathy Gharaee, H Ansari-Astaneh, M Armanfar, F Purpose : To evaluate the effectiveness of corneal cross-linking in improving the signs and symptoms of bullous keratopathy. Materials and Methods : This prospective non-randomized case series evaluated 20 eyes with bullous ketratopathy that underwent corneal cross-linking (C3R) with riboflavin and ultraviolet-A (UVA, 370 nm, 3 mW/cm <sup>2</sup> ). C3R was performed for 30 min in a routine procedure after removal of epithelium. Central corneal thickness (CCT), corneal haze, visual acuity (VA), and the presence of irritating symptoms were recorded before the procedure, and at 1 week, 1 months, 3 months, and 6 months after the procedure. Results : The mean CCT was 872 ± 162 μm (range: 665-1180 μm) before the procedure. Following the procedure, CCT was 855 ± 175 μm after 1 week, 839 ± 210 μm after 1 month, 866 ± 185 μm after 3 months, and 863 ± 177 μm after 6 months (P>0.05, all visits). There was no significant improvement in VA or corneal clarity after 6 months. Improvement of the following symptoms: burning, pain, and foreign body sensation were reported after 6 months by 83.3%, 75.0%, and 66.7% of patients, respectively. Persistent epithelial defect occurred in five patients (25%) resolved with frequent lubrication and bandage contact lenses. Conclusion : The outcomes of this study indicate corneal cross-linking is not an effective treatment for bullous keratopathy with respect to VA and CCT, although it can improve irritation and discomfort. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/58/75889 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75890 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Schnyder corneal dystrophy in a Saudi Arabian family with heterozygous UBIAD1 mutation (p.L121F) Al-Ghadeer, H Mohamed, JY Khan, AO Schnyder corneal dystrophy is a rare dominant disorder mostly reported in Western and occasionally Asian populations. This report documents the condition in an affected family from the historically isolated Arabian Peninsula. A child and her mother had central crystalline keratopathy consistent with Schnyder corneal dystrophy. Diagnostic UB1AD1 testing revealed a known point mutation (c.361C>T, p.L121F) in both individuals. Available asymptomatic family members had normal ophthalmic examinations and did not have the mutation. Blood lipid profiles for the two patients revealed mildly elevated total cholesterol and low-density lipoproteins. This report documents Schnyder corneal dystrophy on the Arabian Peninsula and further confirms its relationship with heterozygous UB1AD1 missense mutation. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/61/75890 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75891 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral hypermetropia, myelinated retinal nerve fibers, and amblyopia Shenoy, R Bialasiewicz, AA Al, BB A 14-year-old hyperopic female with poor vision in both eyes was evaluated for ophthalmic and systemic diseases. The patient had bilateral retinal fiber myelination and greater vision loss in the more hyperopic eye. This was a rare case of reverse Straatsma syndrome, the clinical presentation which may be accompanied with significant vision loss. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/65/75891 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75892 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral progressive visual loss in an epileptic, mentally retarded boy Guerriero, S Vetrugno, M Ciracì, L Artuso, L Dell'Aglio, R Petruzzella, V Leber's hereditary optic neuropathy (LHON) is a maternally inherited, monosymptomatic disorder, characterized by severe central vision loss and optic atrophy that most frequently affects young men. The classic LHON phenotype is associated to three mitochondrial DNA mutations, mostly homoplasmic, in the Mt-ND4, Mt-ND6, and Mt-ND1 genes, encoding for complex I subunits of the mitochondrial respiratory chain. Rare cases have been described in the literature in association with variable central nervous system involvement in a syndromic form called LHON 'plus.' In the present study, we report the case of a 16-year-old boy with the 3460/ND1 mutation who presented with epilepsy, migraine, and mental retardation as non-ophthalmic features. We also investigated his relatives who all had the 3460/ND1 mutation. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/67/75892 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75878 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Primary congenital glaucoma and the involvement of CYP1B1 Kaur, K Mandal, AK Chakrabarti, S Primary congenital glaucoma (PCG) is an autosomal recessive disorder in children due to the abnormal development of the trabecular meshwork and the anterior chamber angle. With an onset at birth to early infancy, PCG is highly prevalent in inbred populations and consanguinity is strongly associated with the disease. Gene mapping of PCG-affected families has identified three chromosomal loci, GLC3A, GLC3B and GLC3C, of which, the CYP1B1 gene on GLC3A harbors mutations in PCG. The mutation spectra of CYP1B1 vary widely across different populations but are well structured based on geographic and haplotype backgrounds. Structural and functional studies on CYP1B1 have suggested its potential role in the development and onset of glaucomatous symptoms. A new locus (GLC3D) harboring the LTBP2 gene has been characterized in developmental glaucoma but its role in classical cases of PCG is yet to be understood. In this review, we provide insight into PCG pathogenesis and the potential role of CYP1B1 in the disease phenotype. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/7/75878 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75894 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Scrofuloderma and bilateral anterior staphyloma of eye: An unusual association Kandar, AK Sinha, R Sharma, N James, KM Bali, SJ Titiyal, JS We report a patient with bilaterally symmetrical perforated corneal ulcers with formation of anterior staphyloma associated with scrofuloderma. A 22-year-old female in her third month postpartum presented with multiple perforated corneal ulcers bilaterally. There was a presence of a skin lesion that was consistent with scrofuloderma. Fine needle aspiration cytology of preauricular lymph nodes showed evidence of granulomatous inflammation consistent with tuberculosis. Corneal scraping revealed the presence of coagulase-negative Staphylococcus. She was treated with topical fortified combination antibiotics (cefazolin and tobramycin). The corneal ulcer resolved with formation of anterior staphyloma in both eyes. The patient underwent anterior staphylectomy and tectonic keratoplasty in both eyes. Eight weeks postoperatively, her visual acuity improved to 20/200 in both eyes with clear grafts. Scrofuloderma may be associated with recurrent phlyctenulosis. Multiple corneal ulcerations coupled with use of topical steroids may result in corneal perforation and formation of anterior staphyloma. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/71/75894 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75895 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular surface squamous neoplasia masquerading as superior limbic keratoconjunctivitis Moshirfar, M Khalifa, YM Kuo, A Davis, D Mamalis, N To report a case of ocular surface squamous neoplasia (OSSN) masquerading as superior limbic keratoconjunctivitis (SLK). A 62-year-old woman was referred with foreign body sensation, irritation, photophobia and decreased vision in the left eye. She was initially treated for 10 months with intermittent topical corticosteroids for a presumed diagnosis of SLK. She underwent excisional biopsy of the superior conjunctiva and was found, on histopathologic evaluation, to have OSSN with moderate to marked dysplasia. This is the first reported case of OSSN masquerading with signs and symptoms of SLK. Any ocular surface lesion refractory to standard medical treatment should raise suspicion for a malignant process and warrant further cytologic or histopathologic evaluation. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/74/75895 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75896 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
T-cell prolymphocytic leukemia presenting as red eye Alwadani, F T-cell prolymphocytic leukemia (T-PLL) is a rare, highly aggressive, mature T-cell neoplasm. Ocular involvement in T-PLL is very rarely described in the literature. There are only two reports in the literature documenting conjunctival involvement in cases with T-PLL. Conjunctival involvement may be the presenting sign of the disease or rarely signifies the relapse of the disease. We present a case of a 36-year-old Saudi male patient in whom bilateral red eyes were the presenting sign of T-PLL. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/77/75896 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75897 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Acquired epiblepharon treated by lateral orbital and fat decompression Almousa, R Sundar, G Conventional lid surgery of acquired epiblepharon secondary to increased orbital volume can be result of under correction of the epiblepharon, because the increased orbital volume remains unaddressed. In this case report, we present a case of acquired epiblepharon, secondary to increased orbital volume, treated with orbital decompression. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/80/75897 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:75898 2011-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Unilateral Vogt-Koyanagi-Harada disease: Report of two cases Agrawal, A Biswas, J In this retrospective report, we present two cases of unilateral Vogt-Koyanagi-Harada (VKH) disease. These patients were evaluated with clinical, ophthalmological and laboratory examinations. Their response following corticosteroid administration was evaluated. Both patients had the characteristic clinical features of VKH involving only one eye, including disc edema, choroidal striae, multiple sub retinal yellow lesions and exudative retinal detachment. These cases indicate that the clinical and angiographic features were typical of VKH disease despite the unilateral involvement. Medknow Publications 2011-01-01 http://www.meajo.org/text.asp?2011/18/1/82/75898 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80697 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
How can hospital programs be strengthened to enhance achievement of Vision 2020 objectives? Ravilla, T Joseph, S The global initiative, "VISION 2020 - The Right to Sight" aims to eliminate avoidable blindness by year 2020. Avoidable blindness by definition are those conditions for which we already have a treatment or a surgical procedure and often a proven strategy to either prevent or cure the condition. Thus, the challenge to realize this goal would be designing the right service delivery systems specific to the local context, organizing the required resources, coordination, and implementing and monitoring these. The key "discipline" that is required to ensure successful implementation is "Management." To be holistic, such management inputs are required both in a program as well as the hospital setting. From a program perspective, the focus will need to be on reaching the unreached, ensuring equity, creating an enabling environment, putting in place the required infrastructure, including that for developing all cadres of the eye care team, and functionally integrating eye care into the general health system and other developmental activities. From a hospital perspective, the management process should manage the internal and external ecosystems as well as all the interfaces to the hospital. It should also put in place systems for ensuring an adequate patient flow, high productivity, quality, sustainability, and accountability. Since in many countries the notion of management in health care or more specifically in eye care is at an early stage or nonexistent, a proactive effort is required to build the management capacity quickly through a structured process. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/102/80697 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80698 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Severe visual Impairment and blindness in infants: Causes and opportunities for control Gogate, P Gilbert, C Zin, A Childhood blindness has an adverse effect on growth, development, social, and economic opportunities. Severe visual impairment (SVI) and blindness in infants must be detected as early as possible to initiate immediate treatment to prevent deep amblyopia. Although difficult, measurement of visual acuity of an infant is possible. The causes of SVI and blindness may be prenatal, perinatal, and postnatal. Congenital anomalies such as anophthalmos, microphthalmos, coloboma, congenital cataract, infantile glaucoma, and neuro-ophthalmic lesions are causes of impairment present at birth. Ophthalmia neonatorum, retinopathy of prematurity, and cortical visual impairment are acquired during the perinatal period. Leukocoria or white pupillary reflex can be cause by congenital cataract, persistent hyperplastic primary vitreous, or retinoblastoma. While few medical or surgical options are available for congenital anomalies or neuro-ophthalmic disorders, many affected infants can still benefit from low vision aids and rehabilitation. Ideally, surgery for congenital cataracts should occur within the first 4 months of life. Anterior vitrectomy and primary posterior capsulotomy are required, followed by aphakic glasses with secondary intraocular lens implantation at a later date. The treatment of infantile glaucoma is surgery followed by anti-glaucoma medication. Retinopathy of prematurity is a proliferation of the retinal vasculature in response to relative hypoxia in a premature infant. Screening in the first few weeks of life can prevent blindness. Retinoblastoma can be debulked with chemotherapy; however, enucleation may still be required. Neonatologists, pediatricians, traditional birth attendants, nurses, and ophthalmologists should be sensitive to a parent's complaints of poor vision in an infant and ensure adequate follow-up to determine the cause. If required, evaluation under anesthesia should be performed, which includes funduscopy, refraction, corneal diameter measurement, and measurement of intraocular pressure. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/109/80698 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80699 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Challenges of trachoma control: An assessment of the situation in Northern Nigeria Rabiu, MM Muhammed, N Isiyaku, S Over the last three decades, a lot has been achieved in the control of trachoma worldwide. New assessment techniques, effective evidence-based control strategy with new methods and drugs, and an aggressive global partnership for the control of the disease have evolved. As such the number of people with the disease and blindness due to the disease had drastically reduced. Trachoma is now only responsible for about 4% of blindness worldwide down from 12% some few decades ago. Some countries are on the verge of eliminating the disease as a public health problem. Despite these achievements numerous challenges remain for achieving trachoma control in endemic communities. This article highlights the challenges faced in one of the known trachoma endemic areas - northern Nigeria. Aspects on the dearth of complete situational data on trachoma, fragmented implementation of the SAFE strategy, community apathy, difficulties faced in ensuring safe, and quality lid surgery in the most difficult terrain where the disease thrives are discussed here. Other unique challenges like managing children with severe trichiasis, curbing the high rate of early-onset recurrence of trichiasis after lid rotation surgery and challenges to maintain supply of antibiotics and implementation of facial cleanliness and environmental improvement components of the control strategy are presented along with the learnt experiences and recommendations. These challenges and their remedies are likely to be shared by other trachoma endemic areas in Africa. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/115/80699 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Prevalence and causes of blindness and visual impairment in Sokoto State, Nigeria: Baseline data for Vision 2020: The right to sight eye care programme Muhammad, N Mansur, RM Dantani, AM Elhassan, E Isiyaku, S Purpose : To estimate the prevalence of low vision and blindness, identify the causes, and suggest policies for an effective eye care program based on 2005 data from Sokoto State, Nigeria. Materials and Methods : A stratified two-stage cluster sampling method was used to quantify the prevalence of blindness and the causes from 4 health zones in Sokoto State. Subjects were evaluated using a magnifying loupe, direct ophthalmoscope and torchlight. Data were collected based on the World Health Organization prevention of blindness coding for an eye examination. Prevalences with 95% confidence intervals (CI) were calculated and surgical coverage for causes of blindness was also analyzed. Results : The response rate was 91%. The prevalence of bilateral blindness was 1.9% (95% CI: 1.5-2.3%) ranging from 1.6% to 2.0% across the four health zones. The prevalence was 2.1% (95% CI: 1.6-2.6%) in males and 1.6% (95% CI: 1.1-2.1%) in females. The leading cause of bilateral blindness was cataract (51.6%), followed by uncorrected aphakia (20.9%) and glaucoma (11%). The prevalence of bilateral operable cataract was 1.9% (95% CI: 1.5-2.3%). The cataract surgical coverage (individuals with visual acuity <6/60) for the study was lower than the couching coverage (4.4% vs. 14.9%, respectively). Surgical coverage for trichiasis was 4.4%. The major barrier to cataract and glaucoma management was cost. Conclusions : The prevalence of blindness in Sokoto State is high yet the main causes are largely avoidable. Barriers can be reduced by appropriate health education regarding the eye care program and the provision of integrated, sustainable, affordable and equitable services. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/123/80700 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80701 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Outcomes of cataract surgeries over 16 years in camps held by Al Basar International Foundation in 38 underdeveloped countries Rushood, AA Purpose : To evaluate the outcomes of 16 years of eye campaigns in 38 countries in Africa, Asia and the Middle East Materials and Methods : A descriptive, retrospective study using the Al-Basar International Foundation (BIF) records. BIF is a non-governmental, non-religious philanthropic organization working in the field of the prevention of blindness since 1989. Having its base in Saudi Arabia and working mainly in Asia and Africa. Study variables included the causes of diminished vision, outcomes of eye surgeries, number of camps, patients assessed, surgeries performed, intraocular lenses (IOLs) implanted, spectacles distributed, general outcomes of campaigns, and other variables. Results : Between the periods of November 1989 and June 2006, BIF conducted 620 eye camps. These camps were conducted by ophthalmologists with expertise of working in eye camps with limited resources and harsh environmental conditions. Over two million people were examined and/or treated, and 186, 765 surgeries were performed. Nearly 100,000 IOLs were implanted and more than 140,000 spectacles were prescribed and distributed. The majority of these activities (74%) took place in Asia and the Middle East. The best corrected visual acuity achieved (BCVA) was ranked good (6/6 -6/18) in 59% of patients and borderline (BCVA 6/18 - 6/60) in 35% and poor (BCVA <6/60) in less than 6% of patients based on World Health Organization (WHO) criteria. Conclusion : Quality assured eye campaigns held by BIF helped the most needy countries and people. Intensive volunteer cataract programs and surgeries such as those provided by the BIF add significant support to the efforts of the WHO and International Agency for the Prevention of Blindness in fighting blindness. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/129/80701 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80702 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Clinical and epidemiologic characteristics of severe childhood ocular injuries in Southern Iran Hosseini, H Masoumpour, M Keshavarz-Fazl, F Razeghinejad, MR Salouti, R Nowroozzadeh, MH Purpose : To evaluate the clinical and epidemiological characteristics of children with ocular trauma. Materials and Methods : We retrospectively reviewed the medical records of 278 children (aged 15 years or less) hospitalized with ocular injuries and treated as inpatients at a tertiary referral center in Shiraz, Iran, from 2005 to 2008. Nominal variables were evaluated with a Chi-square test. A P-value less than 0.05 indicated statistical significance. Results : The cohort was comprised of 205 (74%) males, outnumbering females by a ratio of 2.81/1. The mean age was 7.6 ΁ 3.96 years. Rural residents comprised 125 (45%) of the cohort. Sharp objects caused ocular injury in 211 (76%) cases, and 207 (74%) cases had open-globe injuries. The lens was injured in 62 (30%) cases at initial examination and 89 (43%) patients according to ultrasound examination (P = 0.006). Twenty-eight cases (10%) developed post-traumatic endophthalmitis. Endophthalmitis was associated with needle injury [odd ratio (OR) = 19.25] and presence of intraocular foreign body (OR = 3.48). Visual acuity of patients with closed-globe injuries was 20/200 or better on both initial and final examinations. Visual acuity of patients with open-globe injuries were in the range of light perception to 20/200. Conclusions : Trauma is an important cause of childhood ocular morbidity in southern Iran. Playing with sharp objects is an important cause of ocular trauma in children, and most injuries can be prevented by careful supervision. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/136/80702 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80703 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence and determinants of glaucoma in citizens of Qatar aged 40 years or older: A community-based survey Al-Mansouri, FA Kanaan, A Gamra, H Khandekar, R Hashim, SP Al, QO Ahmed, MF Background : We present the prevalence and determinants of glaucoma among subjects 40 years of age and older in Qatar. Materials and Methods : This community-based survey was held in 2009 at 49 randomly selected clusters. Demographic details and history of glaucoma was collected by the nurses. Ophthalmologists evaluated the optic disc and retina using a digital camera housed in a mobile van. Visual field was tested with an automated perimeter, the intraocular pressure with an applanation tonometer and the angle of the anterior chamber by gonioscopy. A panel of glaucoma experts diagnosed subjects with glaucoma. Results : This survey enrolled 3,149 (97.3%) participants. The age- and sex-adjusted prevalence of glaucoma in the population aged 40 years and older was 1.73% (95% confidence intervals [CI] 1.69-1.77). Accordingly, 5,641 individuals in this age group in Qatar would have glaucoma. Chronological age of 60 years and older (Odds ratio [OR] 11.1) and the presence of myopia (OR 1.78) were predictors of glaucoma. Open-angle glaucoma was diagnosed in 44 (65.7%) individuals with glaucoma. In nine (13.4%) and 15 (20.9%) subjects, angle closure glaucoma and other (post-traumatic, pseudoexfoliation) glaucoma were present. Bilateral blindness (vision <3/60) and severe visual impairment (<6/60) were found in four (6%) and three (4.5%) subjects with glaucoma, respectively. Glaucoma was treated in 36 (54%) subjects. Conclusions : The prevalence of glaucoma among citizens of Qatar aged 40 years and older was 1.71%. Glaucoma was associated with the age of 60 years and older and the presence of myopia. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/141/80703 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80704 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Six year trend in cataract surgical techniques in Iran Hashemi, H Alipour, F Mehravaran, S Rezvan, F Alaeddini, F Fotouhi, A Purpose : To determine the cataract surgery techniques performed in Iran from 2000 to 2005. Materials and Methods : This study was part of the Iranian Cataract Surgery Survey (ICSS) which was a retrospective cross-sectional study. All major ocular surgery units and 10% of randomly selected minor units throughout Iran were included. Excluding the 2 week Iranian New Year holiday, 1 week per season between 2000 and 2005 (a total of 24 weeks) was selected for each center, and data on all cataract surgeries performed during these weeks were collected by reviewing patient records. The ANOVA repeated measure test was performed to determine longitudinal changes with a P<0.05 denoting statistical significance. Results : Phacoemulsification with intraocular lens (IOL) implantation has become the surgical method of choice in Iran, increasing from less than 7% in 2000 to 57% in 2005 (P<0.0001). Extracapsular cataract extraction showed a reverse trend compared to phacoemulsification, decreasing from greater than 91% in 2000 to 41% in 2005 (P<0.0001). Intracapsular cataract extraction and lensectomy were rarely performed without significant changes over time (P>0.05). Conclusion : Phacoemulsification with IOL implantation has become the preferred cataract surgery method in Iran during recent years. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/150/80704 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80705 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
The association between refractive errors and cataract: The Tehran eye study Hashemi, H KhabazKhoob, M Miraftab, M Mohammad, K Fotouhi, A Purpose : To determine the association between refractive errors and different types of cataract in Tehran, Iran. Materials and Methods : In a cross-sectional survey with a stratified cluster sampling approach, refractive errors were tested under cycloplegia. Myopia and hyperopia were defined as a spherical equivalent refractive error <-0.5 diopters (D) and more than +0.5 D, respectively. Cataract was graded according to the Lens Opacities Classification System III classification and the association between refractive errors and cataract was assessed. Of 1434 participants over the age of 40 years who participated in the study, data from 1313 right eyes were analyzed. Results : The mean age of the participants was 52.7 ± 10.0 years, and 58.3% (n = 767) were female. Overall, myopia was more prevalent among those with cataract (odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.38-2.89). Based on the type of cataract and refractive errors, the odds of myopia was significantly higher with nuclear cataracts (OR: 1.81, 95% CI: 1.14-2.87). The odds of myopia was higher for cases of nuclear cataract with some degrees of posterior subcapsular cataract (PSC) (OR: 3.33, 95% CI: 1.42-7.80). Of nine participants with cortical cataract, seven participants had hyperopia (OR: 3.77, 95% CI: 0.78-18.31). Conclusion : Individuals with nuclear and PSC showed a significantly higher prevalence of myopia while the prevalence of hyperopia was lower in those with cataract. High myopia was seen in higher grades of nuclear cataract. The high percentage of hyperopia was also significant in patients with cortical cataract. More studies are necessary to clarify the correlation between cortical cataract and hyperopia. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/154/80705 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80706 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Epidemiology of penetrating eye injury in Ibadan: A 10-year hospital-based review Oluyemi, F Purpose : To assess risk factors associated with the occurrence of penetrating ocular injuries among patients presenting to an eye hospital at Ibadan, Nigeria. Materials and Methods : All cases of penetrating ocular injury presenting over a 10 - year period, were identified by retrospective chart review. All current cases of penetrating ocular injury identified were included. All information was obtained retrospectively from the medical records. Results : The cohort consisted of 135 cases. The follow-up was for an average period of 24.6 weeks (range, 12-312 weeks). Injuries were most likely to occur at home, in a domestic setting (58%). The most common mechanism of injury was projectile missiles hitting the eye. The age range for injuries was 9 months to 70 years. Penetrating ocular injury was most frequent in the 20-29 years group (31.9%) followed by the 0-9 years age group (31.1%). Males were more frequently involved than females (ratio 4:1). The final acuity was better than 6/18 in 14.8% and less than 3/60 in 59.3% of cases. Conclusions : Penetrating ocular injury occurs, most frequently, in a domestic setting and mostly as a result of working with sharp objects. Preventive measures are recommended to reduce visual disabilities due to ocular injuries. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/159/80706 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80707 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmic research priorities and practices in Nigeria: An assessment of the views of Nigerian ophthalmologists Mahmoud, AO Ayanniyi, AA Lawal, A Omolase, CO Ologunsua, Y Samaila, E Purpose : To study the views of ophthalmologists on research priorities and outcomes in Nigeria. Materials and Methods : A structured questionnaire was distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. The participants' background information, relative research priorities, frequency of publications, research types, publication media, challenges faced in publishing and impact on health practice or policy were collected. Results : Eighty-nine (74.2%) of the 120 questionnaires were returned. Childhood blindness was given the highest priority for ophthalmic research by 42.9% of the respondents, and genetic studies had the least priority (19.8%). About two-thirds of the respondents had either never been involved or only involved occasionally in any type of ophthalmic research. Clinical trials (13.1%) and basic science studies (12%) were the least-performed types of research. About 51% of the respondents indicated that they had never published in journals nor did so "occasionally"; only 9% quarterly and 43% published less than once a year. They also indicated that their research very rarely resulted in change of clinical practice or health policy (20%). Conclusions : Research works conducted by respondents were largely simple low-budget ones that rarely had significant impacts and outcomes, including publication. There is a need to retrain and emphasize the importance of research during undergraduate and postgraduate medical education. Adequate resources and research infrastructure should be provided for ophthalmic research in Nigeria. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/164/80707 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80708 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Enucleation and evisceration in the Palestinian territories Keenan, TD Sargent, NJ Purpose : To examine the demographics and indications in patients undergoing eye removal at St. John Eye Hospital (SJEH) in Jerusalem, the largest single provider of ophthalmic care in the Palestinian Territories. Materials and Methods : In this retrospective study, medical records were reviewed for patients undergoing enucleation or evisceration at SJEH from November 2004 to March 2007. Calculation of percentage, mean and median was performed for the demographics, and indications for enucleation and evisceration. Results : Thirty-three eyes of 32 patients were removed during the period under study. Twelve enucleations and 21 eviscerations were performed. Mean age was 39 years, and 19 patients were male. Indications included severe trauma (8 eyes), painful blind eye with (5 eyes) or without (9 eyes) infection, and ophthalmic neoplasm (3 eyes). Conclusion : The incidence of surgical eye removal at SJEH from 2004 to 2007 was around one patient per month for a population over three million. This rate appears far lower than those reported in previous studies of similar Palestinian populations. Prompt access to medical care for Palestinians is required to mitigate ophthalmic morbidity. Approximately half of the cases were caused by severe trauma or infection, with rubber bullet injuries responsible for 20% of the traumatic cases. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/170/80708 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80709 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Transition to phacoemulsification at the farabi eye hospital, Iran Hashemi, H Mohammadi, S Mazouri, A Majdi-N, M Jabbarvand, M Z-Mehrjardi, H Purpose : To provide objective evidence on the transition of cataract surgical care at Farabi Eye Hospital, Iran. Materials and Methods : Two separate years, 2003 and 2006, were selected for evaluation. One thousand nine hundred fifty-seven surgical records of age-related cataract cases were randomly selected and reviewed. Three hundred fifty-three patients (405 eyes) in 2006 and 125 patients (153 eyes) in 2003 were selected randomly for a follow-up examination. The two phases were compared in terms of surgical routines, patient characteristics and outcomes for statistical differences. P <0.05 was considered statistically significant. Results : The phacoemulsification rate increased from 25% to greater than 90% between 2003 and 2006, rates of corneal incisions and use of foldable intraocular lenses tripled, administration of general anesthesia dropped from 80% to 12%, the outpatient admission rate rose from 5.2% to 71%, 4% vs. 66% of the operations were performed by a senior phacoemulsification surgeon and the number of advanced surgeons changed from 6% to 38% (all P-values < 0.001). In 2006, more patients at the two extremes of age, more patients with poor systemic conditions and myopes underwent surgery (all P-values < 0.05); the cataract surgery volume increased by 49% and post-operative visual acuity improved (P = 0.03) while patient satisfaction was unchanged. Conclusion : We objectively documented the transition in cataract surgery technique to phacoemulsification at the Farabi Eye Hospital in the mid-2000s. This was accompanied by significant expansion of the spectrum of cataract surgery candidates and remarkable attainment of surgical skill. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/173/80709 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80710 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Herpes zoster ophthalmicus: Disease spectrum in young adults Gupta, N Sachdev, R Sinha, R Titiyal, JS Tandon, R Purpose : To establish the clinical profile of herpes zoster ophthalmicus (HZO) in adults younger than 40 years and correlate the clinical manifestation with their immune status. Materials and Methods : A retrospective chart review was performed of patients younger than 40 years who presented with HZO. Data were collected on demographics, medical history, clinical presentation, results of serological investigations, and visual outcome. Results : The study cohort comprised 18 subjects with a mean age of 29.7 ΁ 6.2 years. Ophthalmic features included lid edema, ptosis, cicatricial lid deformities, sclerokeratitis, peripheral ulcerative keratitis, neuroparalytic keratitis, keratouveitis with concomitant glaucoma, secondary bacterial keratitis and superficial punctate keratitis with dry eye, optic neuritis, and trochlear nerve palsy. Eight of 18 (44.4%) subjects were found to be positive for Human Immunodeficiency Virus (HIV). Disseminated herpetic lesions were seen present in 5 (63%) of these 8 subjects. Postherpetic neuralgia was noted in 6 (75%) of 8 HIV-positive subjects and in 1 HIV-negative patient. Final visual acuity was 20/40 or better in 90% of the immunocompetent subjects and 20/200 or worse in 100% of the HIV-positive subjects. Conclusions : Immunocompetent young adults do present with features of HZO. However, the disease spectrum in HIV-negative patients is localized, less severe, and more amenable to therapy as compared with young adults with HIV. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/178/80710 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80711 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Primary transpupillary thermotherapy of choroidal melanocytic lesions Gündüz, K Karslioglu, MZ Köse, K Purpose : To evaluate the role of primary transpupillary thermotherapy (TTT) in the treatment of choroidal melanocytic lesions. Materials and Methods : Retrospective chart review of 24 patients (24 eyes) with choroidal melanocytic lesions, including 20 choroidal melanoma and four choroidal nevus treated with primary TTT. Choroidal nevus cases treated with primary TTT either demonstrated risk factors for growth into an early melanoma or had overlying choroidal neovascularization. Results : The mean initial tumor basal diameter was 6.6 (3.0-10.0) mm and the mean initial tumor thickness was 3.0 (1.0-5.0) mm. The mean number of TTT sessions was 2.5 (1-6). The mean decrease in tumor thickness was 1.2 mm (from 3.0 to 1.8 mm) at a mean follow-up of 22.7 (range 3-90) months. On the LogMar scale, visual acuity was stable at 1.0. Complications occurred in 50% of eyes. The most frequent complications were vitreous hemorrhage [5 patients (20.8%)], focal cataract [5 patients (20.8%)], iris atrophy [4 patients (16.6%)] and posterior synechia [4 patients (16.6%)]. There was no significant difference in the complication rate with respect to tumor thickness >3 mm versus tumor thickness ≤3 mm and juxtapapillary versus nonjuxtapapillary location (Fisher's exact test, P>0.05). Kaplan-Meier curves showed that 9% of eyes develop recurrence by 1 year and 27% develop recurrence by 5 years after primary TTT. Two eyes (8.3%) were enucleated because of neovascular glaucoma and one eye (4.1%) was exenterated because of extraocular tumor recurrence. Globe salvage was achieved in 21 patients (87.5%). One patient (4.1%) with extraocular tumor recurrence developed liver metastasis and expired. Conclusions : Although TTT may be useful in the treatment of small choroidal melanocytic lesions, the high complication and recurrence rates warrant close monitoring of patients after primary TTT even when a flat chorioretinal scar has been achieved. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/183/80711 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80712 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Supra-descemet's fluid drainage with simultaneous air injection: An alternative treatment for Descemet's membrane detachment Ghaffariyeh, A Honarpisheh, N Chamacham, T In this report, we present an alternative technique to manage Descemet's membrane detachment (DMD). We call the technique supra-Descemet's fluid drainage with intracameral air injection. Under topical anesthesia, we injected air through the stab incision to fill 2/3 of the anterior chamber. Then we inserted the tip of a curved 10/0 needle through the corneal surface (entry angle at 45 degrees) into the supra-Descemet's area 3 times to drain this fluid. In our method, we neither injected expanding gas or viscoelastic nor used a suture. Consequently, there was little chance for suture-induced astigmatism or increased intraocular pressure. This technique may be considered a relatively safe and simple surgical method for the management of postoperative DMD. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/189/80712 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80713 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Median facial cleft in amniotic band syndrome Das, D Das, G Gayen, S Konar, A Amniotic band syndrome manifests at birth with a variety of malformations ranging from constriction ring to defects incompatible to life, in various parts of the body. Although some theories have been proposed for the development of this syndrome, the exact cause remains unknown. The median facial cleft is an extremely rare manifestation of amniotic band syndrome with a relative paucity of reports available in the literature. Here, we report one such case. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/192/80713 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80714 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Computerized motion sensitivity screening tests Wiwanitkit, V Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/195/80714 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80715 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Authors' reply Babalola, OE Umeh, RE Mahmoud, AO Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/195/80715 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80716 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Early experience with intravitreal bevacizumab combined with laser treatment for retinopathy of prematurity Raizada, S Al, KJ Al, FA Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/196/80716 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80693 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Addressing residual challenges of Vision 2020: The right to sight Babalola, OE Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/91/80693 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80694 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
A retrieval system for patients with avoidable blindness due to diabetic retinopathy who do not present for ophthalmic assessment in Oman Khandekar, R Al, LJ Barakat, N Background : Many patients with diabetes do not present for eye examinations, foregoing the recommended management for diabetic eye care. Proactive steps are being taken in Oman to retrieve defaulters (patients who do not present or "no-show") with Sight Threatening Diabetic Retinopathy (STDR). We present the outcomes of the defaulter retrieval system in five regions of Oman in 2009. Materials and Methods : Ophthalmologists examine eyes periodically, family physicians focus on primary prevention of Diabetic Retinopathy (DR) and medical retina specialists manage DR in Oman. A person with proliferative stage of DR (PDR) and/or Diabetic Macular Edema (DME) in either eye is considered as STDR and is registered at regional hospitals. The eye care staff identify the defaulters and the hospital staff help them retrieve the defaulters. The reminder of reappointment is sent using the text messages on telephone. The glycemic control of STDR cases was also noted in Nizwa Hospital. Results : We registered 654 STDR cases, of which 494 (75%) were defaulters. Lack of awareness, transport, absence of a decision maker, and fear of laser treatment were the main causes for defaulting. We successfully retrieved 328 (66.4%) defaulters. The retrieval rates among male and female patients were 51.2% and 82%, respectively. The retrieval varied by region. In Nizwa hospital, 114 of 131 STDR cases (85%) had poor glycemic control. Conclusion : Defaulter retrieval system could help healthcare providers to identify and motivate patients with STDR towards better compliance. Primary prevention measures among STDR cases were poor and need further focus. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/93/80694 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:80695 2011-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Overcoming gender inequity in prevention of blindness and visual impairment in Africa Mganga, H Lewallen, S Courtright, P Background : Globally, and in Africa, after adjusting for age, women are about 1.4 times more likely to be blind than men. While women generally live longer than men, the lack of accessibility to and use of services is likely the most important reason for excess blindness in women in Africa. Aim : We sought to review the literature on vision loss in Africa and summarize the findings related to gender equity. Materials and Methods : Information from across sub-Saharan Africa was collected on the evidence of gender inequity and reasons for this inequity. Finally, the results were used to generate suggestions on how gender equity could be improved. Results : In all published surveys (except one), cataract surgical coverage among women was lower than cataract surgical coverage among men. Although data available are limited, similar findings appeared in the use of services for other disease conditions, notably, childhood cataract and glaucoma. Evidence suggests that a variety of approaches are needed to improve the use of eye care services. Three main strategies are needed to address gender inequity in vision loss in Africa. First, it is important to address transport needs. Second, counseling of patients and family members is required. Finally, programs need to put in place pricing systems that make the services affordable the population. Conclusions : VISION 2020 can be achieved in Africa, but investment is needed in a variety of strategies that will ensure that eye care services are affordable, accessible, and acceptable to women and girls. Medknow Publications 2011-04-01 http://www.meajo.org/text.asp?2011/18/2/98/80695 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84044 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Blindness in Iraq: Leading causes, target patients, and barriers to treatment Al-Shakarchi, FI Purpose : To define the main causes of blindness, demographic characteristics and barriers to care of blind patients attending a teaching eye hospital in Iraq. Material and Method : Successive new patients, 6 years of age and older, who attended three outpatients clinics at Ibn Al-Haetham Teaching Eye Hospital (IAHTEH), Baghdad, Iraq, from September 1 to November 30, 2007, were included in this study. Inclusion criterion was fulfillment of the World Health Organization's definition of blindness. The cause of blindness was identified and subjects were interviewed for collection of data on demographic characteristics and barriers to treatment. Results : Of 18612 consecutive patients who attended the outpatient clinics, 497 (2.7%) patients were blind. Cataract (76.1%), diabetic retinopathy (12.9%), and glaucoma (5%) were the leading causes of blindness. The majority of blind patients had low socioeconomic status and poor educational level. In cases of cataract, the most important barrier to treatment was the waiting list at the hospital (53.7%). A lack of awareness was the most important barrier to treatment for patients with diabetic retinopathy (54.7%) and glaucoma (56%). Conclusions : The preliminary data from our study will aid in the development of blindness prevention programs in Iraq. Priorities include decreasing waiting lists for cataract surgeries at governmental hospitals. Active health promotion programs for early detection and treatment of diabetic retinopathy and glaucoma are also warranted. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/199/84044 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84045 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Knowledge of primary prevention of diabetic retinopathy among general ophthalmologists, mid level eye care personnel and general physicians in Oman Khandekar, R Deshmukh, R Vora, U Al, HS Objective : We present the outcomes of knowledge of diabetes and associated ocular complications among personnel comprising the eye care team in Oman. Materials and Methods : A closed ended questionnaire was administered during November 2008 and November 2009 to eye care team members in six regions of Oman, where trainings were held. All participants of these trainings were included in our study. The questionnaire comprised 15 questions that tested the knowledge of the diagnosis and treatment of diabetes and its ocular complications. They circled the most suitable reply for a list of choices. The replies were compared with the gold standard (answers from a medical retina specialist, a diabetologist's and general ophthalmologists answers). The participants were divided into two groups; acceptable (more than 50% score compared to gold standard) and less than desired (less than 50% score compared to gold standard.) We estimated the areas of acceptable level of knowledge in different subgroups. Results : All 87 (100%) of eye care team members participated. Of the 42 general ophthalmologists, 30 (71.4%) had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complication of diabetes. The acceptable level of knowledge among mid level eye care providers and general physicians was found in 15 (54.5%) and 4 (33.3%) respondents respectively. Conclusion : Less than the desired number of participants of the eye care team had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complications of diabetes. The training of eye care personnel need to enhance knowledge in the weak areas is identified in this study. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/204/84045 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84047 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Adopting western retinopathy of prematurity screening programs in eastern countries, are we screening properly? Gharaibeh, A Khassawneh, M Khriesat, W Alkhatib, S Migdadi, Y Purpose : To describe retinopathy of prematurity (ROP) among Jordanian preterm infants and evaluate the efficacy of applying current Western screening guidelines for Jordanian preterms. Materials and Methods : In this retrospective, descriptive hospital-based study, we collected data on preterm infants who were referred by their neonatologist for ROP screening at King Abdullah University Hospital between July 2006 and June 2007. Guidelines suggested by the American Academy of Pediatrics were followed. Additionally, older preterms considered at risk for ROP by the neonatal intensive care unit were screened. Any neonate with stage 1 ROP or higher in either eye was considered a positive case of ROP. Results : Ninety-one preterms were included in the study. The median birth weight was 1390 gm (range,730-1980 gms) and the gestational age ranged from 26 to 35 weeks with 64.8% of preterms ≤ 32 weeks. ROP occurred in 28.6% of all patients, in 20% of infants with birth weight greater than 1500 gms and in 9.4% of preterms with gestational age ≥ 32 weeks. Six patients (6.6%) required laser treatment, two with low birth weight greater than 1250 gm and one was 33 weeks of age. Consanguinity was identified in 19.2% of infants with ROP while consanguinity in infants who did not develop ROP was 1.9%. This difference was statistically significant (P<0.05). Conclusion : ROP occurs in premature infants in Jordan with gestational age above 32 weeks and birth weight above 1250 gm. Future guidelines for screening should incorporate the current study outcomes. A prospective, population-based is required to set national guidelines for ROP screening in the Jordanian population and similarly for different populations worldwide. Consanguinity may play a role in ROP development and further genetic studies may aid in elucidating the pathogenesis of ROP. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/209/84047 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84048 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion Chalam, KV Lin, S Murthy, RK Brar, VS Gupta, SK Radhakrishnan, R Purpose : The purpose was to determine if birth weight (BW) alone can be the sole criterion for screening infants at risk for retinopathy of prematurity (ROP). Materials and Methods : In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Guidelines (1997). Variables examined included gestational age (GA), birth weight (BW), and a composite variable BWGA Index [(grams Χ weeks)/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW ≤1250 g, and Group 2, BW >1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic (ROC) curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. Results : Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve (AUC) of 0.797 (standard error [SE] = 0.0329, P < 0.0001); for GA, AUC was 0.801 (SE = 0.0340, P < 0.0001) and for the BWGA Index, the AUC was 0.808 (SE = 0.0324, P < 0.0001). Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. Conclusion : Data from our neonatal intensive care unit suggest that birth weight ≤ 1250 g alone is an adequate parameter to identify premature infants at risk for ROP. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/214/84048 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84051 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Intravitreal bevacizumab as a primary treatment for idiopathic choroidal neovascularization Cheema, RA Mushtaq, J Cheema, MA Purpose : To report long-term outcomes of the use of intravitreal bevacizumab in subjects with idiopathic choroidal neovascularization (ICNV). Materials and Methods : Six consecutive subjects with ICNV were included in this prospective study. All subjects received 1.25 mg intravitreal bevacizumab at diagnosis. A decrease in best corrected visual acuity (BCVA), presence of increased retinal edema or hemorrhage, increased retinal thickness on optical coherence tomography (OCT) or increased leakage documented by fluorescein angiography prompted further injections of bevacizumab. Results : The study cohort was comprised of 3 males and 3 females with a mean age of 31.17 years. Mean follow-up was 13.8 months (range, 8 months to 20 months). Following intravitreal bevacizumab injection, vision improved in 3 subjects, remained stable in 3 subjects and no patient lost visual acuity. The mean BCVA improved to logMAR 0.20 at final follow-up from baseline at 0.950 logMAR (P=0.031). The mean central macular thickness and central foveal thickness at the last postoperative visits were reduced from pre-treatment levels of 374.33 ± 146.52 and 347.16 ± 213.97 to 251.20±35.36 and 215.33 ± 43.94 μm, respectively. (P = 0.99 and P = 0.16, respectively). Four subjects required repeat treatments. The total number of repeat treatments was 4. Two subjects required no repeat injections, 3 subjects had 1 retreatment and one subject required 2 additional treatments. The injections were well tolerated by all the subjects, with no ocular or systemic adverse events. Conclusion : Intravitreal injection of 1.25 mg bevacizumab in patients with ICNV is effective in improving and stabilizing vision. Additional studies, particularly determination of optimal protocol for timing of re-injection are required to assess long-term effects. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/220/84051 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84052 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Retinal detachment after laser In Situ keratomileusis Al-Rashaed, S Al-Halafi, AM Purpose : To report characteristics and outcome of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for myopia. Materials and Methods : A retrospective chart review of patients who presented with RRD after myopic LASIK over a 10-year period. Results : Fourteen eyes were identified with RRD. Of these, two of 6112 LASIK procedures were from our center. The mean age of patients with RRD was 35.43 years. The mean interval of RRD after LASIK was 37.71 months (range, 4 months to 10 years). The macula was involved in eight eyes and spared in six eyes. Retinal breaks included a macular hole in two eyes, and giant tear in two eyes. Multiple breaks (>2 breaks) occurred in 6 cases. Pars plana vitrectomy (PPV) was performed in 3 (21.4%) eyes, a scleral buckle (SB) was performed in 4 (28.5%) eyes and 7 (50%) eyes underwent combined PPV and SB. Mean follow-up was 15.18 months (range, 1 month to 7 years). The retina was successfully attached in all cases. The final visual acuity was 20/40 or better in 7 (50%) eyes, 20/40 to 20/60 in 4 (28.5%) eyes, and 20/200 or less in 3 (21.4%) eyes. Poor visual outcome was secondary to proliferative vitreoretinopathy, epiretinal membrane, macular scar and amblyopia. Conclusion : The prevalence of RRD after LASIK was low at our institute. Anatomical and visual outcomes were acceptable in eyes that were managed promptly. Although there is no cause-effect relationship between LASIK and RRD, a dilated fundus examination is highly recommended before and after LASIK for myopia. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/224/84052 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84053 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Antibiotic susceptibility patterns of pseudomonas corneal ulcers in contact lens wearers Mohammadpour, M Mohajernezhadfard, Z Khodabande, A Vahedi, P Purpose : To evaluate the resistance or susceptibility of Pseudomonas aeruginosa, the most common pathogen in contact lens keratitis and corneal ulcer, to different antibiotic regimens. Materials and Methods : This cross-sectional study included all patients with recently diagnosed contact lens corneal ulcer whose culture results were positive for P. aeruginosa, from March 2009 to March 2010. The empirical antibiotic therapy was changed to appropriate antibiotics according to the culture results, provided that satisfactory clinical improvement was not achieved with the initial antibiotic regimen. The overall sensitivity or resistance of P. aeruginosa to the most commonly used antibiotics was assessed based on the results of the antibiograms. Results : Fifty-two patients (43 females and 9 males) were included. Forty-five patients (86%) were wearing cosmetic contact lenses, while 7 patients (14%) were using therapeutic contact lenses. Thirty-nine patients (75%) were hospitalized and13 patients (25%) were followed up through an outpatient clinic. Thirty patients (58%) had central ulcers, whereas 22 patients (42%) had peripheral ulcers. Twelve patients (23%) had hypopyon in their first exam. The mean time to diagnose the ulcer after the last time wearing was 2 days (range: 12 hours to 5 days). AMT was required for 10 patients (19%). Based on the antibiograms, PA was shown to be sensitive in 100% of cases to ceftazidime and ciprofloxacin. Amikacin, imipenem, and gentamicin were the second most effective antibiotics. Conclusion : P. aeruginosa was highly sensitive to ceftazidime, ciprofloxacin, and amikacin. All cases were resistant to cefazolin. Resistance to multiple antibiotics might be a significant concern in patients with corneal ulcers. In referral centers dealing with corneal ulcers, the initial antibiotic regimens should be changed from time to time to prevent this phenomenon. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/228/84053 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84054 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Outcomes of retreatment after aborted laser In Situ keratomileusis due to flap complications Al-Mezaine, HS Al-Amro, SA Al-Fadda, A Al-Obeidan, S Purpose : To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis (LASIK) due to flap complications. Materials and Methods : This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment. Results : Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes (66.7%), buttonhole flaps in 7 eyes (21.2%), free partial flaps in 3 eyes (9.1%), and a free complete flap in 1 eye (3.0%). Twenty-two eyes (66.7%) were retreated with LASIK, and 11 eyes (33.3%) were retreated with surface ablation. The mean spherical equivalent (SE) was −0.23 ± 0.72 D, the mean astigmatism was −0.65 ± 0.89 D, and the mean loss of the best corrected visual acuity (BCVA) was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation (P = 0.610). There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation (P = 0.756). There were no intraoperative complications and no eyes required a second retreatment. Conclusion : Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/232/84054 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84055 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Visual outcomes of conductive keratoplasty to treat hyperopia and astigmatism after laser in situ keratomileusis and photorefractive keratectomy Habibollahi, A Hashemi, H Mehravaran, S Khabazkhoob, M Aim : To determine the effect of conductive keratoplasty (CK) for the treatment of induced hyperopia and astigmatism after complicated myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Materials and Methods : In this interventional case series, 11 eyes of seven subjects with a history of previous LASIK or PRK with inadequate stromal bed or flaps complications were enrolled. Inclusion criteria included residual spherical hyperopia of 1.00 to 3.00 diopters (D) and cylinder of -0.75 to -3.00 D. The modified Refractec nomogram and the LightTouch technique of CK were performed on all eyes. To treat cylinder, a pair of spots per -0.75 D of cylinder were delivered to the flat meridian. Uncorrected visual acuity at near and far (UCVAN and UCVAF respectively, logMAR), best corrected VA at near and far (BCVAN and BCVAF respectively, logMAR) were measured. Refractive outcome, contrast sensitivity, wave front aberrations were measured preoperatively and postoperatively. Statistical analysis was performed with the Wilcoxon signed rank test and the repeated measures analysis of variance with P<0.05 indicating statistically significant change from preoperatively to 1 year postoperatively. Results : The mean preoperative sphere (MS) was 2.57 ± 1.19 D and cylinder (MC) was -1.5 ± 0.49 D. Postoperatively, there was a significant decrease in MS to 0.36±0.98 D (P=0.003) and MC to -1.25 ± 0.76 D at 1 year (P<0.05, both cases). Spherical equivalent (SE) significantly decreased from +2.13 ± 1.09 D to -0.47 ± 1.29 D (P<0.001). The mean UCVAN significantly improved from 0.56 ± 0.32 preoperatively to 0.17 ±0.16 postoperatively (P=0.003). The mean UCVAF was 0.29 preoperatively and 0.22 postoperatively (P=0.353). Mean BCVAN was 0.18 and 0.02 after surgery, and mean BCVAF for far was 0.07 (P>0.05, both cases). Conclusions : CK is a predictable and reliable method to correct hyperopia after LASIK and PRK, however cylinder correction may induce irregular and unpredictable outcomes and a modified nomogram is required for further studies. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/238/84055 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84056 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Response of diabetic papillopathy to intravitreal bevacizumab Al-Dhibi, H Khan, AO Diabetic papillopathy is an uncommon hyperemic optic disc swelling that occurs in patients with long-standing diabetes, is typically self-resolving with minimal effect on vision, and is likely ischemic in origin. The purpose of the current report is to document the response of diabetic papillopathy to intravitreal injection of bevacizumab (Avastin, Genentech Inc, San Francisco, California, USA), a humanized monoclonal antibody to vascular endothelial growth factor. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/243/84056 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84058 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Temporary exudative retinal detachment following photodynamic therapy in a patient with retinal capillary hemangioblastoma Selver, OB Yaman, A Saatci, AO A 21-year-old male with von Hippel-Lindau syndrome was treated for a retinal hemangioblastoma with photodynamic therapy (PDT). We employed the standard PDT protocol with doubled treatment duration. Seven days after the procedure, there were some perilesional intra- and subretinal hemorrhages and significant exudative retinal detachment extending inferiorly. Four weeks later, the hemorrhages had mostly cleared, and diminished subretinal fluid and partial regression of the hemangioblastoma were noted. PDT might induce temporary subretinal fluid accumulation in eyes with retinal hemangiomas. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/246/84058 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84060 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Acute papillitis in young female with toxoplasmosis Alipanahi, R Sayyahmelli, S Papillitis and complicating acute toxoplasma retinochoroiditis, are unusual and atypical features of toxoplasmosis. This report presents a female with unusual acute papillitis. This patient had an active toxoplasmic chorioretinitis lesion that appeared to involve the optic nerve head and a major blood vessel as well as central nervous systems (CNS). Papillitis may be secondary to juxtapapillary retinitis (Jensen choroiditis). Very rarely, the optic nerve head may be the primary site of involvement. This case report illustrates a rare presentation of acute papillitis in a young immunocompetent female. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/249/84060 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84062 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Radial keratoneuritis as a presenting sign in Acanthamoeba keratitis Alfawaz, A The visual outcomes of Acanthamoeba keratitis, a rare cause of corneal infection, can be devastating. This paper reports two contact lens wearers with severe pain and photophobia who presented to the emergency room. Biomicroscopy revealed radial keratoneuritis in both individuals. Tissue culture on a nonnutrient agar plate with Escherichia coli overlay resulted in a heavy growth of Acanthamoeba. The inpatient treatment included 0.02% polyhexamethylene biguanide, chlorhexidine, neomycin/polymyxin B/bacitracin (Neosporin), and oral fluconazole, which successfully controlled the corneal infection and improvement in the best corrected visual acuity in both patients. Infection did not recur during the 12-month follow-up period. Acanthamoeba keratitis can present as radial keratoneuritis, mimicking other common corneal infections resulting in diagnostic and treatment delays. Early diagnosis and prudent treatment of Acanthamoeba keratitis are the keys to restoring vision and avoiding the subsequent need for penetrating keratoplasty. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/252/84062 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:84066 2011-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Superior and inferior ophthalmic veins thrombosis with cavernous sinus meningioma Vyas, S Das, PJ Gupta, SK Kakkar, N Khandelwal, N Ophthalmic vein thrombosis is an extremely rare entity. We present a case of middle-aged female who presented with proptosis. Contrast-enhanced computed tomography and magnetic resonance imaging showed cavernous sinus meningioma with ipsilateral superior and inferior vein thrombosis. A brief review of the vascular involvement of the meningioma and ophthalmic vein thrombosis is presented along with the case. Medknow Publications 2011-07-01 http://www.meajo.org/text.asp?2011/18/3/256/84066 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90125 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
As is our Pathology, So is our Practice Biswas, J Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/259/90125 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90126 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Biopsy pathology in uveitis Biswas, J Annamalai, R Krishnaraj, V Uveitis is fraught with speculations and suppositions with regard to its etiology, progress and prognosis. In several clinical scenarios what may be perceived as due to a systemic infection may actually not be so and the underlying etiology may be an autoimmune process. Investigations in uveitis are sometimes the key in identification and management. Invasive techniques could be of immense value in narrowing down the etiology and help in identifying the cause. This article updates one on the invasive techniques used in biopsy such as anterior chamber paracentesis, vitreous tap and diagnostic vitrectomy, iris and ciliary body biopsy, choroidal and retinochoroidal biopsy and fine needle aspiration biopsy (FNAB). In populations where certain infections are endemic, the clinical scenario does not always respect a known presentation and the use of biopsy is resorted to as a sure way of confirming the etiology. Biopsies have a role in diagnosis of several inflammatory and infectious conditions in the eye and are pivotal in diagnosis in several dilemmas such as intraocular tumors and in inflammations. Appropriate and timely use of biopsy in uveitis could enhance the diagnosis and provide insight into the etiology, thus enabling precise management. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/261/90126 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90127 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Update in pathological diagnosis of orbital infections and inflammations Yuen, HK Biswas, J Yanoff, M Orbital infections and inflammations include a broad spectrum of orbital diseases that can be idiopathic, infectious, from primary or secondary inflammatory processes. Being able to properly diagnose and manage these orbital diseases in a timely manner can avoid permanent vision loss and possibly save a patient's life. When clinicians are faced with such patients, quite often the exact diagnosis cannot be made just based on clinical examination, various laboratory tests and imaging are needed. Moreover, orbital biopsies with histopathological analyses are often required, especially for the atypical cases. Thus, it is important for the clinicians to be familiar with the pathological features and characteristics of these orbital diseases. This review provides a comprehensive update on the clinical and pathological diagnosis of these orbital infections and inflammations. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/268/90127 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90128 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Update on pathologic diagnosis of corneal infections and inflammations Vemuganti, GK Murthy, SI Das, S One of the most frequent types of corneal specimen that we received in our pathology laboratory is an excised corneal tissue following keratoplasty. Several of these cases are due to corneal infections or the sequelae, like corneal scar. Advances in the histological and molecular diagnosis of corneal infections and inflammations have resulted in rapid and accurate diagnosis of the infectious agent and in the overall understanding of the mechanisms in inflammatory diseases of the cornea. This review provides an update of histopathological findings in various corneal infections and inflammations. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/277/90128 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90129 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Femtosecond laser-assisted cataract surgery: A current review Moshirfar, M Churgin, DS Hsu, M To evaluate the safety, efficacy, advantages, and limitations of femtosecond laser-assisted cataract surgery through a review of the literature. A PubMed search was conducted using topic-appropriate keywords to screen and select articles. Initial research has shown appropriate safety and efficacy of femtosecond laser-assisted cataract surgery, with improvements in anterior capsulotomy, phacofragmentation, and corneal incision. Limitations of these studies include small sample size and short-term follow-up. Cost-benefit analysis has not yet been addressed. Preliminary data for femtosecond laser-assisted cataract surgery shows appropriate safety and efficacy, and possible advantage over conventional cataract surgery. Questions to eventually be answered include comparisons of long-term postoperative complication rates-including infection and visual outcomes-and analysis of contraindications and financial feasibility. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/285/90129 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90130 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Combined viscocanalostomy-trabeculectomy for management of advanced Glaucoma- A comparative study of the contralateral eye: A pilot study Eid, TM Tantawy, WA Purpose : To compare combined viscocanalostomy-trabeculectomy (VISCO-TRAB) to trabeculectomy (TRAB) for the management of advanced glaucoma. Materials and Methods : The study cohort comprised of 18 subjects with bilateral advanced glaucoma who underwent VISCO-TRAB surgery (VISCO-TRAB group) in the right eye and TRAB (TRAB group) in the left eye. VISCO-TRAB constituted lamellar scleral flap, deep scleral flap dissection with deroofing of Schlemm's canal (SC), viscodilation of SC, penetrating trabeculectomy, peripheral iridectomy, and tight flap closure. All eyes received subconjunctival mitomycin. Success criteria included intraocular pressure (IOP) < 14 mmHg or > 30% lowering of IOP with no devastating complications. A P value less than 0.05 was considered statistically significant. Results : Mean IOP was significantly lower after VISCO-TRAB compared to TRAB at 1 week and 3 months postoperatively (P<0.05). No eyes lost more than two lines of Snellen acuity. There were more hypotony-related complications after TRAB than VISCO-TRAB surgery. Target IOP was achieved in 83.3% in the VISCO-TRAB group compared to 55.6% in the TRAB group. Conclusion : Combined VISCO-TRAB is effective in reducing IOP to the target level for advanced glaucoma with lower postoperative complications. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/292/90130 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90131 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Oral propranolol for the treatment of periorbital infantile hemangioma: A preliminary report from Oman Harikrishna, B Ganesh, A Al-Zuahibi, S Al-Jabri, S Al-Waily, A Al-Riyami, A Al-Azri, F Masoud, F Al-Mujaini, A Purpose : To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects. Materials and Methods : Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated. Results : Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy. Conclusions : Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/298/90131 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90132 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Serendipity, the humble case report and modern health science challenges Meyer, D Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/303/90132 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90133 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Oestrus ovis as a cause of red eye in Aljabal Algharbi, Libya Abdellatif, MZ Elmazar, HM Essa, AB Purpose : To study the common presenting signs of external ophthalmomyiasis caused by Oestrus ovis larvae in Aljabal Algharbi province, Libya. Materials and Methods : A prospective non- comparative study was conducted from September 2009 to July 2010 at the Gharian outpatient clinic, Gharian, Aljabal Algharbi, Libya. The common presenting features of patients with external ophthalmomyiasis and data on the organism that caused the disease were collected. Results : Twenty one cases diagnosed with external ophthalmomyiasis were recorded. There were fourteen males (66.67%) and seven females (33.33%) in the cohort. The mean age was 14.29 ± 3.46 years (range, 8 years to 22 years: males; 13.39 ± 3.03 years and females; 16.67 ± 3.75 years). The main complaint was redness (100.00%), itching (71.43%) and tearing (57.14%). Twelve patients (57.14%) were from rural areas and 9 patients (42.9%) were from urban areas. The causative organism was found to be first instar of Oestrus ovis larvae. Conclusion : External ophthalmomyiasis caused by Oestrus ovis can cause red eye in patients from Aljabal Algharbi, Libya and requires careful examination to ensure early diagnosis and proper treatment. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/305/90133 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90134 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Photodynamic therapy of symptomatic choroidal nevi Amselem, L Gündüz, K Adan, A Karslıoğlu, MZ Rey, A Sabater, N Valldeperas, X Purpose : To evaluate the role of photodynamic therapy (PDT) for patients with symptomatic choroidal nevi involving the fovea or located near the fovea with subretinal fluid extending to the fovea. Materials and Methods : Retrospective review of five patients who underwent PDT for choroidal nevi at two separate centers in Ankara and Barcelona. Results : The mean initial logMAR visual acuity was 0.5 (range: 0 to 1.5). The mean largest tumor base diameter was 3.2 mm (range: 2.1-4.5 mm) and the mean tumor thickness was 1.1 mm (range: 0.7-1.6 mm). The mean number of PDT sessions was 1.6 (range:1-3). The mean final tumor thickness was 1.0 mm (range: 0-1.6 mm) at a mean follow-up of 19 months (range: 12-32 months). The mean final logMAR visual acuity was 0.4 (range: 0-1.5). Subfoveal fluid disappeared or decreased significantly in 4 of 5 eyes (80%) after PDT. Conclusions : PDT led to resolution of subretinal fluid with preservation of visual acuity in many symptomatic choroidal nevi in this study. Careful case selection is important as PDT of indeterminate pigmented tumors may delay the diagnosis and treatment of an early choroidal melanoma and thereby increase the risk for metastasis. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/309/90134 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90135 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Primary orbital liposarcoma: Histopathologic report of two cases Al-Qahtani, AA Al-Hussain, H Chaudhry, I El-Khamary, S Alkatan, HM Liposarcoma is a malignant tumor of adipose tissue. Considered the most common soft tissue sarcoma in adults, orbital liposarcoma is extremely rare. Most cases of orbital liposarcoma are primary and rarely metastatic. We report two cases of primary orbital liposarcoma with clinical presentation, radiologic studies (available for one case), and detailed histopathologic features. A brief review of primary orbital liposarcoma is also presented. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/314/90135 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90136 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Histopathologic findings in two cases with history of intrastromal corneal ring segments insertion Al-Amry, M Alkatan, HM Intrastromal corneal ring segments (INTACS) implantation for mild myopia or keratoconus is simple and effective in most cases. Rarely, major complications can occur due to implantation. In this case report, we present two examples of possible intraoperative and postoperative complications of INTACS. The first case had histopathologic documentation of Descemet's membrane perforation as an intraoperative complication and the second case had accumulation of foamy histiocytes along the lamellar channels which has not been previously reported. These complications suggest further study is required on the long term effect of INTACS implantation on corneal tissue. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/317/90136 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90137 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Susac's syndrome in a 27-Year-Old female Adelpoor, M Farahvash, MS Fard, MA Nikdel, M Kiarudi, MY A 27-year-old woman was referred by the neurologist for ophthalmic examination. She had a history of headache, visual loss in her right eye, four-limb paresthesia, and behavioral changes over the previous 10 months. The patient complained of tinnitus and hearing loss for two weeks. The patient was initially diagnosed with multiple sclerosis, but auditory and retinal involvement (small branch retinal artery occlusion in fluorescein angiography) raised the possibility of Susac's syndrome. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/320/90137 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90138 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Orbital Rosai-Dorfman Disease in a Five-Year-Old boy Al-Moosa, AJ Behbehani, RS Hussain, AE Ali, AE Rosai-Dorfman disease (RDD) is characterized by histiocytic proliferation and massive cervical lymphadenopathy, although some patients have extra-nodal involvement. We report a case of extranodal RDD in a five-year-old child, initially misdiagnosed as orbital inflammatory disease and treated with oral steroids. A subsequent orbital biopsy three years later confirmed the diagnosis of Rosai Dorfman disease. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/323/90138 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90139 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Lacrimal gland fistula after upper eyelid blepharoplasty Kashkouli, MB Heirati, A Pakdel, F To report the first case of lacrimal gland fistula after upper eyelid blepharoplasty for blepharochalasis. Standard upper blepharoplasty and the hooding excision were performed in a female with blepharochalasis. The patient developed a fistulous tract with tearing from the incision few days after hooding excision. Fistula excision and lacrimal gland repositioning were performed. There were no complications after the repositioning procedure (6 months follow up). Prolapsed lacrimal gland and fistula formation can occur after upper blepharoplasty hooding excision. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/326/90139 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90140 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Lacrimal glands: Size does matter! Mohan, S Hegde, A A 40-year-old woman presented with vague headaches and blurred vision. Contrast-enhanced magnetic resonance imaging of the brain revealed bilaterally symmetrical diffuse enlargement of the lacrimal glands. A fine needle biopsy of the lacrimal gland was consistent with sarcoidosis. Although, isolated lacrimal gland involvement is rare, it may be the initial clinical presentation of sarcoidosis, as seen in this patient. Imaging plays a vital role in these unsuspected cases and careful evaluation of the lacrimal glands with dedicated thin section, fat suppressed, axial and coronal orbital imaging, may help identify a pathological cause and avoid a delay in diagnosis. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/328/90140 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90141 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Surgical treatment and histopathology of a symptomatic free-floating primary pigment epithelial iris cyst in the anterior vitreous Al-Kahtani, E Alkatan, HM We report the surgical removal of an iris pigment epithelial cyst that was floating freely in the posterior chamber of an 18-month-old child. The reason for surgical removal was disturbance in near vision secondary to the movement of the cyst across the visual axis. Visual disturbance secondary to a unilateral anterior vitreous iris cyst at this age is a rare presentation and, to the best of our knowledge, has not been reported previously as an indication for surgery. We performed histopathological study of the cyst aspirate to determine its contents and its possible origin. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/331/90141 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90142 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Different patterns of orbital roof involvement by cholesterol granuloma Alsuhaibani, AH Al-Rubaie, K Al-Khiary, H Nerad, JA Two patients presented with cholesterol granuloma (CG), with completely different patterns of orbital roof involvement. One patient had a large intraorbital cystic CG, whereas the other had a very large intraosseous CG of the frontal bone. The presentation of CG with variable orbital roof involvement highlights the importance of being aware of the clinical characteristics and the imaging features of CG. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/333/90142 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:90143 2011-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Visual disturbance as the first symptom of chronic myeloid leukemia Huang, PK Sanjay, S Chronic myeloid leukemia (CML) is a well-studied entity and advances made in diagnosis and treatment have improved the disease outcome. Patients with ophthalmic manifestation of CML have been reported to have lower 5-year survival rates. Hence, recognizing the early fundus changes may improve outcome by allowing earlier diagnosis and treatment. We report a case of a previously healthy 30-year-old Myanmarese male, who presented with a minor visual disturbance, complaining of seeing a 'black dot' in his left visual field for the past 1 week. Fundoscopic examination revealed bilateral retinal blot hemorrhages, white-centered hemorrhage, and preretinal hemorrhage over the left fovea. The full blood count and peripheral blood film were abnormal, and bone marrow biopsy confirmed the diagnosis of CML. Cytoreduction therapy was promptly commenced and his symptoms resolved, with improvement in visual acuity. No complications were recorded at 1-year follow-up. Medknow Publications 2011-10-01 http://www.meajo.org/text.asp?2011/18/4/336/90143 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92108 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
From the Editor's Desk Edward, DP Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/1/92108 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92124 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Incidence of retinopathy of prematurity and risk factors in the South-Western Region of Iran Feghhi, M Haghi, F Kasiri, A Farahi, F Dehdashtyan, M Movasaghi, M Rahim, F Aims: The aim of this study was to report the incidence of retinopathy of prematurity (ROP) and the contribution of various risk factors to ROP in the south-western region of Iran. Material and Methods: This cross-sectional case-control series reviewed all low birth weight (LBW, ≤2000 g) neonates and/or neonates less than 32 weeks gestational age who had been hospitalized in the Neonatal Intensive Care Unit from 2006 to 2010. The cohort was divided into infants without ROP (nonROP group) and infants with ROP (ROP group). Infants were first examined by a group of pediatric ophthalmologists 6 weeks after delivery, and then were followed every 1-2 weeks until death, discharge or complete retinal avascularization. If an infant developed ROP, further examinations were performed based on the Early Treatment for Retinopathy of Prematurity Study protocol. Demographic data, medical treatment, and ophthalmic disorders were all statistically analyzed. Results: A total of 576 infants met the criteria for evaluation. Of 576 total patients, 183 infants (32%) (88 males, 95 females) had ROP. There were significant differences between groups in gestational age, body weight, and duration of oxygen administration, and sepsis (P<0.05). Male/female ratio, single and multiple births, and jaundice, phototherapy, and blood transfusion were not significant. The majority of ROP was stage I or II (137, 74.8%). Stage III or greater developed in 46 infants (25.1%) [Note: The ocular history and ocular outcomes are not risk factors.] Conclusions: The incidence of ROP in this study is higher than that in other parts of the world. Awareness and knowledge of ROP and its relative risks need to be reinforced in ophthalmologists and other health practitioners. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/101/92124 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92125 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Outcome of endophthalmitis treatment in a tertiary referral center in Southern Iran Rahimi, M Ghassemifar, V Nowroozzadeh, MH Purpose: The purpose of this study was to investigate the causative organisms, the clinical characteristics, visual outcomes, and the incidence of acute endophthalmitis after cataract surgery. Materials and Methods: In this retrospective study, a chart review was performed for patients treated in a tertiary referral center for acute endophthalmitis after cataract surgery from January 2005 to December 2009. During the study period, 62 additional patients with acute postoperative endophthalmitis were referred to and treated in this center. Therefore the cohort comprised 70 patients (8 of whom underwent cataract surgery at our center, and 62 who were referred). Demographic, clinical, and laboratory data were analyzed. The primary outcome measure was final visual acuity. P<0.05 indicated statistical significance Results: During the study period, 7737 cataract surgeries were performed in this center. Eight (0.10%) of 7737 eyes developed acute postoperative endophthalmitis. Subgroup analysis indicated that extracapsular cataract extraction was associated with a fourfold higher risk of endophthalmitis compared with phacoemulsification. We found better initial visual acuity (VA) (≥ hand motion) (P<0.001) and negative cultures (P=0.021) were independently associated with a more favorable visual outcome. Patients with relative afferent papillary defect (RAPD) were associated with lower initial VA (P<0.001) and worse visual outcome (P=0.001). Positive microbial cultures were found for 33 (42.9%) cases. Staphylococcus aureus was the most common organism isolated. Positive cultures were more frequently found in patients with RAPD. The "gram-positive coagulase-negative" and "no growth" groups had the best visual outcome. Associated keratitis and avoiding intraocular steroids were associated with the risk of evisceration. Conclusion: The visual outcome after endophthalmitis was generally poor and only one eighth of the eyes achieved a final corrected visual acuity of ≥20/200. Therefore, better treatment strategies are warranted. Immediate treatment is essential and the role of primary vitrectomy requires further investigation. In addition, RAPD, as an objective test, may complement VA for predicting the prognosis and planning the course of treatment. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/107/92125 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92126 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Long-term results of phacoemulsification combined with primary posterior curvilinear capsulorhexis in adults Yazici, AT Bozkurt, E Kara, N Yildirim, Y Demirok, A Yilmaz, OF Objective: To evaluate the 2-year outcomes of phacoemulsification combined with primary posterior curvilinear capsulorhexis (PPCC) in adults. Materials and Methods: In this retrospective case series, 93 eyes of 91 patients with bilateral age-related cataract who underwent phacoemulsification combined with PPCC were evaluated. The study included cases due to postoperative residual posterior capsule opacification despite careful polishing. Data were evaluated on preoperative and postoperative best corrected visual acuity (CDVA) (Snellen acuity), slit-lamp biomicroscopy and intraocular pressure (IOP) measurement. Perioperative and postoperative complications were also recorded. Results: The mean follow-up was 24.9 ±13.5 months (range, 12-53 months). At the last visit, 87.1% of the eyes had CDVA ≥ 20/40 and 58% had ≥ 20/25. Posterior capsular opacification (PCO) occurred in 2 (2.2%) of patients. No serious complications such as retinal detachment and endophthalmitis were observed during follow-up. Conclusions: Cataract surgery combined with PPCC is a safe procedure with a low rate of complications over the long term. This procedure reduced the necessity of Nd:YAG laser capsulotomy in adults with postoperative residual posterior capsule opacification despite careful polishing. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/115/92126 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92127 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Pixeye virtual reality training has the potential of enhancing proficiency of laser trabeculoplasty performed by medical students: A pilot study Alwadani, F Morsi, MS Objective: To compare the surgical proficiency of medical students who underwent traditional training or virtual reality training for argon laser trabeculoplasty with the PixEye simulator. Materials and Methods: The cohort comprised of 47 fifth year male medical students from the College of Medicine, King Faisal University, Saudi Arabia. The cohort was divided into two groups: students (n = 24), who received virtual reality training (VR Group) and students (n = 23), who underwent traditional training (Control Group). After training, the students performed the trabeculoplasty procedure. All trainings were included concurrent power point presentations describing the details of the procedure. Evaluation of surgical performance was based on the following variables: missing the exact location with the laser, overtreatment, undertreatment and inadvertent laser shots to iris and cornea. Results: The target was missed by 8% of the VR Group compared to 55% in the Control Group. Overtreatment and undertreatment was observed in 7% of the VR Group compared to 46% of the Control Group. Inadvertent laser application to the cornea or iris was performed by 4.5% of the VR Group compared to 34% of the Control Group. Conclusion: Virtual reality training on PixEye simulator may enhance the proficiency of medical students and limit possible surgical errors during laser trabeculoplasty. The authors have no financial interest in the material mentioned in this study. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/120/92127 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92128 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Survey of the attitudes of Nigerian ophthalmologists to and resources for ophthalmic research Mahmoud, AO Ayanniyi, AA Lawal, A Omolase, CO Ologunsua, Y Samaila, E Aim: To study the views of ophthalmologists on their attitude to and the resources for ophthalmic health research in Nigeria and draw appropriate policy implications. Materials and Methods: Structured questionnaires were distributed to 120 ophthalmologists and ophthalmic residents who were attending an annual congress in Nigeria. Data were collected on background information, importance attributed to research, motivation for conducting research, funding, ethical oversight, literature search, and statistical support. The coded responses were statistically analyzed. P < 0.05 was statistically significant. Results: Eighty-nine of the 120 questionnaires were returned giving a response rate of 74.2%. Research function was rated a distant last by 49.5% of the respondents after clinical service (93.2%), teaching (63.1%), and community service (62.8%). Advancement of knowledge was the strongest motivating factor for conducting research (78.2 %). Securing funding (91.8%) and finding time (78.8%) were the major constraints. The ethical review committees were considered suboptimal by the respondents. Literature searches for research were conducted on the internet (79.3%) and was independent of age (P = 0.465). Research data were stored and analyzed on commonly available statistical software. Conclusions: Although study respondents regarded research highly, they were severely constrained in conducting research due to lack of access to funds and finding time away from the clinical workload. We recommend periodic (re)training on conducting good research including preparation of successful applications for research grants and allotting protected research time for ophthalmologists in Nigeria. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/123/92128 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92129 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence of visual impairment and associated risk factors in subjects with type II diabetes mellitus: Sankara Nethralaya diabetic retinopathy epidemiology and molecular genetics study (SN-DREAMS, report 16) Rani, PK Raman, R Gella, L Kulothungan, V Sharma, T Purpose: To report the prevalence of visual impairment (VI) and the associated risk factors in type II diabetic subjects. Materials and Methods: The study included type II diabetes mellitus subjects who were enrolled from a cross-sectional study. Participants underwent biochemical testing and comprehensive ocular examination including stereo fundus photography. The VI was defined based on the World Health Organization criteria. Results: The prevalence of VI was 4% in the cohort. The risk factors associated with the presence of VI included a female gender, age greater than 60 years, low socio-economic status, hypertension, microalbuminuria, macroalbuminuria, neuropathy, use of insulin and alcohol. Various ocular risk factors are nuclear sclerosis, subjects who have undergone cataract surgery, myopia and sight-threatening diabetic retinopathy (STDR). After adjusting for the factors using stepwise logistic regression analysis, hypertension, use of alcohol, post-cataract surgery and myopia were not risk factors. Stepwise logistic regression analysis indicated that VI was higher among subjects older than 60 years (odds ratio (OR): 4.95 [2.67-9.15]) and those who belonged to a low socio-economic status (OR: 2.91 [1.24-6.85]). The systemic risk factors for VI included microalbuminuria (OR: 2.91 [1.59-5.33]), macroalbuminuria (OR: 4.65 [1.57-13.77]) and presence of neuropathy (OR: 1.97 [1.09-3.59]) among subjects. Subjects with nuclear sclerosis (OR: 36.82 [11.12-112.36]) and presence of STDR (OR: 4.17 [1.54-11.29]) were at a higher risk of VI. Cataract was the most common cause of VI in the cohort. Conclusion: Visual impairment, among type II diabetic subjects (4%), is a major public health problem that needs to be addressed. Cataract is the most common reversible cause of vision impairment in this population. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/129/92129 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92111 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Update on sympathetic Ophthalmia Arevalo, JF Garcia, RA Al-Dhibi, HA Sanchez, JG Suarez-Tata, L Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye. The incidence of SO ranges from 0.2 to 0.5% after penetrating ocular injuries and 0.01% after intraocular surgery. Vitreoretinal surgery and cyclodestructive procedures are considered risk factors. The time from ocular injury to onset of SO varies greatly, ranging from a few days to decades, with 80% of the cases occurring within 3 months after injury to the exciting eye and 90% within 1 year. The diagnosis is based on clinical findings rather than on serological testing or pathological studies. It presents as a bilateral diffuse uveitis. Patients report an insidious onset of blurry vision, pain, epiphora, and photophobia in the sympathizing, non-injured eye. Classically this is accompanied by conjunctival injection and a granulomatous anterior chamber reaction with mutton-fat keratic precipitates (KPs) on the corneal endothelium. In the posterior segment, the extent of inflammation can vary. Systemic corticosteroids are the first line therapy for SO. If patients are non-responsive to steroid therapy or have clinically significant side effects, cyclosporine, azathioprine or other immunosuppressive agents can be used for long-term immunomodulatory therapy. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/13/92111 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92130 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Assessing the knowledge and skills in clinical ophthalmology of medical interns: Survey results from Enugu, South-Eastern Nigeria Eze, BI Oguego, NC Uche, JN Shiwoebi, JO Mba, CN Purpose: To compare the skills and knowledge of clinical ophthalmology among medical interns in Enugu, Nigeria, to the recommendations of the International Council of Ophthalmology (ICO). Materials and Methods: A questionnaire-based cross-sectional survey was conducted of Medical Interns attending the University of Nigeria Teaching Hospital and Enugu State University Teaching Hospital, from April 2010 to June 2010. Data on cohort demographics, undergraduate ophthalmology exposure, clinical skills and diagnostic competencies were collected and analyzed. Statistical significance was indicated by P < 0.05. Results: The cohort comprised 81 males and 48 females (sex ratio = 1.7 : 1), aged 21-35 years (mean: 26.8 ± 2.4 years). The gender difference was significant ( P < 0.05). The response rate was 88.7%. The duration of undergraduate ophthalmology exposure ranged from 1 to 4 weeks. Exposure was often adequate in cornea/external eye (95.3%), lens/cataract (95.3%) and glaucoma (92.2%); but not in vitreo-retinal disease (47.3%), neuro-ophthalmology (45.7%) and refractive surgery (0.0). The majority were competent at visual acuity testing (97.7%) and visual field examination (93.0%). There was lower competency at anterior chamber assessment (49.6%) and slit-lamp examination (39.5%). The majority could confidently diagnose conjunctivitis (96.1%) and cataract (90.7%), but not strabismus (42.6%) or macular degeneration (20.2%). Conclusions: Medical interns in Enugu displayed gaps in their undergraduate ophthalmology exposure, clinical knowledge and skills. This has implications for stakeholders in medical education and eye care delivery. Review of the curriculum, provision of training resources and compliance with ICO guidelines could address the deficiencies. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/135/92130 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92131 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparison of hospital versus rural eye camp based pediatric cataract surgery Ram, J Sukhija, J Thapa, BR Arya, VK Purpose: To compare the outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation in an eye camp setting and tertiary care center. Materials and Methods: Children aged 5-16 years with visually significant cataract underwent phacoaspiration with IOL implantation in an eye camp (eye camp group) or tertiary care center (TCC group). All surgeries incorporated contemporary microsurgical techniques with implantation of polymethyl-methacrylate (PMMA) IOL. Major postoperative complications were managed at a tertiary care center. Postoperative complications, visual acuity and compliance were evaluated using the Chi-square test. A P value less then 0.05 was considered as statistically significant. Results: The cohort comprised 59 children in the eye camp group and 48 children in the TCC group. Thirty two of fifty nine (54.23%) eyes in the eye camp group and 30/48 (62.5%) eyes in the TCC group achieved 20/40 or better best corrected visual acuity (BCVA) postoperatively. Postoperatively, 36 (61%) eyes in the eye camp group and 22 (45.83%) eyes in the TCC group required Nd: YAG laser capsulotomy or a pars plana membranectomy. (P> 0.05) The most striking feature was loss to follow up. In the eye camp group, loss to follow was 20% at one year, 49% at two years, 62% at 3 years and 67% at 4 years compared to 12.5, 21, 27 and 33% respectively in the TCC group (P<0.05, all cases). Conclusions: The outcomes of camp and tertiary care center (hospital) based pediatric cataract surgery were similar. However, the major drawback of camp based surgery was loss to follow up which eventually affected the management of amblyopia and postoperative complications. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/141/92131 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92132 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
A comparative study of mitomycin C and 5-fluorouracil trabeculectomy in West Africa Anand, N Dawda, VK Purpose: To report the comparative efficacy and safety of intraoperative 5-fluorouracil (5-FU) or mitomycin C (MMC) in primary trabeculectomy in Nigeria. Materials and Methods: Retrospective chart review of patients undergoing primary antimetabolite trabeculectomy in Lagos, Nigeria between 1996 and 2003. We included 129 patients (132 eyes) of the 210 patients with greater than one year postoperative follow-up. Success rates between groups were compared by Kaplan-Meier survival analysis. IOP changes between groups were compared with ANOVA test. Non-parametric comparisons were performed with the Chi-square test with Yates correction or Fisher exact test. A P value less than 0.05 was considered statistically significant. Results: Seventy-three eyes underwent 5-FU (5-FU group) and 59 eyes underwent MMC augmentation (MMC group) during primary trabeculectomy. The 5-FU group had longer mean follow-up of 53 ± 26 months than the MMC group (38 ± 18 months, P<0.001). The preoperative intraocular pressure was 25.4 ± 6.2 in the MMC group and 25.8 ± 6.0 mm Hg in the 5FU group (P=0.8). Postoperative IOPs were significantly lower (P<0.05) in the MMC group at all follow up visits except between 30-35 months (P=0.07). The probability of maintaining an IOP less than 19 mmHg and 15 mmHg without additional medication or needle revisions at 2 and 3 years postoperatively was 71 (95% CIs, 54-82%) and 64% (95% CIs, 53-76%) respectively for the 5FU group and 81 (95% CIs,71-92%) and 79% (95% CIs,69-90%) respectively for the MMC group. The MMC group had significantly better survival times, both for IOP less than 19 mm Hg (P=0.03) and IOP less than 15 mm Hg (P= 0.006). At last follow up, 40 eyes (30.3%) had lost more than 2 lines of Snellen visual acuity, 24 from 5-FU and 16 from the MMC group (P=0.8). The MMC group was statistically less likely than the 5-FU group to require medications (18.5% vs. 41.1%, P =0.007) or needle revisions (5.1% vs. 17.8%, P=0.03) to control IOP. Blebitis and endophthalmitis developed in one eye each in both groups. Persistent hypotony was observed in 4 eyes (6.8%) in the MMC group only. Conclusions: In this study of Nigerian patients, intraoperative application of MMC was more efficacious than 5-FU in lowering IOP following primary trabeculectomy. However, delayed ocular hypotony was only seen with MMC use. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/147/92132 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92133 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Cluster bomb ocular injuries Mansour, AM Hamade, H Ghaddar, A Mokadem, AS Awwad, S Purpose: To present the visual outcomes and ocular sequelae of victims of cluster bombs. Materials and Methods: This retrospective, multicenter case series of ocular injury due to cluster bombs was conducted for 3 years after the war in South Lebanon (July 2006). Data were gathered from the reports to the Information Management System for Mine Action. Results: There were 308 victims of clusters bombs; 36 individuals were killed, of which 2 received ocular lacerations and; 272 individuals were injured with 18 receiving ocular injury. These 18 surviving individuals were assessed by the authors. Ocular injury occurred in 6.5% (20/308) of cluster bomb victims. Trauma to multiple organs occurred in 12 of 18 cases (67%) with ocular injury. Ocular findings included corneal or scleral lacerations (16 eyes), corneal foreign bodies (9 eyes), corneal decompensation (2 eyes), ruptured cataract (6 eyes), and intravitreal foreign bodies (10 eyes). The corneas of one patient had extreme attenuation of the endothelium. Conclusions: Ocular injury occurred in 6.5% of cluster bomb victims and 67% of the patients with ocular injury sustained trauma to multiple organs. Visual morbidity in civilians is an additional reason for a global ban on the use of cluster bombs. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/153/92133 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92134 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Evaluation of a novel, non contact, automated focal laser with integrated (NAVILAS<sup>®</sup> ) fluorescein angiography for diabetic macular edema Chalam, KV Murthy, RK Brar, V Radhakrishnan, R Khetpal, V Grover, S Purpose: To evaluate the procedural experience and complications of a novel integrated laser delivery system (NAVILAS<sup>;</sup> ; OD-OS Teltow, Germany) that combines automated laser delivery with color fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF) and infrared imaging with a frequency doubled YAG laser. Materials and Methods: This prospective study evaluated surgical experience with the NAVILAS automated photocoagulation system for the treatment of patients with diabetic macular edema (DME). Subjective assessment of the accuracy of laser spot placement and postoperative complications were documented. Results: Twelve patients (7 males, 5 females) were enrolled in this pilot study. Five patients were phakic and 7 were pseudophakic. Image overlays and the tracking system allowed accurate delivery of laser spots of varying size, duration and power. None of the patients reported any pain and tolerated the procedure well. No complications were reported in the study. Conclusion: In this pilot study, the NAVILAS system allowed accurate laser spot placement with no complications in patients with DME. However a larger sample with longer follow up is required to determine the safety of this procedure. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/158/92134 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92135 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Neodymium: Yttrium-aluminum-garnet laser anterior hyaloidotomy to treat trapped triamcinolone acetonide behind the crystalline lens after intravitreal injection Ascaso, FJ Cascante, JM A 65-year-old male underwent intravitreal triamcinolone acetonide (IVTA) injection for treating a clinically significant macular edema (CSME) due to background diabetic retinopathy in his left eye. On the first postoperative day, visual acuity dropped from 20/80 to hand movements. Slit-lamp examination showed the drug between the posterior capsule of the lens and the anterior hyaloid face. Two weeks later, visual acuity and the milky fluid seemed unchanged. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser anterior hyaloidotomy was performed. One week later, slit-lamp examination of the retrolental space revealed the complete disappearance of triamcinolone and intraocular pressure remained stable. After a follow-up period of 2 months, visual acuity increased to 20/50 with the lens remaining clear. Nd:YAG laser anterior hyaloidotomy is an effective, simple, useful and minimally invasive outpatient procedure in patients with persistent entrapment of triamcinolone behind the crystalline lens, allowing the drug to clear without trauma to the lens. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/163/92135 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92136 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral simultaneous disc edema and cataract associated with Albright hereditary osteodystrophy Sengupta, S Ravindran, RD Kannusamy, V Tamrakar, V A 16-year-old female presented with poor vision in both eyes. On clinical examination, she had bilateral cataracts and optic disc edema bilaterally on ultrasound examination. Extensive intracranial calcification was evident on computerized tomography. Physical examination revealed short stature, rounded chubby face, dental abnormalities, brachydactyly, and obesity. Laboratory evidence of hypocalcemia, hyperphosphatemia, elevated parathyroid hormone level (indicative of pseudohypoparathyroidism) along with the constellation of phenotypical characteristics lead to a diagnosis of Albright's hereditary osteodystrophy. This case is being presented to increase awareness regarding presence of coexisting and previously undiagnosed hypocalcemic syndromes in pediatric cataracts. The role of an ophthalmologist may be pivotal in diagnosing such an entity as documented in the present case. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/166/92136 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92137 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular Angiogenesis: Principles and Practice Edward, DP Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/169/92137 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92109 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
International Ophthalmology and the Implications for Progress McDonnell, PJ Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/2/92109 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92112 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Pediatric refractive surgery in evolution Song, J Al-Ghamdi, I Awad, A With the advent of corneal refractive surgery using excimer laser technology, treatment for corneal and refractive disorders have advanced tremendously and become very precise and predictable. The use of these techniques in the treatment of corneal and refractive disorders in children, especially during the amblyogenic ages, would be invaluable. Numerous reports on refractive surgery in children have demonstrated that it can be performed safely and efficaciously in the pediatric population. However, controversy still exists whether it should be done in this population. We explore the available published data to address this controversy. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/22/92112 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92113 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Evisceration in the modern age Phan, LT Hwang, TN McCulley, TJ Evisceration is an ophthalmic surgery that removes the internal contents of the eye followed usually by placement of an orbital implant to replace the lost ocular volume. Unlike enucleation, which involves removal of the entire eye, evisceration potentially causes exposure of uveal antigens; therefore, historically there has been a concern about sympathetic ophthalmic (SO) associated with evisceration. However, critical review of the literature shows that SO occurs very rarely, if ever, as a consequence of evisceration. Its clinical applications overlap with those of enucleation in cases of penetrating ocular trauma and blind painful eyes, but it is absolutely contraindicated in the setting of suspected intraocular malignancy and may be preferred for treatment of end-stage endophthalmitis. From a technical standpoint, traditional evisceration has a limitation in the orbital implant size. Innovations with scleral modification have overcome this limitation, and accordingly, due to its simplicity, efficiency, and good cosmetic results, evisceration has once again been gaining popularity. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/24/92113 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92114 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The hot orbit: Orbital cellulitis Chaudhry, IA Al-Rashed, W Arat, YO Orbital cellulitis is an uncommon condition previously associated with severe complications. If untreated, orbital cellulitis can be potentially sight and life threatening. It can affect both adults and children but has a greater tendency to occur in the pediatric age group. The infection most commonly originates from sinuses, eyelids or face, retained foreign bodies, or distant soources by hematogenous spread. It is characterized by eyelid edema, erythema, chemosis, proptosis, blurred vision, fever, headache, and double vision. A history of upper respiratory tract infection prior to the onset is very common especially in children. In the era prior to antibiotics, vision loss from orbital cellulitis was a dreaded complication. Currently, imaging studies for detection of orbital abcess, the use of antibiotics and early drainage have mitigated visual morbidity significantly. The purpose of this review is to describe current investigative strategies and management options in the treatment of orbital cellulitis, establish their effectiveness and possible complications due to late intervention. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/34/92114 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92110 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Diabetic macular edema: Current and emerging therapies Wenick, AS Bressler, NM Diabetic macular edema is a leading cause of vision impairment among people within the working- age population. This review discusses the pathogenesis of diabetic macular edema and the treatment options currently available for the treatment of diabetic macular edema, including for focal/grid photocoagulation, intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor agents. The biologic rationale for novel therapeutic agents, many of which are currently being evaluated in clinical trials, also is reviewed. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/4/92110 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92115 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The past, present, and future of exudative age-related macular degeneration treatment Barak, Y Heroman, WJ Tezel, TH Treatment of exudative age-related macular degeneration has been revolutionized within the last 6 years with the introduction of vascular endothelial growth factor neutralizing agents. Previously popular "destructive treatments," such as laser photocoagulation and photodynamic treatment have either been abandoned or used as an adjunct to pharmacotherapy. Despite the increase in vision after antivascular endothelial growth factor (VEGF) agents, they require repetitive and costly intravitreal injections that also carry the inherit risks of infection, retinal tears, and detachment. Several new and more potent VEGF inhibitors are at different stages of development. The goal of evolving pharmacotherapy is to preserve the therapeutic effect while reducing or eliminating the discomfort of intravitreal drug delivery, as well as identify new therapeutic targets. Complement inhibitors, immunomodulators, integrin inhibitors are a few of the new class of drugs that are expected to be in our armamentarium soon. Current medications act to decrease leakage through abnormal subretinal choroidal vasculature and promote involution. However, these medications are only effective in treating the active stage of the choroidal neovascular membrane. Restoration of vision of a large number of patients with involuted choroidal neovascular membranes is warranted. For this purpose, tissue engineering techniques have been employed to reconstruct the subretinal anatomy. Discovery of biomarkers, pharmacogenetics, and very specific targeting holds the promise of increased potency and safety in the future. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/43/92115 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92116 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Diabetic retinopathy and inflammation: Novel therapeutic targets Rangasamy, S McGuire, PG Das, A Most anti-vascular endothelial growth factor (VEGF) therapies in diabetic macular edema are not as robust as in proliferative diabetic retinopathy. Although the VEGF appears to be a good target in diabetic macular edema, the anti-VEGF therapies appear to be of transient benefit as the edema recurs within a few weeks, and repeated injections are necessary. There is new evidence that indicates 'retinal inflammation' as an important player in the pathogenesis of diabetic retinopathy. There are common sets of inflammatory cytokines that are upregulated in both the serum and vitreous and aqueous samples, in subjects with diabetic retinopathy, and these cytokines can have multiple interactions to impact the pathogenesis of the disease. The key inflammatory events involved in the blood retinal barrier (BRB) alteration appear to be: (1) Increased expression of endothelial adhesion molecules such as ICAM1, VCAM1, PECAM-1, and P-selectin, (2) adhesion of leukocytes to the endothelium, (3) release of inflammatory chemokines, cytokines, and vascular permeability factors, (4) alteration of adherens and tight junctional proteins between the endothelial cells, and (5) infiltration of leukocytes into the neuro-retina, resulting in the alteration of the blood retinal barrier (diapedesis). VEGF inhibition itself may not achieve neutralization of other inflammatory molecules involved in the inflammatory cascade of the breakdown of the BRB. It is possible that the novel selective inhibitors of the inflammatory cascade (like angiopoietin-2, TNFα, and chemokines) may be useful therapeutic agents in the treatment of diabetic macular edema (DME), either alone or in combination with the anti-VEGF drugs. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/52/92116 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92117 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Assessment and management of proximal and incomplete symptomatic obstruction of the lacrimal drainage system Kashkouli, MB Pakdel, F Kiavash, V Epiphora is a common complaint of patients who present to an Ophthalmology Clinic. In many cases, epiphora is due to an obstruction in the lacrimal drainage system. However, a subgroup of symptomatic patients with epiphora has a patent lacrimal drainage system. Such cases are usually termed 'functional obstruction' and / or 'stenosis of the lacrimal drainage system'. Various etiologies and diagnostic and therapeutic approaches have been described in literature, which implies the lack of a standardized approach. This article will review the evolving diagnostic and therapeutic approaches in literature, and in the end, propose a paradigm in approaching this group of patients. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/60/92117 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92118 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Role of inflammation in the pathogenesis of diabetic retinopathy Diabetic retinopathy (DR) remains a major cause of worldwide preventable blindness. The microvasculature of the retina responds to hyperglycemia through a number of biochemical changes, including activation of protein kinase C, increased advanced glycation end products formation, polyol pathway, and oxidative stress, and activation of the renin angiotensin system (RAS). There is an accumulating body of evidence that inflammation plays a prominent role in the pathogenesis of DR. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/70/92118 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92119 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Enhancing advocacy for eye care at national levels: What steps to take for the next decade? Rabiu, MM Al, RA Qureshi, MB Gersbeck, J The global initiative for the elimination of avoidable blindness by the year 2020-(VISION 2020- The Right to Sight), established in 1999, is a partnership of nongovernmental organizations (NGOs), governments, bilateral organizations, corporate bodies and the World Health Organization. The goal is to eliminate the major causes of avoidable blindness by the year 2020. Significant progress has been made in the last decade. For example, the adoption of three major World Health Assembly resolutions (WHA 56.26, 59.25 and 62.1) requesting governments to increase support and funding for the prevention of blindness and eye care. Additionally, the approval of the VISION 2020 declaration, development of plans and establishment of prevention of blindness committees and a designation of a coordinator by most participating countries represent other major achievements. Furthermore there has been increased political and professional commitment to the prevention of visual impairment and an increase in the provision of high-quality, sustainable eye care. Most of these achievements have been attributed to the advocacy efforts of VISION 2020 at the international level. The full success of this global initiative will likely depend on the extent to which the WHA resolutions are implemented in each country. However, most ratifying countries have not moved forward with implementation of these resolutions. To date, only few countries have shown consistent government support and funding for eye care pursuant to the resolutions. One of the main reasons for this may be inadequate and inappropriate advocacy for eye care at the national level. As such it is believed that the success of VISION 2020 in the next decade will depend on intense advocacy campaigns at national levels. This review identified some of the countries and health programs that have had fruitful advocacy efforts, to determine the factors that dictated success. The review highlights the factors of successful advocacy in two countries (Australia and Pakistan) that secured continued government support. The review further explores the achievements of the HIV/AIDs control network advocacy in securing global and national government support. Common factors for successful advocacy at the national level were identified to include generation of evidence data and effective utilization of the data with an appropriate forum and media to develop a credible relationship with prominent decision makers. Aligning eye care programming to the broad health and development agendas was a useful advocacy effort. Also a broad all-encompassing coalition of all stakeholders provides a solid platform for effective and persistent advocacy for government support of eye care. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/75/92119 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92120 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
The use of antivascular endothelial growth factor agents in the perioperative period in diabetic vitrectomy Abu-Yaghi, NE Bakri, SJ Pars plana vitrectomy is an established surgical method for the treatment of proliferative diabetic retinopathy and its complications. Anti-vascular endothelial growth factor agents suppress vascular proliferation and may be used as pharmacological adjuvants to reduce the incidence of postoperative hemorrhage in the vitreous cavity and to facilitate the surgical approach. We conducted an electronic search to identify prospective randomized controlled trials looking at the use of -perioperative vascular endothelial growth factor suppression in diabetic patients undergoing vitrectomy. We found six prospective randomized trials with only one being double-masked. We present a summary of the findings. Four studies suggest that the use of perioperative, anti-vascular endothelial growth factor agents facilitate vitrectomy surgery, but only one study supports their use to reduce the chances of early postoperative vitreous bleeding. Two studies did not find a significant benefit for their use before surgery to reduce the recurrence of vitreous hemorrhage in proliferative diabetic retinopathy. More randomized double blinded studies with a larger number of patients are needed to establish a clear recommendation regarding the use of these agents. Those studies should factor in the use of endo-tamponade with gas or silicone oil following vitrectomy. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/83/92120 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92121 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Short-term visual outcomes of Boston keratoprosthesis type I in Saudi Arabia Al, AK Hantera, M Purpose: To evaluate the visual outcomes, complications and retention of threadless type I Boston keratoprosthesis (KPro) in Saudi Arabia. Materials and Methods: Retrospective analysis of four eyes of four patients (one female and three males; age range: 48 to 72 years) who underwent Boston type I threadless KPro implantation between January and December 2009. Results: In the median follow-up of 11 months (range 6 to 14 months), visual outcomes were satisfactory. Preoperative diagnosis included two patients of post-trachoma dense vascularized corneal scarring, one patient of corneal alkali burn and one patient of repeated failed corneal grafts. All patients demonstrated significant improvement in vision; with pre-operative visual acuity of hand movements (HM), counting fingers and HM improved to best corrected visual acuity (BCVA) of 20/200, 20/60, 20/50 and 20/30 on their last follow-up visits respectively. None of the patients developed glaucoma as a result of the procedure. No retro-prosthetic membrane developed till the last follow-up visit. One of the four patients had a corneal melt (due to severe dryness associated with trachoma) 6 months after the KPro implantation and underwent a successful KPro revision. Despite the relatively poor prognosis expected in alkali burn eye, the patient attained the maximum BCVA (20/30) of the four eye series on the last follow-up visit at six months. Conclusion: In consistent with the earlier reports from other parts of the world, all the 4 eyes had a significant increase in vision after Boston type I KPro implantation. However, patients require close lifelong follow-up to manage any complications. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/88/92121 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92122 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence of human immunodeficiency virus seropositivity among eye surgical patients at a rural eye care facility in South-Eastern Nigeria Okoye, O Magulike, N Chuka-Okosa, C Purpose: To determine the prevalence of human immunodeficiency infection among patients who underwent surgery at a rural eye care facility in southeastern Nigeria. Materials and Methods: A retrospective chart review was performed for all patients who had undergone surgery and a pre-operative Human Immunodeficiency Virus (HIV) test, between August 2008 and July 2009 at the Eye unit of the Presbyterian Joint Hospital, Ohaozara, Ebonyi State, Nigeria. Data were analyzed for age, sex, type of surgery and HIV status. Frequency, percentage and 95% confidence intervals (CI) were calculated with univariate analysis and the parametric method. Results: A total of 380 cases were reviewed comprised of 228 males and 152 females (M:F= 1.5:1).The mean age of the cohort is 56 years (range, 4 years to 91 years). Fourteen patients (3.7%; 95% confidence interval 1.8 - 5.6) were HIV positive. Conclusion: A high HIV sero-prevalence was reported in our study. Infection-control precautionary measures are indicated to minimize risk of HIV transmission to ophthalmic surgeons and allied health-workers. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/93/92122 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:92123 2012-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Outcomes of the Boston keratoprosthesis in Jordan Shihadeh, WA Mohidat, HM Purpose: To report the indications, outcomes, and complications of the Boston type I keratoprosthesis (KPro) from the first Jordanian study on the subject. Materials and Methods: A retrospective chart review was conducted on 20 eyes of 19 consecutive patients who had Boston type I KPro implantation at King Abdullah University Hospital. Surgeries were performed by the same surgeon (WS) from November 2007 to March 2010. Data collected included age, sex, primary indication, number of previous grafts, preoperative comorbidities, visual acuity before and after surgery, and complications. Results: The mean age of the participants was 51.7±19.9 years (range: 10-80 years). The mean follow-up was 18.1±9.5 months (range: 3-6 months). The most common primary corneal pathology was vascularized corneal opacity (40%). Best corrected visual acuity (BCVA) improved significantly in 85% of eyes; 65% had a BCVA of 20/200 or better and 25% had a BCVA of 20/50 or better. The most frequent complication was retroprosthesis membrane (RPM) formation, which occurred in 45% of eyes. Two eyes (10%) had implant extrusion and required further surgery. Conclusion: Boston Kpro offers a reasonably safe and effective solution for patients with corneal blindness in whom the prognosis for natural corneal grafting is poor. Medknow Publications 2012-01-01 http://www.meajo.org/text.asp?2012/19/1/97/92123 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95244 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
A potpourri of ocular disorders Edward, DP Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/177/95244 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95245 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Screening and public health strategies for diabetic retinopathy in the Eastern Mediterranean Region Khandekar, R Diabetic retinopathy (DR) is a complication of diabetes mellitus that can cause blindness. As the prevalence of diabetes increases globally and patients live longer, the cases of DR are increasing. To address the visual disabilities due to DR, screening of all diabetics is suggested for early detection. The rationale and principles of DR screening are discussed. Based on the available evidence, the magnitude of DR in countries in the Eastern Mediterranean region (EMR) is presented. Public health strategies to control visual disabilities due to DR are discussed. These include generating evidence for planning, implementing standard operating procedures, periodic DR screening, focusing on primary prevention of DR, strengthening DR management, health information management and retrieval systems for DR, rehabilitating DR visually disabled, using low-cost technologies, adopting a comprehensive approach by integrating DR care into the existing health systems, health promotion/counseling, and involving the community. Although adopting the public health approach for DR has been accepted as a priority by member countries of EMR, challenges in implementation remain. These include limitations in the public health approach for DR compared to that for cataract, few skilled workers, poor health systems and lack of motivation in affecting health-related lifestyle changes in diabetics.Visual disabilities due to DR are likely to increase in the coming years. An organized public health approach must be adopted and all stakeholders must work together to control severe visual disabilities due to DR. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/178/95245 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95246 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Photodynamic therapy with verteporfin for corneal neovascularization Al-Torbak, AA Purpose: To investigate the efficacy of photodynamic therapy (PDT) with verteporfin for the treatment of patients with corneal neovascularization. Materials and Methods: Retrospective interventional case series of 33 eyes of 32 patients with stable corneal neovascularization who were refractory to conventional treatment and were treated with single photodynamic therapy with verteporfin (6 mg/m <sup>[2]</sup> ) at King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia between January 1, 2007 and December 30, 2009. The mean age was 40.7 ± 19 years (range 16-76 years). The mean follow-up for all patients was 13.1 ± 5.5 months (range 6-24 months). The average amount of corneal neovascularization was 2.7 ± 1.9 (1-10). Corneal neovascularization was deep in 19 (57.6%) eyes and superficial in 14 (42.4%) eyes. Preoperative and postoperative visual acuity and intraocular pressure, and clinical outcome of the treatment were assessed. Statistical analysis was performed to investigate the association to potential risk factors, to assess the change in data and determine the risks for failure. A P-value less than 0.05 was statistically significant. Results: At the last follow-up visit, 22 (66.7%) eyes showed a decrease in corneal neovascularization and evidence of vascular thrombosis. Complete vascular occlusion was achieved in 14 (42.4%) eyes, partial occlusion was achieved in 8 (24.2%) eyes, and the vessels were patent in 11 (33.3%) eyes. The corneal neovascularization score and depth of the vessels were found to be significant risk factors for failure (P = 0.0001 and 0.046, respectively). However, the diagnoses or causes of corneal neovascularisation were not statistically significant. No significant systemic or ocular complications associated with photodynamic therapy were observed. Conclusion: Photodynamic therapy with verteporfin was effective for the treatment of corneal neovascularization in the majority of the cases in this study. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/185/95246 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95247 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Xerophthalmia in a Traditional Quran Boarding School in Sudan Abbass, MA Idris, SS Purpose: To determine the prevalence of xerophthalmia at a traditional boarding school where children do not receive a diet adequate in vitamin A. Materials and Methods: A cross-sectional survey of 406 males residing in a Quranic traditional school was conducted using the World Health Organization xerophthalmia checklist. The association between the prevalence of night blindness and proportion of students staying at the school for 6 consecutive months and those eating solely at the school was investigated. The difference in age between children with night blindness and those without was investigated. Statistical significance was indicated by P<0.05. Results: The prevalence of night blindness, conjunctival xerosis and Bitot's spots was 24%, 12.5% and 1%, respectively. None of the boys had corneal ulceration, corneal scars and corneal xerosis. No significant association was observed between the differences in mean age and development of night blindness (P=0.657). There was a significant association between the duration of stay (cut-off of 6 months continuously) at the institute and the development of night blindness (P=0.023). There was no statistical significance between regularly eating at the "maseed" and outside the "maseed" and the development of night blindness (P=0.75). Conclusion: Children residing at a traditional school are vulnerable to developing xerophthalmia where the diet is inadequate in vitamin A. Institutional caregivers should be made aware of the importance of providing a balanced diet rich in vitamin A. Institutional caregivers should also be educated on the signs and symptoms of vitamin A deficiency for early detection of xerophthalmia. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/190/95247 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95248 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Central corneal thickness in Iranian congenital glaucoma patients Amini, H Fakhraie, G Abolmaali, S Amini, N Daneshvar, R Purpose: To compare central corneal thickness (CCT) in subjects with controlled primary congenital glaucoma (PCG) and nonglaucomatous subjects and to investigate the correlation between CCT and intraocular pressure (IOP) in the study population. Materials and Methods: Twenty-three consecutive PCG cases with controlled IOP and no clinical evidence of corneal edema comprised the Study Group. There was an interval of at least 2 months between last intraocular surgery and inclusion in the study. Twenty-one subjects with strabismus or lacrimal drainage insufficiency who did not have glaucoma or any history of intraocular surgery or ocular trauma comprised the control group. The Control Group was age and sex-matched. Data from ultrasonic pachymetry and applanation tonometry were analyzed for differences between groups. Correlation of the study parameters was investigated. A P-value less than 0.05 was statistically significant. Results: Data from both eyes of subjects in the Study Group and Control Group were included in the original analysis. Mean CCT was statistically significantly higher in the Study Group compared to the Control Group (589.42 ± 53.44 μm vs. 556.14 ± 30.51 μm, respectively; P=0.001). There was a significant correlation between CCT and IOP (r=0.63; P<0.0001). Similar statistically significant outcomes were observed when only one eye per subject was used in a reanalysis of the data for the Study and Control Groups. Conclusion: Patients with PCG who had controlled IOP have statistically significantly thicker corneas than nonglaucomatous age and sex-matched subjects The thicker cornea could significantly alter IOP measurement with applanation tonometry. Pachymetry should be considered an essential part of the evaluation for PCG. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/194/95248 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95249 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Evaluation of sterile uveitis after iris-fixated phakic intraocular lens implantation Sedaghat, M Zarei-Ghanavati, M Ansari-Astaneh, M Patel, V Sikder, S Purpose: To evaluate the clinical features, and visual outcomes of sterile uveitis after iris-fixated phakic intraocular lens implantation (pIOLs) (Artisan-Artiflex<sup>®</sup> and Verisyse-Veriflex<sup>®</sup> ). Material and Methods: In this retrospective non-comparative case series, the medical records of 117 eyes implanted with Artisan-Artiflex<sup>®</sup> (Ophtec BV, Groningen, Netherlands) and Verisyse-Veriflex<sup>®</sup> (AMO, Santa Ana, CA) iris claw phakic IOLs were analyzed for postimplantation sterile uveitis. The mean age of the 87 patients included in the study was 27.2±7.4 years. Of these patients, 56 (64.3%) were men and 31 (35.6%) were women. Patient age, gender, IOL brand type, refractive error, optic diameter, unilateral vs bilateral implantation, and anterior chamber depth were analyzed. Features of uveitis, uncorrected and best corrected visual acuity (VA) at presentation and at follow-up visits were examined. The mean follow-up time was 14.6 months (range: 6-37 months). Results: Clinically significant uveitis was observed in 12 of 117 eyes (10.3%) in a total of ten patients. Of these ten patients, four (40%) were women and six (60%) were men, and the mean age was 25.1±5.3 years (range: 18-36 years). Among those with bilateral implantation, 6.9% of patients developed bilateral uveitis, while 13.8% (4 of the 29 implanted bilaterally) developed unilateral uveitis. Foldable pIOL implantation was the only variable associated with the development of uveitis (P=.03). Conclusion: Although the prognosis is usually benign, sterile uveitis occurred in 10.3% of patients after iris-fixated pIOL implantation. The implantation of a foldable pIOL was the only variable associated with sterile uveitis. Appropriate medical management can be effective treatment, without the need for pIOL replacement. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/199/95249 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95251 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Macular retinal and nerve fiber layer thickness in early glaucoma: Clinical correlations Arvanitaki, V Tsilimbaris, MK Pallikaris, A Moschandreas, I Minos, E Pallikaris, IG Detorakis, ET Purpose: Previous studies have evaluated macular retinal thickness (RT) and nerve fiber layer thickness (RNFLT) changes in early glaucoma using elaborate optical coherence tomography (OCT) scanning protocols. Materials and Methods: This study examines RT and RNFLT using standard scanning protocols in early glaucoma. In this prospective, nonrandomized case series, 95 eyes of 95 patients were evaluated, including 29 nonglaucomatous subjects (control group), 34 glaucoma suspects, and 32 early manifest glaucoma patients. RT and RNFLT were measured using scanning fast macular thickness map and Fast RNFLT (3.4) protocols on a 1.70 mm radius around the macular center (respectively) in all four quadrants. The fast RNFLT (3.4) protocol was transposed on the macula from the peri-papillary area. Data were statistically analyzed for differences between groups, and for correlations between parameters. P<0.5 was statistically significant. Results: Both early manifest glaucoma patients and glaucoma suspects had significantly lower RT than controls in all quadrants. RNFLT differences in all quadrants were not statistically significant (P>0.05). RT was significantly inversely correlated with axial length in early manifest glaucoma patients and glaucoma suspects but not in controls. Conclusions: The finding that RT was significantly lower in early manifest glaucoma patients and glaucoma suspects indicates that the transposition of the OCT fast RNFL thickness (3.4) protocol from the peri-papillary area to the peri-macular area can be used for early glaucoma diagnosis. Intraretinal changes in early glaucoma, likely precede nerve fiber changes. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/204/95251 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95254 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparison of Humphrey Matrix Frequency Doubling Technology to standard automated perimetry in neuro-ophthalmic disease Yoon, MK Hwang, TN Day, S Hong, J Porco, T McCulley, TJ Purpose: We compared Humphrey Matrix FDT 30-2 (FDT) and Humphrey Visual Field Analyzer 30-2 SITA standard (SAP) in the assessment of anterior (optic nerve or chiasm) and posterior (retro-chiasmal) afferent visual pathway defects. Materials and Methods: In this retrospective comparative study, the charts of 37 patients (16 males, range 13-84 years, mean 72.1), with neuro-ophthalmic visual field defects who were tested with both FDT and SAP, were reviewed. Two masked graders assessed the concordance and extent of field defects between the perimeters. The mean concordance between anterior and posterior disease was compared using the Wilcoxon rank sum test. The mean deviation (MD) and pattern standard deviation (PSD) of each perimeter were correlated with the Spearman coefficient. Results: Twenty-eight patients had anterior and nine had posterior disease. Most had a fair or good concordance (89.3% anterior, 88.9% posterior). When comparing anterior to posterior disease, the mean concordance of the defects of the two parameters was not statistically different (P = 0.94 and P = 0.61 for total deviation and pattern deviation, respectively). The MD and PSD between perimeters had a significant correlation. Conclusions: Our series, using 30-2 field analysis, demonstrates fair to good correlation between FDT and SAP in the majority of patients. In roughly 10% findings between FDT and SAP were discordant. This difference was similar for anterior and posterior disease. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/211/95254 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95255 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Office-based slit-lamp needle revision with adjunctive Mitomycin-C for late failed or encapsulated filtering blebs Amini, H Esmaili, A Zarei, R Amini, N Daneshvar, R Purpose: The purpose of this study was to assess the results of bleb needling in glaucomatous patients with late failed filtering blebs. Materials and Methods: A retrospective case series of 27 eyes of 27 patients was considered. All patients underwent needle bleb revision with adjuvant mitomycin-C performed at the slit lamp, during an office visit. Complete success was defined as postneedling intraocular pressure (IOP) ≤ 21 mmHg without any antiglaucoma medications and qualified success was IOP ≤ 21 mmHg with topical antiglaucoma medications. Results: There were 12 eyes with encapsulated blebs and 15 eyes with flat blebs. The mean interval between index filtering surgery and bleb revision was 32.74 ± 15.36 months. Mean IOP was 25.07 ± 4.80 mmHg before surgery and 19.66 ± 4.97 mmHg at last postoperative follow-up. The mean follow-up was 20.31 ± 15.63 months. Complete and qualified successes were 7.4% and 51.9%, respectively. Cumulative rates of success at 1, 2, 3, and 4 years were 76%, 65%, 49%, and 37%, respectively. The mean number of antiglaucoma medications was reduced from 3.15 ± 0.36 preoperatively to 2.33 ± 1.21 postoperatively (P<0.001). Conclusion: Slit-lamp needle revision in office is a simple and effective method for treating late encapsulated or flat filtering blebs without significant complications even for late bleb failure. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/216/95255 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95256 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Can opposite clear corneal incisions have a role with post-laser in situ keratomileusis astigmatism? El-Awady, H Ghanem, AA Purpose: To evaluate the astigmatic correcting effect of paired opposite clear corneal incisions (OCCIs) on the steep axis in patients with residual astigmatism after laser in situ keratomileusis (LASIK) Materials and Methods: Thirty-one eyes of 24 patients with a mean age of 28.4 years ±2.46 (range, 19-36 years) were recruited for the study. Inclusion criteria included residual astigmatism of ≥1.5 diopter (D) after LASIK with inadequate residual stromal bed thickness that precluded ablation. The cohort was divided into two groups; group I (with astigmatism ranging from -1.5 D to -2.5 D) and group II (with astigmatism > -2.5 D). The steep axis was marked prior to surgery. Paired three-step self-sealing opposite clear corneal incisions were performed 1-mm anterior to the limbus on the steep axis with 3.2-mm keratome for group I and 4.1 mm for group II. Patients were examined 1 day, 1 week, 1 month, 3 months and 6 months, postoperatively. Visual acuity, refraction, keratometry, and corneal topography were evaluated preoperatively and postoperatively. Analysis of the difference between groups was performed with the Student t-test. P<0.05 was considered statistically significant. Results: The mean uncorrected visual acuity (UCVA) improved from 0.35±0.13 (range, 0.1-0.6) to 0.78±0.19 (range, 0.5-1) in group I and from 0.26±0.19 (range, 0.1-0.5) to 0.7±0.18 (range, 0.4-1) in group II. The increase in UCVA was statistically significant in both groups (P=0.001, both cases). The mean preoperative and postoperative keratometric astigmatism in group I was 2.0±0.48 D (range, 1.5-2.5 D) and 0.8±0.37 D (range, 0.1-1.4 D), respectively. The decrease in keratometric astigmatism was highly statistically significant in group II (P=0.001.). Mean surgically induced astigmatic reduction by vector analysis was 1.47±0.85 D and 2.21±0.97 D in groups I and II respectively. There were no incision-related complications. Conclusions: Paired OCCIs were predictable and effective in correcting post-LASIK astigmatism and required no extra surgical skill or expensive instruments. OCCIs are especially useful in eyes with insufficient corneal thickness for LASIK retreatment. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/222/95256 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95258 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Inner and outer retinal volumetric and morphologic analysis of the macula with spectral domain optical coherence tomography in retinitis pigmentosa Sheth, SS Rush, RB Natarajan, S Purpose: To use spectral domain optical coherence tomography (OCT) to assess the features of the inner and outer layers of the macula in subjects with retinitis pigmentosa (RP). Design: Prospective observational comparative study. Materials and Methods: Subjects with RP with reduced central visual acuity and central macular thinning (RP group) underwent spectral domain OCT evaluation along with age-matched healthy control subjects (control group). Using the E-MM5 raster protocol, a 5 × 5 mm central macular cut was acquired with inner and outer macular volumes serving as the primary outcome measures. A structural analysis of the inner and outer retinal layers at the macula in the RP group was also performed using the HD cross-line protocol. Results: The RP group comprised six eyes of six RP subjects and control group comprised six eyes of six control subjects. The outer macular volume was significantly lower (P<0.05) in the RP group (2.01±0.44 mm <sup>[3]</sup> ) compared to the control group (4.68±0.16 mm <sup>[3]</sup> ). There was no difference in the mean inner macular volume between the RP group (2.46±0.24 mm <sup>[3]</sup> ) and the control group (2.55±0.22 mm <sup>[3]</sup> ). No significant structural alteration was noted in the inner retinal layers of the RP group. There was no significant correlation (r = -0.04, P>0.05) between best-corrected visual acuity and outer macular volume in the RP group. Conclusions: Spectral domain OCT findings confirm that RP preferentially affects the outer retinal layers in the macula. Although the number of patients included in this study was small, it demonstrated relatively well-preserved volume and morphology of the inner retinal layers using spectral domain OCT. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/227/95258 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95259 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular clinical profile of patients with pseudoexfoliation syndrome in a Tertiary Eye Care Center in South India Philip, SS John, SS Simha, AR Jasper, S Braganza, AD Purpose:To study the clinical profile of pseudoexfoliation (PEX) syndrome in a hospital setting. Materials and Methods: A case series of patients with PEX, with and without glaucoma attending the general ophthalmology clinic of a tertiary care center in South India. All patients underwent a complete ophthalmologic evaluation including recording diurnal variation of tension (DVT), gonioscopy and visual field assessment. Results: The study cohort comprised 529 patients (752 eyes). There were 296 (56%) females. The highest number of patients (261 patients) was from the age group between 60 and 69 years. Of 752 eyes, 57.8% eyes had unilateral PEX and 72% had established PEX. Gonioscopy showed open angles in 98.1% of eyes. Intraocular pressure (IOP) greater than 21 mmHg in at least 1 of 4 measurements was recorded in 5.7% eyes. DVT was normal in 96.4% of unilateral PEX eyes, similar to fellow non-PEX eyes. Pseudoexfoliation glaucoma occurred in 1.9% of eyes and 4.7% of eyes were glaucoma suspects. There was no correlation between the stage of PEX and increased IOP. Mean central corneal thickness of PEX eyes was 522 ± 27μ. Pupillary dilatation in 90.5% eyes with early PEX was ≥ 7 mm. Conclusions: A small percentage of PEX eyes had raised IOP, and the number of eyes with glaucomatous optic neuropathy was even lower. PEX eyes did not demonstrate wide fluctuations in IOP. No correlation was found between raised IOP and stage of PEX. There was good pupillary dilatation in early stage PEX eyes suggesting that all PEX eyes may not have poor pupillary dilatation and related complications. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/231/95259 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95260 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Pupil-sparing complete third nerve palsy from cryptogenic midbrain stroke in an otherwise-healthy young adult with patent foramen ovale Khan, AO Although pupil-sparing in acute unilateral complete third nerve palsy is often a sign of ischemic nerve injury, it is not specific for injury outside of the midbrain. This report documents acute pupil-sparing complete third nerve palsy in an otherwise healthy young adult with patent foramen ovale and associated atrial dilatation who suffered cryptogenic focal midbrain stroke, presumably from a paradoxical embolism. The patent foramen ovale was surgically closed. Over the next several months neurological recovery was complete except for diplopia and relatively comitant hypotropia, which responded well to conventional strabismus surgery. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/237/95260 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95262 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Multifocal cysticercosis with optical coherence tomography findings in a child Agarwal, M Jha, V Chaudhary, SP Singh, AK We herein report a case with multifocal cysticercosis - sub-conjunctival cysticercus cyst, sub-retinal cysticercosis, and neurocysticercosis in a child. The optical coherence tomography (OCT) findings of the sub-retinal cysticercus cyst are reported. He was treated with anti-helminthic drugs and oral prednisolone followed by surgical removal of the sub-retinal cyst. He subsequently underwent silicone oil removal with lens aspiration and intraocular lens implantation maintaining stable vision Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/240/95262 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95263 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
A case of cat-scratch disease with unusual ophthalmic manifestations Ghazi, NG Sams, WA We report a case of cat-scratch disease with unusual posterior segment manifestations. A 12-year-old healthy male presented with three weeks history of decreased visual acuity in the right eye. A significant history of cat exposure and elevated Bartonella titers were present. A large white-gray vascularized mass extending off the optic disk, an early stellate maculopathy, a plaque of choroiditis, an inferior serous retinal detachment involving the macula were present in the right eye. Sector papillitis and a focal area of chorioretinitis along the superotemporal arcade with associated retinal artery to vein anastomosis were present in the left eye. Bilateral optic nerve head involvement including peripapillary angiomatosis, retinal-retinal anastomosis and plaque choroiditis as ocular complications of cat-scratch disease have not been previously described to our knowledge and make this case noteworthy. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/243/95263 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95265 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparison of optical coherence tomography findings in a patient with central retinal artery occlusion in one eye and end-stage glaucoma in the fellow eye Greene, DP Richards, CP Ghazi, NG This case describes a patient with chronic central retinal artery occlusion in one eye and end-stage traumatic glaucoma in the fellow eye. Optical coherence tomography (OCT) of the macula of the chronic phase of central retinal artery occlusion of the right eye indicated loss of the normal foveal depression, extensive inner retinal atrophy, and marked retinal thinning. In contrast, scans of the left eye with end-stage glaucoma demonstrated an intact foveal depression and limited retinal thinning. The pattern of macular OCT findings in this patient illustrates distinguishing features between chronic central retinal artery occlusion and chronic optic neuropathy due to end-stage glaucoma. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/247/95265 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95266 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Concurrent macular corneal dystrophy and keratoconus Mohammad-Rabei, H Shojaei, A Aslani, M A 21-year-old female presented with progressive bilateral visual loss for the past 8 years. The patient had no history of systemic disease, surgery or medications. Complete ophthalmologic examination and topography were performed. On ophthalmic examination, uncorrected visual acuity was counting fingers at 2.5 m (20/50 with pinhole) in the right and left eyes. Both corneas appeared hazy on gross examination. On slit-lamp biomicroscopy, focal grayish-white opacities with indistinct borders were noted in the superficial and deep corneal stroma of both eyes. Both corneas were thin and bulging. Corneal topography showed a pattern consistent with keratoconus. The patient underwent penetrating keratoplasty (PKP). Histopathologic studies after PKP confirmed the diagnosis of macular corneal dystrophy and keratoconus in the same eye. The patient was clinically diagnosed as a case of concurrent macular dystrophy and keratoconus, which is a very rare presentation. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/251/95266 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95268 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Acute retinal necrosis after Boston type I keratoprosthesis Al-Amri, AM Al-Rashaed, S Al-Kharashi, S A case report of a 68-year-old male who developed acute retinal necrosis (ARN) after Boston type I keratoprosthesis is presented. The procedure was performed for multiple graft failure secondary to herpetic keratitis. Clinical data including visual acuity, color fundus photography, fluorescein angiography, laboratory tests findings, and management are presented. After exclusion of other causes by laboratory workup, the patient was diagnosed with ARN most likely secondary to herpetic infection. Intravenous acyclovir and oral prednisolone were administered to the patient resulting in marked improvement in visual acuity and regression in the size of the retinitis. The patient eventually developed a soft eye and choroidal detachment with light perception vision. In patients with a history of herpetic keratitis or keratouveitis, it is highly advisable to maintain prophylactic systemic antiviral treatment before and after any ocular procedure such as the Boston keratoprosthesis. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/254/95268 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95269 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Rhino-orbito-cerebral mucormycosis in an immunocompetent patient: Case report and review of literature Shatriah, I Mohd-Amin, N Tuan-Jaafar, TN Khanna, RK Yunus, R Madhavan, M Rhino-orbito-cerebral mucormycosis is a fungal infection that can be fatal especially in immunocompromised patients. It is extremely rare in immunocompetent individuals. We describe here an immunocompetent patient who survived rhino-orbito-cerebral mucormycosis due to Saksenaea vasiformis, and provide a literature review of this rare entity. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/258/95269 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95270 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral transient pupil closure after iris supported intraocular lens implantation in a case with Marfan syndrome Kara, N Bozkurt, E Yazici, AT Demirok, A A 16-year-old woman presented with Marfan syndrome and bilateral ectopia lentis. The surgical treatment including removal of the crystalline lens and implantation of an iris-supported intraocular lens in both eyes at a week interval. Postoperatively, the biomicroscopic examination showed total pupil closure bilaterally. After the topical tropicamide treatment, the pupil returned to normal shape. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/262/95270 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95271 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Combination of intracameral and intrastromal voriconazole in the treatment of recalcitrant Acremonium fungal keratitis Haddad, RS El-Mollayess, GM We present a report of a 28-year-old female with fungal keratitis due to Acremonium that was unresponsive to full medical therapy over 3 weeks. The patient was treated with superficial keratectomy, intrastromal and intracameral voriconazole injections. There was a marked clinical improvement beginning on day 3 post-therapy that was sustained until the last follow-up at 6 months. This is the first case of fungal keratitis due to Acremonium treated by a combination of intrastromal and intracameral voriconazole. This cost-effective treatment modality proved to be significant in impeding the progression of this potentially blinding disease and improving visual prognosis. Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/265/95271 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95272 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal endothelial cell density following cataract surgery in eyes with previous blunt trauma Gupta, VP Gupta, P Gupta, R Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/269/95272 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:95274 2012-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Authors' reply Yeniad, B Corum, I Ozgun, C Medknow Publications 2012-04-01 http://www.meajo.org/text.asp?2012/19/2/270/95274 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97919 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmology: Now and then Grover, S Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/271/97919 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97920 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Incidence and natural course of symptomatic central serous chorioretinopathy in pregnant women in a maternity hospital in Kuwait Said-Ahmed, K Moustafa, G Fawzy, M Purpose: To report the incidence, clinical features and natural course of central serous chorioretinopathy (CSR) in pregnant women in Kuwait. Materials and Methods: Patients were actively recruited from a private maternity hospital. Out of the 17,000 pregnant women who visited the antenatal care clinics (Al-Orf Hospital, Kuwait) over 3 years, 900 had visual complaints. Patients with visual complaints underwent complete ophthalmological assessment. Medical records of patients with CSR were reviewed, and a full clinical ophthalmological assessment was performed including measurement of best corrected visual acuity, intraocular pressure, slit lamp biomicroscopy, dilated indirect ophthalmoscopy and Amsler grid screening, color and red free fundus photography and retinal optical coherence tomography. All patients were evaluated throughout the course of pregnancy and for 6 months after delivery. Results: Four patients had CSR among the 17,000 pregnant women reviewed over 3 years corresponding to an incidence of 0.008 % per year. Two patients (50%) had CSR with white subretinal exudates and 2 (50%) had no exudates. There was complete resolution in all patients (100%) within 3 months after delivery. Conclusions: In pregnant women, CSR can present with or without retinal exudates and completely resolves in either case. Further studies with a larger sample size are warranted to investigate the risk factors in pregnant women. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/273/97920 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97922 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Screening for retinopathy of prematurity in South of Iran Afarid, M Hosseini, H Abtahi, B Purpose: The purpose of this study is to report the screening data for retinopathy of prematurity (ROP) at a screening center in Southern Iran. Materials and Methods: A chart review was performed of all screened neonates who were referred to Poostchi screening center affiliated to Shiraz University of Medical Sciences from February 2006 to January 2010. Statistical analysis of data was performed with the Chi-square and independent t-test where appropriate. A P < 0.05 was considered statistically significant. Results: Of 787 infants referred, 293 (37.2%) had some form of ROP and 77 cases (9.8%) had plus disease, only 6 (2%) patients progressed to advanced ROP stages 4 and 5. The mean gestational age (GA) of patients with ROP (ROP group) was statistically significantly lower at 29.46 ± 2.31 weeks compared to patients without ROP (non-ROP group) (31.56 ± 2.03 weeks) (P < 0.05). The mean GA of patients with plus disease was statistically significantly lower at 28.92 ± 2.18 weeks compared to patients without plus disease (30.98 ± 2.30 weeks) (P < 0.05). The mean birth weight in the ROP group was statistically significantly lower at 1248.46 ± 301.75 g compared to the non-ROP group (1485.79 ± 268.66 g) (P < 0.05). The mean birth weight of patients with plus disease was statistically significantly lower at 1207.92 ± 334.79 g compared to patients without plus disease (417.99 ± 293.19 g) (P < 0.05). There was no difference in the occurrence of ROP or plus disease between single or multiple births, normal vaginal delivery, and caesarian section and between clomiphene users and nonusers (P > 0.05, all cases). Conclusion: Greater cooperation between ophthalmologists, neonatologists, gynecologists, and health policy makers is necessary to optimize ROP screening programs. Data from this study can be used by health policy makers for implementation of health programs. These programs must include screening guidelines and effective coordination among the screening centers, antenatal, obstetric, and neonatal care services. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/277/97922 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97925 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Cataract blindness, surgical coverage, outcome, and barriers to uptake of cataract services in Plateau State, Nigeria Odugbo, OP Mpyet, CD Chiroma, MR Aboje, AO Purpose: The purpose was to estimate the prevalence of blindness due to cataract, assess visual outcomes of cataract surgery, and determine the cataract surgical coverage rate and barriers to uptake of services among individuals aged 50 years or older in Plateau State, Nigeria. Materials and Methods: A population-based, cross-sectional survey of 4200 adults 50 years or older was performed. Multistage stratified random sampling, with probability proportional to size was used to select a representative sample. The Rapid Assessment of Cataract Surgical Services protocol was used. Statistical significance was indicated by (P < 0.05). Results: The cohort comprised 4115 subjects (coverage: 98%). The prevalence of bilateral blindness due to cataract was 2.1%, [95% confidence intervals (CI): 1.7-2.5%] in the entire cohort, 2.4% in females (95% CI: 1.8-3.8%); and 1.8% in males (95% CI: 1.2-2.4%) (χ<sup>2</sup> = 0.85, P > 0.05). The prevalence of monocular blindness due to cataract was 5.9% (95% CI: 5.2-6.6%). The cataract surgical coverage for subjects with visual acuity (VA) less 3/60 was 53.8% in the entire cohort; 60.5% for males and 48% for females (χ<sup>2</sup> = 2.49, P > 0.05). The couching coverage for subjects who were blind was 12%. A total of 180 eyes underwent surgical intervention (surgery or couching) for cataract, of which, 48 (26.7%) eyes underwent couching. The prevalence of bilateral (pseudo) aphakia was 1.5%, (95% CI: 1.2-1.9%) and 2.7% (95% CI: 2.2-3.2%) for unilateral (pseudo) aphakia. Visual outcomes of the 180 eyes that underwent surgical intervention were good (VA ≥ 6/18) in 46 (25.6%) eyes and poor (VA < 6/60) in 105 (58.3%) eyes. Uncorrected aphakia was the most common cause of poor outcome (65.1%). Most subjects who underwent cataract surgery were not using spectacles 74 (71.2%). Cost and lack of awareness were the main barriers to uptake of cataract surgery services. Conclusion: Couching remains a significant challenge in Nigeria. The outcomes of cataract surgery are poor with the lack of aphakic correction being the main cause of the poor outcomes. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/282/97925 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97927 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Retinopathy of prematurity: A study of prevalence and risk factors Mohamed, GB Othman, MF Background: Retinopathy of prematurity (ROP) is a serious complication of prematurity treatment and can lead to blindness unless recognized and treated early. Objective: The objective was to estimate the prevalence of ROP in preterm infants in the Neonatal Intensive Care Unit (NICU), to identify the risk factors which predispose to ROP, and to assess the outcome of these cases. Materials and Methods: A ROP prospective screening survey was performed enrolling all prematures admitted to the NICU from January 2009 to December 2010, with a gestational age of 32 weeks or less at birth and a birth weight of 1500 g or less. Infants whose gestational age was >32 weeks or birth weight was >1500 g were included if they were exposed to oxygen therapy for more than 7 days. A total of 172 infants (84 males and 88 females) had retinal evaluation by indirect ophthalmoscopy from the fourth postnatal week and followed up periodically. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis. Infants who progressed to stage 3 ROP were given laser therapy. Results: Out of the studied 172 infants, 33 infants (19.2%) developed ROP in one or both eyes; 18 (54.5%) cases stage 1, 9 (27.3%) cases stage 2, and 6 (18.2%) cases stage 3. None of the studied neonates presented ROP at stages 4 or 5. The six cases diagnosed as ROP stage 3 underwent laser ablative therapy. Univariate analysis showed that there was a significant relationship between the occurrence of ROP and gestational age (P = 0.000), sepsis (P = 0.004), oxygen therapy (P = 0.018), and frequency of blood transfusions (P = 0.030). However, an insignificant relationship was found between the occurrence of ROP and sex, mode of delivery, birth weight, respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, hypotension, phototherapy, duration of oxygen therapy, mechanical ventilation, and CPAP (all P > 0.05). Gestational age, sepsis, oxygen therapy, and frequency of blood transfusions remained significant variables after logistic regression analysis. Conclusion: The prevalence of ROP in this study was 19.2%; low gestational age, sepsis, oxygen therapy, and frequent blood transfusions were significant risk factors for ROP. Laser was effective in treatment and decreasing the progression of ROP. As this is a unit-based study, a comprehensive countrywide survey on ROP in Egypt is recommended to determine any regional differences in disease prevalence. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/289/97927 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97928 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Screening for diabetic retinopathy: The first telemedicine approach in a primary care setting in Bahrain Al, AE Ahmed, AA Purpose: To develop an integrated diabetic retinopathy screening program that uses telemedicine. Materials and Methods: In this evaluation of diagnostic technology, six telemedical screening units were established to cover all regions of Bahrain. The units were equipped with a digital fundus camera at the primary health care clinic. Fundus photographs were transmitted via the Internet to a centralized reading center. A retinal specialist at the reading center assessed the images. Results: From 2003 to 2009, 17,490 diabetic patients were screened. Of the screened patients, 20% were diagnosed with diabetic retinopathy. Of these cases, 31% required treatment. Conclusion: Telemedicine-based screening program is a feasible and efficient means of detecting diabetic retinopathy and providing treatment. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/295/97928 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97930 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Selective laser trabeculoplasty in Egyptian patients with primary open-angle glaucoma Abdelrahman, AM Eltanamly, RM Purpose: To assess the change in intraocular pressure (IOP) in Egyptian patients after selective laser trabeculoplasty (SLT) as a primary or adjunctive treatment for primary open-angle glaucoma (POAG). Materials and Methods: One hundred and six eyes with POAG were enrolled in this prospective study. Patients were divided into two groups: recently diagnosed cases with no preoperative medications (group 1) and; patients with confirmed glaucoma on medical therapy (group 2). All patients underwent 360° SLT. Patients were evaluated to 18 months postoperatively. Data were analyzed on postoperative changes in IOP, number of medications and complications. A P-value less than 0.05 was statistically significant. Results: A statistically significant drop in IOP occurred, from 19.55 ± 4.8 mmHg preoperatively, to16.03 ± 2.8 mmHg postoperatively (P< 0.001). Each group had a statistically significant drop in IOP (P< 0.001). There was a statistically significant decrease in the number of medications in group 2 from 2.25 ± 0.97 medications preoperatively to 1.0 ± 1.3 medications postoperatively (P=0.004). No serious complications occurred for the duration of the study. Conclusion: SLT can be safely and effectively used as primary or adjunctive therapy for the treatment of POAG. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/299/97930 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97931 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Efficacy, predictability, and safety of laser-assisted subepithelial keratectomy for the treatment of myopia and myopic astigmatism Al-Tobaigy, FM Purpose: The purpose was to report the refractive and visual outcomes of laser-assisted subepithelial keratectomy (LASEK) for the treatment of myopia. Materials and Methods: A retrospective, noncomparative consecutive case series of 173 of 91 patients who had undergone LASEK is presented. Primary outcome variables included uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, epithelialization time, pain, haze, and complications. Results: Preoperatively, the mean spherical equivalent (SE) was −3.71 ± 1.63 D (range, −0.875 D to 8.25 D), and the mean LogMAR BSCVA was −0.0374 ± 0.0767 D (range, −0.47 D to 0.00 D). On the final visit, the mean SE was −0.05 ± 0.335 D (range, −1.63 D to 1.00 D), the mean LogMAR UCVA was 0.04674 ± 0.0771 D (range, −0.3010 D to 0.1249 D) and the mean LogMAR BSCVA was −0.0164 ± 0.0497 (range −0.3010 to 0.124). All eyes achieved vision of 20/40 or better, and 83.2% of the eyes achieved a vision of 20/25 or better. One 64 (94.94%) and all the eyes were within ± 0.50 D and ± 1.00 D of the attempted correction respectively. Complete epithelialization occurred in 4.70 ± 2.09 days (range, 2-10 days). At the final visit, 79.7% of eyes had a clear cornea. Grade 1 haze developed in 17.34% of the eyes, grade 2 haze developed in 2.89% of eyes developed; no eyes developed grade 3 or 4 haze. Conclusions: LASEK is a safe, effective, and predictable method for the treatment of myopia and myopic astigmatism. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/304/97931 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97932 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Development and validation of an Arabic version of the visual functioning index VF-14 for cataract patients Mousa, A Kalantan, H Purpose: To develop and validate an Arabic version of the Visual Functioning Index (VF-14) for patients with cataracts. Materials and Methods: The VF-14 was translated into Arabic by an epidemiologist and an ophthalmologist, both fluent in Arabic and English. The VF-14 was administered to patients diagnosed with cataract at two hospitals in Egypt and two hospitals in Saudi Arabia. Patients were also administered three other forms; the cataract symptoms score (CSS); global measure of vision; and cataract medical form. Internal reliability and external validity were measured. Index sensitivity to visual acuity was detected and potential effective factors were investigated. Correlation analyses were performed. A p value less than 0.05 was considered statistically significant. Results: The translated VF-14 was consistent and reliable (σ = 0.763, p < 0.0001). It was also statistically significantly sensitive to vision (p < 0.0001). The mean calculated index was 62.18 ± 19.34, and was highly correlated with; CSS and other scores (p < 0.0001, all cases). Factors that may affect the index are; age, sex, vision, wearing glasses, type, position, and severity of cataract. Conclusion: The Arabic VF 14 is a reliable and valid tool for evaluation of both visual functioning and quality of visual life among cataract patients. It is also sensitive to changes in visual acuity, demographic, and clinical characteristics. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/309/97932 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97936 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Effects of inhaled fluticasone on intraocular pressure and central corneal thickness in asthmatic children without a family history of glaucoma Alsaadi, MM Osuagwu, UL Almubrad, TM Purpose: The aim of this study is to report the effects of fluticasone-inhaled corticosteroid on intraocular pressure (IOP) and central corneal thickness (CCT) of asthmatic children without a family history of glaucoma. Materials and Methods: In this prospective study, 93 children were divided into two groups: 69 asthmatic children with no family history of glaucoma who were taking inhaled fluticasone propionate 250 μg daily for at least 6 months (Group 1) and 24 age-matched control subjects without asthma (Group 2). Three measurements each, of IOP and CCT, were performed with a hand-held noncontact tonometer and a noncontact specular microscope, respectively, over a 12-week period. The order of IOP and CCT measured were randomized at each visit. Between-group comparison and the relationship between CCT and IOP measurements were investigated. P < 0.05 was statistically significant. Results: The mean age was 8 ± 2.4 years (range, 5−15 years) and 9 ± 2.9 years (range, 5−15 years) for Groups 1 and 2, respectively (P = 0.1337). The mean IOP was 14 ± 3.3 mmHg (range, 10−24 mmHg) and 14 ± 2.9 mmHg (range, 11−22 mmHg) for Groups 1 and 2, respectively (P = 0.3626). The mean CCT was 531 ± 30.1 μm (range, 467−601 μm) and 519 ± 47.0 μm (range, 415589 μm) for Groups 1 and 2, respectively (P = 0.1625). There was a weak but statistically significant correlation between IOP and CCT in Group 1 (Pearson's R = 0.3580, P = 0.0025). Conclusions: Inhaled fluticasone at the regular dose used in this study over a short period (6-24 months) was not associated with a significant effect on CCT and IOP measured with noncontact devices in asthmatic children between 5 and 15 years, without a family history of glaucoma. A weak correlation between IOP and CCT values in asthmatic children did exist. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/314/97936 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97939 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Olive-harvesting eye injuries Yulish, M Pikkel, J Purpose: To document the types of ocular trauma that occurs during the olive-harvesting season in a region of the Middle East. Materials and Methods: Ophthalmic assessments of all patients were performed by one ophthalmologist. Examinations included visual acuity, slit-lamp evaluation of the anterior segment, intraocular pressure measurement and posterior segment assessment after pupil dilatation. Results: The study cohort comprised 119 patients who presented for ocular injury due to olive harvesting. Seven patients (5.9%) had severe ocular trauma. Two of these patients presented with corneal perforation, and five with retinal edema. Six patients with severe ocular injury were male. Conclusions: Ocular injuries are common when olives were harvested manually or with sticks. A preventive program to reduce injury should consider environmental and cultural factors. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/320/97939 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97941 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center Zare, M Javadi, MA Einollahi, B Karimian, F Feizi, S Azimzadeh, A Purpose: The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Materials and Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. Results: During this period, 1859 eyes of 1624 patients with a mean age of 41.3 ± 21.3 years underwent corneal transplantation. The most common indication was keratoconus (38.4%) followed by aphakic/pseudophakic bullous keratopathy (11.7%), previous failed grafts (10.6%), infectious corneal ulcers (10.1%), non-herpetic corneal scars (7.6%), trachoma keratopathy (4.7%), stromal corneal dystrophies (4.6%), post-herpetic corneal scar (3.7%), Fuchs' endothelial dystrophy (0.8%), and congenital hereditary endothelial dystrophy (0.4%). Techniques of corneal transplantation included penetrating keratoplasty (PKP; 70.9%), deep anterior lamellar keratoplasty (DALK; 20.1%), conventional lamellar keratoplasty (LKP; 4.4%), and Descemet's stripping automated endothelial keratoplasty (DSAEK; 2.3%). Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Conclusion: Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications and surgical techniques were observed from 2004 to 2009. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/323/97941 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97945 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparison of levobupivacaine 0.5% or bupivacaine 0.5% both in a mixture with lidocaine 2% for superficial extraconal blockade Ahmad, N Zahoor, A Al, AA Al, JS Riad, W Purpose: To evaluate the quality and efficacy of Peribulbar blockade for superficial extraconal anesthesia with levobupivacaine 0.5% versus bupivacaine 0.5%, both combined with lidocaine 2% for patients undergoing phacoemulsification. Materials and Methods: In this prospective, double blind study, 150 patients were randomly divided into two groups: group-1 received a Peribulbar block (PB) with a mixture of evobupivacaine 0.5% and lidocaine 2% while group-2 received a PB with a mixture of bupivacaine 0.5% and lidocaine 2%. The block was performed by insertion of a short needle (15 mm) in infra-temporal space just above inferior orbital notch. An initial volume of 6 9 ml of either mixture was injected until total upper eyelid drop. Akinesia score was assessed at 2, 5, and 10 min after the block. The degree of pain was assessed by a verbal rating scale immediately after block, at the end of surgery and 4 h postoperatively. The patients and surgeons were asked to rate their satisfaction level of the quality of block postoperatively. Data were analyzed with the unpaired, two-tailed t-test and the Chi-square test as appropriate. P < 0.05 was considered statistically significant. Results: There were no significant differences between groups with respect to the akinesia score (P = 0.2) at 2, 5, and 10 min, the number of supplementary injections (P = 0.84) and initial and total required volume of local anesthetics (P = 0.80 and 0.81, respectively). There was no significant difference between the groups regarding surgeon and patient satisfaction (P = 0.53 and P = 0.74, respectively). Similarly the verbal rating scales assessed at three different occasions were not significantly different between the groups (P > 0.05 all cases). The need for additional intra-operative topical anesthetic was also similar between the groups. (P = 0.69). Conclusions: Superficial extra-conal block with a mixture of levobupivicaine 0.5% and lidocaine 2% or bupivicaine 0.5% and lidocaine 2% provides similar block quality and efficacy. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/330/97945 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97948 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral traumatic expulsive aniridia after phacoemulsification Oltra, EZ Chow, CC Lunde, MW We report a case of bilateral traumatic expulsive aniridia after uneventful phacoemulsification through small clear corneal incisions. Phacoemulsification was performed 8 and 13 months prior to the trauma in the left and right eyes, respectively. In both eyes, the intraocular lens and capsular bag were undisturbed after trauma. After resolution of hyphema, transient elevated intraocular pressure, and anterior chamber inflammation, best corrected visual acuity returned to 20/25 in each eye 6 months later. Self-sealing clear corneal wounds likely serve as a decompression valve during blunt trauma, thus preventing devastating intraocular damage and globe rupture. The intraocular lens may absorb the external force, therefore preventing damage to the capsular bag and zonules as well as preventing prolapse of posterior structures. A review of previously reported cases of traumatic aniridia is also presented. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/334/97948 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97953 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Imaging studies in a case of infectious scleritis after pterygium excision Nguyen, P Yiu, SC A 44-year-old woman presented with a painful red eye for 2 weeks. Ultrasound biomicroscopy and optical coherence tomography were instrumental in the diagnosis and management of this case of infectious scleritis associated with previous pterygium excision complicated by choroidal and retinal detachments. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/337/97953 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97957 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Optic nerve thickening and infarction as the first evidence of orbital involvement with mucormycosis Alsuhaibani, AH Al-Thubaiti, G We report a 53-year-old female with uncontrolled diabetes mellitus who presented with decreased vision in the right eye for a few hours duration. Orbital computed tomography and magnetic resonance imaging were performed at presentation and showed a thickening and infarction of the right optic nerve with no other orbital abnormalities. A few days later, the patient developed necrosis in the region of the right medial canthus and nasal mucosa. Tissue biopsy confirmed the diagnosis of mucormycosis. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/340/97957 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97960 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Spontaneous, uncomplicated dissolution of a large cotton fiber in the laser in situ keratomileusis interface Prakash, G Sharma, N Choudary, V Titiyal, JS In this article, we report the spontaneous dissolution of a long cotton thread in the laser in situ keratomileusis (LASIK) flap interface. In this observational case report, sequential follow-up of a post-LASIK eye with a long cotton fiber noticed in the LASIK interface was performed. The postoperative course was uneventful, with no evidence of infection, uveitis, or any other complications. The cotton thread underwent spontaneous dissolution. Conservative management of a cotton fiber, not causing any symptoms and noticed after the immediate postoperative follow-up period is over, seems to be a possible alternative to flap relift and intervention. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/343/97960 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97962 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Vitreous asteroid hyalosis prolapse into the anterior chamber simulating iris metastasis Shields, CL Romanelli-Gobbi, M Lally, SE Shields, JA Two asymptomatic elderly women who underwent cataract extraction 7 or more years previously and with intraocular lens placement presented with a linear bead-like white multinodular mass in the inferior angle simulating iris metastasis versus large inflammatory precipitates. There was no iris infiltration. In the first case, the posterior lens capsule was intact and there was no evidence of gelatinous vitreous in the anterior chamber, whereas in the second case, the capsule was open and there was gelatinous vitreous prolapse. In both cases, there was asteroid hyalosis in the vitreous. Both patients were diagnosed with prolapsed vitreous asteroid hyalosis into the anterior chamber and managed with observation. Vitreous asteroid hyalosis can prolapse into the anterior chamber of pseudophakic elderly patients with or without capsular opening and can simulate an intraocular tumor. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/346/97962 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97965 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Dirofilaria in the anterior chamber: A rare occurrence Chopra, R Bhatti, SM Mohan, S Taneja, N Dirofilariasis is a parasitic infection of the carvivores that may present as a zoonotic infestation in humans. Systemic involvement in man is subcutaneous, pulmonary, or ocular. We report a rare occurrence of ocular dirofilariasis in a 25-year-old male patient who presented with pain and redness in the eye. A live, white, coiled, and highly motile worm was present in the anterior chamber. The worm, however, could not be detected in the anterior chamber, posterior segment, or the angle of the anterior chamber when the patient was taken to the operating room for surgical removal of the worm. The patient was made to lie prone till the worm reappeared in the anterior chamber and was removed by paracentesis. The worm was identified as Dirofilaria repens on the basis of microscopic and histopathological examination. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/349/97965 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:97968 2012-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Successful removal of a conjunctival myxoma Al-Ghadeer, H Al-Assiri, A Al-Odhaib, S Alkatan, H A 45-year-old woman presented with conjunctival myxoma in the right eye. A mixture of healon and trypan blue solution 0.06 mg was injected through a 27-gauge needle into the conjunctiva to delineate the lesion to achieve complete removal. This technique is effective in delineating the myxoma while preserving its integrity during removal. It may also help in lowering recurrence. Medknow Publications 2012-07-01 http://www.meajo.org/text.asp?2012/19/3/352/97968 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102738 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Are we slowly erasing "Idiopathic" from our ophthalmic vocabulary? Meyer, D Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/355/102738 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102739 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
The short to medium-term risks of intracameral phenylephrine Williams, GS Radwan, M Kadare, S Purpose: To compare outcomes and complications of patients undergoing phacoemulsification with and without the administration of intracameral phenylephrine. Materials and Methods: In this retrospective study, a chart review was performed. Two groups with an equal number of patients who did or did not receive intracameral phenylephrine during phacoemulsification were compared for differences in outcomes, risk factors and complications. The Chi-square test was used for comparison between groups. P<0.05 was statistically significant. Results: The two groups were well matched with regard to preoperative ophthalmic and systemic risk factors for complications and had very similar phacoemulsification power and time profiles. No differences in outcome were detected (P>0.05, all comparisons). Conclusion: This retrospective study suggests that intracameral phenylephrine normalizes the intraoperative risk of small pupil cataract surgery and is not associated with an increased risk of systemic or postoperative ophthalmic complications. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/357/102739 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102740 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Isolates and antibiotic resistance of culture-proven endophthalmitis cases presented to a referral center in Tehran Falavarjani, KG Nekoozadeh, S Modarres, M Parvaresh, MM Hashemi, M Soodi, R Alemzadeh, SA Purpose: To evaluate the spectrum of organisms causing endophthalmitis and their resistance pattern to standard antimicrobial agents. Materials and Methods: Medical records of culture positive eyes treated at Rassoul Akram Hospital for endophthalmitis during the past 5 years were reviewed. Specimens were obtained during pars plana vitrectomy or vitreous tap. Results: Sixty-five isolates including 36 (55.4%) gram-positive organisms, 28 gram-negative organisms (43.1%), and 1 (1.5%) fungus were studied. The most common organism identified was Coagulase-negative staphylococcus in 16 eyes (24.6%). Among the antibiotics available for intravitreal injection, the least antibiotic resistance was for vancomycin in gram-positive organisms and amikacin and ceftazidime in gram-negative isolates. Conclusions: Gram-positive isolates were the most prevalent organisms; however, a high isolation rate for gram-negative organisms was obtained. Considering that no single antibiotic provides coverage for all of the organisms, a combination therapy using vancomycin/amikacin or vancomycin/ceftazidime seems to be useful as the initial empiric treatment of suspected bacterial endophthalmitis. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/361/102740 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102741 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Cataract blindness in Osun state, Nigeria: Results of a survey Kolawole, OU Ashaye, AO Mahmoud, AO Adeoti, CO Purpose: To estimate the burden of blindness and visual impairment due to cataract in Egbedore Local Government Area of Osun State, Nigeria. Materials and Methods: Twenty clusters of 60 individuals who were 50 years or older were selected by systematic random sampling from the entire community. A total of 1,183 persons were examined. Results: The age- and sex-adjusted prevalence of bilateral cataract-related blindness (visual acuity (VA) < 3/60) in people of 50 years and older was 2.0% (95% confidence interval (CI): 1.6-2.4%). The Cataract Surgical Coverage (CSC) (persons) was 12.1% and Couching Coverage (persons) was 11.8%. The age- and sex-adjusted prevalence of bilateral operable cataract (VA < 6/60) in people of 50 years and older was 2.7% (95% CI: 2.3-3.1%). In this last group, the cataract intervention (surgery + couching) coverage was 22.2%. The proportion of patients who could not attain 6/60 vision after surgery were 12.5, 87.5, and 92.9%, respectively, for patients who underwent intraocular lens (IOL) implantation, cataract surgery without IOL implantation and those who underwent couching. "Lack of awareness" (30.4%), "no need for surgery" (17.6%), cost (14.6%), fear (10.2%), "waiting for cataract to mature" (8.8%), AND "surgical services not available" (5.8%) were reasons why individuals with operable cataract did not undergo cataract surgery. Conclusions: Over 600 operable cataracts exist in this region of Nigeria. There is an urgent need for an effective, affordable, and accessible cataract outreach program. Sustained efforts have to be made to increase the number of IOL surgeries, by making IOL surgery available locally at an affordable cost, if not completely free. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/364/102741 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102742 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence of refractive errors among school children in Gondar town, northwest Ethiopia Yared, AW Belaynew, WT Destaye, S Ayanaw, T Zelalem, E Purpose: Many children with poor vision due to refractive error remain undiagnosed and perform poorly in school. The situation is worse in the Sub-Saharan Africa, including Ethiopia, and current information is lacking. The objective of this study is to determine the prevalence of refractive error among children enrolled in elementary schools in Gondar town, Ethiopia. Materials and Methods: This was a cross-sectional study of 1852 students in 8 elementary schools. Subjects were selected by multistage random sampling. The study parameters were visual acuity (VA) evaluation and ocular examination. VA was measured by staff optometrists with the Snellen E-chart while students with subnormal vision were examined using pinhole, retinoscopy evaluation and subjective refraction by ophthalmologists. Results: The study cohort was comprised of 45.8% males and 54.2% females from 8 randomly selected elementary schools with a response rate of 93%. Refractive errors in either eye were present in 174 (9.4%) children. Of these, myopia was diagnosed in 55 (31.6%) children in the right and left eyes followed by hyperopia in 46 (26.4%) and 39 (22.4%) in the right and left eyes respectively. Low myopia was the most common refractive error in 61 (49.2%) and 68 (50%) children for the right and left eyes respectively. Conclusions: Refractive error among children is a common problem in Gondar town and needs to be assessed at every health evaluation of school children for timely treatment. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/372/102742 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102743 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparing the rate of regression after conductive keratoplasty with or without prior laser-assisted in situ keratomileusis or photorefractive keratectomy Moshirfar, M Anderson, E Hsu, M Armenia, JM Mifflin, MD Purpose: To assess the regression rate of conductive keratoplasty (CK) in patients with or without previous laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Setting: University of Utah, Medical School, John A. Moran Eye Center, Salt Lake City, Utah. Materials and Methods: A retrospective, age-matched chart review identified records of 6 patients who underwent CK after refractive surgery and 12 patients who underwent CK without prior refractive surgery. The main outcome measures were postoperative uncorrected and corrected visual acuities and refraction changes over time. Results: Preoperatively, the mean manifest refraction spherical equivalent (MRSE) of the 15 eyes (12 patients) that underwent CK without refractive surgery was 0.83 diopters (D) and the 7 eyes (6 patients) that underwent CK after refractive surgery had an average MRSE of 0.27 D. Postoperatively, the mean MRSE of the refractive surgery patients was -0.86 D at 6 months, regressing to -0.67 D at 12 months. The postoperative MRSE in the eyes without refractive surgery was -0.58 D. at 6 months, regressing to -0.38 D at 12 months. The rate of regression was linear in both groups, calculated at 0.033 D per month in all patients. Conclusions: Patients with previous LASIK or PRK showed a greater treatment response to CK but regressed at a similar rate as those eyes without prior LASIK or PRK. Overall CK is a safe procedure that inevitably regresses. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/377/102743 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102744 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Survey of low vision among students attending schools for the blind in Nigeria: A descriptive and interventional study Mosuro, AL Ajaiyeoba, AI Bekibele, CO Eniola, MS Adedokun, BA Purpose: The aim of this study is to determine the prevalence of low vision among students attending all the schools for the blind in Oyo State, Nigeria. The study set out to determine the proportion of students with low vision/severe visual impairment after best correction, to determine the causes of the low vision, to document the associated pathologies, to determine the types of treatment and visual aid devices required, and to provide the visual aids needed to the students in the schools. Materials and Methods: All schools students for the blind in Oyo State were evaluated between August 2007 and January 2008. All the students underwent a thorough ophthalmic examination that included measurement of visual acuity, retinoscopy and subjective refraction, tests for visual aids where indicated, and a structured questionnaire was administered. Results: A total of 86 students were included in the study and the mean age was 19.4 ± 8.19 years. Twenty six (30%) were under 16 years of age. The most common cause of blindness was bilateral measles keratopathy/vitamin A deficiency (VAD) in 25 students (29.1%). The most common site affected was the cornea in 25 students (29.1%), the lens in 23 (26.7%), and the retina/optic nerve in 16 (18.6%). Preventable blindness was mainly from measles keratopathy/VAD (29.1%). Eleven students benefited from refraction and correction with visual aids; two having severe visual impairment (SVI), and nine having visual impairment (VI) after correction. Conclusion: The prevalence of low vision in the schools for the blind in Oyo State is 2.3%, while the prevalence of visual impairment is 10.5%. These results suggest that preventable and treatable ocular conditions are the source of significant childhood blindness in Oyo State. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/382/102744 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102745 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
The effect of software upgrade on optical coherence tomography measurement of the retinal nerve fiber layer thickness Seibold, LK Kahook, MY Purpose: To determine the effect of software upgrades on retinal nerve fiber layer (RNFL) thickness measurements taken by spectral domain optical coherence tomography (SD-OCT). Methods: Eighty normal eyes (40 patients) were scanned for RNFL thickness measurements using Spectralis (Heidelberg Engineering, Heidelberg, Germany) SD-OCT. Scan analysis was performed using version 4.0 software and then reanalyzed with version 5.1.3. Student paired t testing and Pearson's correlation coefficient were used for statistical analysis. Results: Average and quadrant RNFL thicknesses generated using version 4.0 and 5.1.3 software on Spectralis demonstrated high correlation (r = 0.955-0.998). Average RNFL thickness using version 4.0 was 0.08΅m thinner than version 5.1.3 (p = 0.409). Quadrant RNFL differences ranged from -0.26 to +0.97΅m (p = 0.146-0.915). Segmentation errors were reduced 33% after the upgrade. Conclusion: Minor RNFL thickness changes may occur after software upgrades in Spectralis OCT. The differences did not reach statistical significance but segmentation errors were improved. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/392/102745 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102746 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Analysis of familial aggregation in total, against-the-rule, with-the-rule, and oblique astigmatism by conditional and marginal models in the Tehran eye study Rakhshani, MH Mohammad, K Zeraati, H Nourijelyani, K Hashemi, H Fotouhi, A Purpose: The purpose was to determine the familial aggregation of the total, against-the-rule (ATR), with-the-rule (WTR), and oblique astigmatism by conditional and marginal models in the Tehran Eye Study. Materials and Methods: Total, ATR, WTR, and oblique astigmatism were studied in 3806 participants older than 5 years from August 2002 to December 2002 in the Tehran Eye Study. Astigmatism was defined as a cylinder worse than or equal to −0.5 D. WTR astigmatism was defined as 0 ± 19°, ATR astigmatism was defined as 90 ± 19°, and oblique when the axes were 20-70° and 110-160°. The familial aggregation was investigated with a conditional model (quadratic exponential) and marginal model (alternating logistic regression) after controlling for confounders. Results: Using the conditional model, the conditional familial aggregation odds ratios (OR) (95% confidence interval) for the total, WTR, ATRs, and oblique astigmatism were 1.49 (1.43-1.72), 1.91 (1.65-2.20), 2.00 (1.70-2.30), and 1.86 (1.37-2.54), respectively. In the marginal model, the marginal OR of the parent-offspring and sib-sib in the total astigmatism were 1.35 (1.13-1.63) and 1.54 (1.13-2.11), respectively; WTR 1.53 (1.06-2.20) and 1.94 (1.21-3.13) and; ATR 2.13 (1.01-4.50) and 2.23 (1.52-3.30). The model was statistically significant in sib-sib relationship only for oblique astigmatism with OR of 3.00 (1.25-7.20). Conclusion: The results indicate familial aggregation of astigmatism in the population in Tehran adjusted for age, gender, cataract, duration of education, and body mass index, so that the addition of a new family member affected with astigmatism, as well as having a sibling or parents with astigmatism, significantly increases the odds of exposure to the disease for all four phenotypes. This aggregation can be due to genetic and/or environmental factors. Dividing astigmatism into three phenotypes increased the odds ratios. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/397/102746 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102759 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Exfoliation syndrome in Nigeria Olawoye, OO Ashaye, AO Teng, CC Liebmann, JM Ritch, R Ajayi, BG Purpose: The purpose of this study was to estimate the prevalence of exfoliation syndrome (XFS) and its association with ocular disease in patients attending the eye clinic of the University College Hospital (UCH) in Ibadan, Nigeria. Materials and Methods: A total of 448 consecutive new patients, aged 30-90 years who presented to the eye clinic of UCH between December 2009 and November 2010 were evaluated. Each patient had a complete ophthalmic examination. Patients with exfoliative material on the anterior lens surface and/or pupillary margin in either or both eyes were considered to have XFS. Means, standard deviation, and 95% confidence intervals were calculated. Results: All the patients examined were from the southern part of Nigeria. Majority (94.2%) were of the Yoruba tribe from southwestern Nigeria, while 5.8% were from southeastern Nigeria. The mean age of the study cohort was 58.5 ± 13.8, 54.8% were males, 12 (2.7%) had XFS. All patients with XFS were of the Yoruba tribe, with a mean age 65.6 ± 5.6 years. There was a male predilection (66.7%). All eyes with XFS had lenticular opacities. XFS was bilateral in eight patients (66.7%) of whom seven patients (87.5%) had glaucoma and lenticular opacities bilaterally. Conclusion: This is the first report of the existence of XFS in Nigeria. Larger studies are necessary in this population to further investigate the disease. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/402/102759 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102760 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular adnexal reactive lymphoid hyperplasia in children Al-Mujaini, A Wali, U Ganesh, A Al-Hadabi, I Burney, I Aim: To describe the clinical and histopathological features of ocular reactive lymphoid hyperplasia in children, and review the literature regarding this entity. Materials and Methods: In this retrospective, interventional case series, a chart review was performed of three patients diagnosed with reactive lymphoid hyperplasia. Details of clinical presentation, ocular and systemic examination findings, management and subsequent course were noted. Results: Three children, aged 9-14 years presented with ocular adnexal masses (two unilateral and one bilateral) with 7-12 months duration. Ocular examination revealed discrete nasal conjunctival masses in two patients, and bilateral eyelid fullness and conjunctival chemosis in the third patient. Systemic evaluation and laboratory tests were normal in all patients. Orbital imaging showed lacrimal gland enlargement in one patient. Histopathological evaluation with immunohistochemical markers established the diagnosis of reactive lymphoid hyperplasia. Two patients underwent surgical excision with complete resolution. All patients have remained stable and at their last follow-up have showed no evidence of recurrence, transformation, or systemic involvement. Conclusion: Reactive lymphoid hyperplasia, though uncommon in children, can have a favorable outcome with timely intervention Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/406/102760 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102762 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral exudative retinal detachment as a presenting sign of acute lymphoblastic leukemia Chinta, S Rani, PK Manusani, U Acute lymphoblastic leukemia (ALL) can present with various ocular complications but exudative retinal detachment is a rare complication. A 36-year-old healthy young adult male presented with gradual decrease in the vision in both eyes over nearly 2 weeks. His best-corrected visual acuities were 20/50 and 20/25 at distance and N12 and N10 at near in the right and left eyes, respectively. Fluorescein angiography and optical coherence topography indicated bilateral exudative retinal detachment. Systemic workup revealed a marked increase in the number of white blood cells with 30% blast cells and immunophenotyping revealed common acute lymphoblastic leukemia-associated antigen (CALLA) positive precursor B-cell lymphoblastic leukemia. Cerebrospinal fluid (CSF) tap was negative. The patient started systemic chemotherapy and steroids. Bilateral exudative retinal detachment may be a presenting sign of acute lymphoblastic leukemiaALL in an otherwise healthy young adult. Clinicians should be aware of the possibility of leukemia in such patients. A simple blood investigation such as complete blood profile confirms the diagnosis. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/410/102762 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102763 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Successful visual rehabilitation in a case of anterior megalophthalmos Hegde, V Jain, R Bappal, A We report a case of 40-year-old female who presented with diminution of vision in both eyes. Ocular evaluation showed presence of bilateral megalocornea with deep anterior chamber, iridodonesis, cataract, and anterior embryotoxon. She was diagnosed with bilateral anterior megalophthalmos. She underwent an uneventful cataract extraction with standard posterior chamber intraocular lens implantation of overall large diameter in the left eye. Zonular dialysis was not evident intraoperatively despite the presence of iridodonesis. Postoperatively the intraocular lens was well centered throughout follow up. This case report reviews this rare disorder and highlights successful visual rehabilitation. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/413/102763 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102764 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Surgically mismanaged ptosis in a patient with congenital fibrosis of the extraocular muscles type I Tawfik, HA Rashad, MA Fibrosis syndromes comprise a rare form of severe limitation of ocular motility. An 11-year-old girl was referred for the correction of eyelid retraction. The eyelid retraction occurred immediately following levator resection surgery performed by a plastic surgeon who missed the restrictive extraocular muscle abnormalities. On examination, both eyes were fixed in an infraducted position (20 prism diopters (Δ)), with a chin-up position and significant lagophthalmos. Bilateral 12-mm inferior rectus recession with adjustable sutures was performed, which resulted in significant reduction of lagophthalmos and elimination of the head tilt. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/416/102764 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102765 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Amniotic membrane transplantation in surgically induced necrotizing scleritis with peripheral ulcerative keratitis Thatte, S Gupta, L A case of surgically induced necrotizing scleritis (SINS) after manual small incision cataract surgery that was associated with peripheral ulcerative keratitis (PUK) at a different site. Neither pathology responded to systemic steroids and progressed to become sight threatening, which is unusual. Progression of SINS was aggressive enough to cause a limbal wound gape, similarly PUK extended up to Descemet's membrane and emergency amniotic membrane transplantation (AMT) was required to save the globe. AMT may regress the scleral and corneal melting successfully. It is not common to observe SINS with PUK at a different site that is unresponsive to systemic steroids. AMT, though palliative treatment, was effective at treating this condition successfully. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/419/102765 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102766 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Confoscan: An ideal therapeutic Aid and screening tool in acanthamoeba keratitis Al, KN Wali, UK Although present worldwide, Acanthamoeba keratitis (AK) is a rare condition. It is a protozoal infection of the eye that is generally caused by wearing contaminated contact lenses or lens solutions. Confoscan and confocal scanning laser tomography (CSLT) are in vivo noninvasive diagnostic tools which provide high definition images of corneal microstructures. Laser in situ keratomileusis (LASIK) is a very common refractive surgery. We report a case series in which the first patient had contact lens induced Acanthamoeba keratitis with corneal epitheliopathy that was unresponsive to conservative treatment. Epithelial debridement was performed based on confoscan findings which confirmed the presence of Acanthamoeba cysts. Subsequently, the cornea re-epithelialized over two days. Another patient had CSLT prior to the LASIK which showed stromal cyst-like structures suggestive of Acanthamoeba keratitis. Four months after medical therapy, repeat CSLT was negative for Acanthamoeba cysts. Third patient was diagnosed with Acanthamoeba infection after undergoing lamellar keratoplasty. CSLT should be used as a screening procedure prior to any corneal refractive surgery to detect and treat protozoal and other infections preoperatively. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/422/102766 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102767 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Primary localized amyloidosis presenting as a tarsal mass: Report of two cases Kamal, S Goel, R Bodh, SA Madhu Amyloidosis and its ophthalmic manifestations are rare. The unusual presentation can result in diagnostic delay and increase ocular morbidity. Additionally, there are various predisposing conditions and systemic involvement can affect various organs. Hence, localized disease warrants a thorough clinical evaluation and laboratory investigation. We report two cases of primary localized amyloidosis presenting as a tarsal mass and ptosis. The diagnosis was established on histopathology. There were no predisposing conditions and no systemic involvement. The disease was probably related to the local immunocyte disorder. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/426/102767 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102769 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Ethmocephaly with amniotic band syndrome Das, G Gayen, S Bandyopadhyay, S Das, D Ethmocephaly is the rarest form of holoprosencephaly, which occurs due to an incomplete cleavage of the forebrain. Clinically, the disease presents with a proboscis, hypotelorism, microphthalmos and malformed ears. Amniotic band syndrome is another rare congenital malformation with ring-like constriction bands in the limbs, head, face or trunk. We present a case of ethmocephaly with amniotic band syndrome, which is likely the first of its kind, published in the literature. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/429/102769 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102770 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Long-term management of orbital and systemic reactive lymphoid hyperplasia with rituximab Chen, A Hwang, TN Phan, LT McCulley, TJ Yoon, MK Rituximab, a monoclonal antibody to the B cell marker CD20, is becoming increasingly popular in the treatment of various orbital disorders. In this university-based interventional case series, we describe two patients with bilateral orbital and extra-orbital reactive lymphoid hyperplasia (RLH) treated with rituximab. Initially both had favorable responses; but roughly a year later recurrent disease necessitated maintenance therapy in both cases. Both again responded to additional courses of rituximab. Although recalcitrant disease may persist after treatment, rituxmab may play a role in the management of RLH with widespread involvement. Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/432/102770 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102772 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Multifocal cysticercosis and optical coherence tomography Wiwanitkit, V Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/436/102772 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102773 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Authors' reply Agarwal, M Jha, V Chaudhary, SP Singh, AK Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/436/102773 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:102774 2012-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Preoperative subconjunctival injection of mitomycin C as an adjunctive treatment 24 hours before excision of primary pterygium Gupta, VP Gupta, P Medknow Publications 2012-10-01 http://www.meajo.org/text.asp?2012/19/4/437/102774 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106378 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Ocular therapeutics of the future Yiu, SC Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/1/106378 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106382 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Strategies for local gene therapy of corneal allograft rejection Nguyen, P Yiu, SC Penetrating keratoplasty is the most common type of tissue transplant in humans. Irreversible immune rejection leads to loss of vision and graft failure. This complex immune response further predisposes future corneal transplants to rejection and failure. A diverse armamentarium of surgical and pharmacologic tools is available to improve graft survival. In this review, we will discuss the various gene therapeutic strategies aimed at potentiating the anterior chamber-associated immune deviation to extend graft survival. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/11/106382 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106384 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Nanotechnology approaches for ocular drug delivery Xu, Q Kambhampati, SP Kannan, RM Blindness is a major health concern worldwide that has a powerful impact on afflicted individuals and their families, and is associated with enormous socio-economical consequences. The Middle East is heavily impacted by blindness, and the problem there is augmented by an increasing incidence of diabetes in the population. An appropriate drug/gene delivery system that can sustain and deliver therapeutics to the target tissues and cells is a key need for ocular therapies. The application of nanotechnology in medicine is undergoing rapid progress, and the recent developments in nanomedicine-based therapeutic approaches may bring significant benefits to address the leading causes of blindness associated with cataract, glaucoma, diabetic retinopathy and retinal degeneration. In this brief review, we highlight some promising nanomedicine-based therapeutic approaches for drug and gene delivery to the anterior and posterior segments. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/26/106384 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106379 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal ectasias: Study cohorts and epidemiology Bialasiewicz, A Edward, DP Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/3/106379 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106385 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Future perspectives for regenerative medicine in ophthalmology Elisseeff, J Madrid, MG Lu, Q Chae, JJ Guo, Q Repair and reconstruction of the cornea has historically relied on synthetic materials or tissue transplantation. However, the future holds promise for treatments using smart biomaterials and stem cells that direct tissue repair and regeneration to ultimately create new ocular structures that are indistinguishable from the original native tissue. The cornea is a remarkable engineering structure. By understanding the physical structure of the tissue and the resulting impact of the structure on biological function, we can design novel materials for a number of ophthalmic clinical applications. Furthermore, by extending this structure-function approach to characterizing corneal disease processes, new therapies can be engineered. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/38/106385 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106386 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Efficacy and safety of intacs SK in moderate to severe keratoconus Hantera, M Purpose: To examine the safety and efficacy of Intacs SK for moderate to severe keratoconus (KC) using femtosecond technology. Materials and Methods: This prospective, non-comparative study included 37 contact lens intolerant keratoconic eyes (stage II-III) of 24 patients who underwent femtosecond-assisted Intacs SK implantation. Inclusion criteria were mean K readings <56.00 D, corneal thickness >400 μm at the incision site, mesopic pupil <6.50 mm. Evaluation included manifest refraction, slitlamp examination, corneal topography, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). P < 0.05 was statistically significant. Results: Thirty-one (83.8%) eyes were classified as Amsler-Krumeich's stage II and 6 (16.2%) were stage III. Mean central pachymetry was 490.3 ± 37.4 μm. UDVA at 6 months post-operatively was significantly better than pre-operatively (0.90 log MAR ± 0.52 standard deviation [SD] versus 0.32 ± 0.27 logMAR; respectively, P < 0.0001), as was the spherical equivalent (SEq) (-3.64 ± 2.52 D vs. -1.84 ± 2.2 D; P < 0.0001). The mean CDVA and manifest cylinder improved compared with pre-operatively (P = 0.319 and P = 0.078, respectively). Average keratometry decreased significantly from 48.50 ± 3.08 D to 44.40 ± 3.03 D (P < 0.0001). Conclusion: Implantation of Intacs SK using femtosecond laser in moderate to severe KC is safe and effective. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/46/106386 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106381 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Presentation, diagnosis and management of limbal stem cell deficiency Sejpal, K Bakhtiari, P Deng, SX The human corneal surface epithelium is continuously repopulated by the limbal stem cells (LSCs). Limbal Stem Cell Deficiency (LSCD) can lead to corneal opacity and vascularization, with consequent visual impairment or blindness. Many acquired and congenital diseases can lead to LCSD by direct injury to the LSCs, destruction of LSC niche, or both. Based on the severity of the disease, LSCD can present with various symptoms and signs. Although LSCD can be detected clinically, laboratory tests are necessary to confirm the diagnosis and monitor the disease progression. This article concisely reviews the clinical presentation, techniques for diagnosis and management of LSCD. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/5/106381 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106387 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Early vitreous hemorrhage after vitrectomy with preoperative intravitreal bevacizumab for proliferative diabetic retinopathy Sato, T Morita, S Bando, H Sato, S Ikeda, T Emi, K Purpose: To evaluate the effect of preoperative intravitreal bevacizumab (IVB) on surgical procedures, visual prognosis, and postoperative complications, especially postoperative vitreous hemorrhage, in cases with proliferative diabetic retinopathy (PDR). Materials and Methods: Seventy-one eyes of 54 consecutive patients (23 eyes of 18 women, 48 eyes of 36 men) were investigated in this study. Twenty-five eyes received IVB one to 30 days before the vitrectomy (Bevacizumab Group) and the other 46 eyes had the vitrectomy alone (Control Group). The surgical procedures, best-corrected visual acuities at baseline, 1, 3, and 6 months after the vitrectomy, and postoperative complications in the Bevacizumab Group were compared to the Control Group. Results: The patients were significantly younger in the Bevacizumab Group compared to the Control Group (P = 0.008). The incidence of preoperative vitreous hemorrhage, tractional retinal detachment, and iris neovascularization was significantly higher in the Bevacizumab Group than in the Control Group (P = 0.017, 0.041, and 0.018, respectively). The surgical procedures performed and the visual acuity at all time points was not significantly different between groups (P > 0.05, all comparisons). The incidence of early (≤4 weeks) postoperative vitreous hemorrhage was significantly higher in the Bevacizumab Group (27%) than in the Control Group (7%; P = 0.027) although the rate of late (>4 weeks) postoperative vitreous hemorrhage was not significantly different between groups (P > 0.05). Conclusion: Vitrectomy with preoperative IVB may have no detrimental effect on surgical procedures and achieves the surgical outcomes for repair of PDR equal to vitrectomy alone despite the obvious selection bias of the patients in this study. However, special monitoring is highly recommended for early postoperative vitreous hemorrhage because bevacizumab in the vitreous may be washed out during vitrectomy. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/51/106387 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106388 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Improving diabetic retinopathy screening in Africa: Patient satisfaction with teleophthalmology versus ophthalmologist-based screening Kurji, K Kiage, D Rudnisky, CJ Damji, KF Purpose: To assess patient preference for diabetic retinopathy (DR) screening with teleophthalmology or face-to-face ophthalmologist evaluation in Nairobi, Kenya. Materials and Methods: Fifty seven diabetic patients from a one-stop multidisciplinary diabetic clinic (consisting of a diabetologist, nurse educator, foot specialist, nutritionist, ophthalmologist, and neurologist) in Nairobi, Kenya were included if they had undergone both a teleophthalmology (stereoscopic digital retinal photographs graded by an ophthalmologist remotely) and a traditional clinical screening exam (face to face examination). A structured questionnaire with a 5-point Likert scale was developed in both English and Swahili. The questionnaire was administered over the telephone. Ten questions were used to compare patient experience and preferences between teleophthalmology and a traditional clinical examination for DR. A mean score >3.25 on the Likert scale was considered favourable. Results: Successfully telephone contact was possible for 26 (58% male, 42% females) of the 57 patients. The mean ages of the male and female patients were 52.4 and 46.5 years respectively. Patients were satisfied with their teleophthalmology examination (mean 4.15 ± 0.97). Patients preferred the teleophthalmology option for future screenings (mean 3.42 ± 1.52). This preference was driven primarily by convenience, reduced examination time, and being able to visualize their own retina. Conclusion: In this study, diabetic patients preferred a teleophthalmology based screening over a traditional ophthalmologist-based screening. The use of teleophthalmology in Africa warrants further study and has the potential to become the screening model of choice. Cost effectiveness in comparison to an ophthalmologist-based screening also requires evaluation. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/56/106388 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106390 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Blindness and severe visual impairment in pupils at schools for the blind in Burundi Ruhagaze, P Kandeke, L Courtright, P Purpose: To determine the causes of childhood blindness and severe visual impairment in pupils attending schools for the blind in Burundi in order to assist planning for services in the country. Materials and Methods: All pupils attending three schools for the blind in Burundi were examined. A modified WHO/PBL eye examination record form for children with blindness and low vision was used to record the findings. Data was analyzed for those who became blind or severely visually impaired before the age of 16 years. Results: Overall, 117 pupils who became visually impaired before 16 years of age were examined. Of these, 109 (93.2%) were blind or severely visually impaired. The major anatomical cause of blindness or severe visual impairment was cornea pathology/phthisis (23.9%), followed by lens pathology (18.3%), uveal lesions (14.7%) and optic nerve lesions (11.9%). In the majority of pupils with blindness or severe visual impairment, the underlying etiology of visual loss was unknown (74.3%). More than half of the pupils with lens related blindness had not had surgery; among those who had surgery, outcomes were generally poor. Conclusion: The causes identified indicate the importance of continuing preventive public health strategies, as well as the development of specialist pediatric ophthalmic services in the management of childhood blindness in Burundi. The geographic distribution of pupils at the schools for the blind indicates a need for community-based programs to identify and refer children in need of services. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/61/106390 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106393 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Type I retinopathy of prematurity in infants with birth weight less than 1251 g: Incidence and risk factors for its development in a nursery in Kuwait Wani, VB Uboweja, AK Gani, M Al-Kandari, J Kazem, M Al-Naqeeb, N Thomas, C Al-Serafi, M Shukkur, MM Purpose: To report the rate of acute retinopathy of prematurity (ROP) and Type I ROP among infants with birth weight (BW) <1251 g and identify the risk factors for the development of Type I ROP. Materials and Methods: A retrospective review of ROP records of infants with BW <1251 g was performed to identify infants with acute ROP and Type I ROP. Infants with Type I ROP were compared with those without Type I ROP to assess the risk factors for the development of Type I ROP. P < 0.05 was statistically significant. Multivariate analysis was performed and odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: Among the 207 infants with BW <1251 g, acute ROP occurred in 154 infants (74.4%) and Type I ROP in 95 eyes of 50 infants (24.4%). The numbers of infants with BW <750 g and BW <1000 g were 19.3% and 58.4%, respectively, and the incidences of Type I ROP were 50% and 36.4%, respectively, among them. Forty-four (46.3%) eyes were treated at stage 2+ ROP in zone I or II. All the eyes treated for Type I ROP showed complete regression. Gestational age at birth (OR 0.657, 95% CI: 0.521-0.827; P < 0.0001) and number of ventilated days (OR 1.017, 95% CI: 1.005-1.029; P = 0.006) were identified as independent risk factors for the development of Type I ROP. Conclusions: The rate of Type I ROP in this study is higher than that in previous studies due to the higher number of infants with BW <1000 g in our cohort and the treatment of more eyes with stage 2+ ROP. However, all the treated eyes had a favorable outcome. Gestational age at birth and number of ventilated days were independent risk factors for the development of Type I ROP. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/66/106393 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106395 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: A clinic-based study Katibeh, M Moein, H Yaseri, M Sehat, M Eskandari, A Ziaei, H Purpose: To determine the prevalence of second-eye senile cataract surgery (SECS) as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. Materials and Methods: In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years (2006-2009) was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected (1,585 out of 10,517 records). Results: First- and second-eye operations were performed in 1,139 (71.9%; 95% confidence interval [CI], 69.5-74.1) and 446 eyes (28.1%; 95% CI, 25.9-30.35), respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 (P = 0.017). The median (interquartile range) interval between the two operations was 9 (4-24) months, which remained stable during the study period. The SECS rate was 10.4% higher (P = 0.01) and the time interval was 13 months shorter (P = 0.007) in patients who underwent phacoemulsification than extracapsular cataract extraction. Conclusion: The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/72/106395 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106397 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
In vivo confocal microscopy in chloroquine-induced keratopathy Paladini, I Menchini, U Mencucci, R In vivo confocal microscopy is becoming a mandatory examination to study corneal abnormalities such as drug deposits in systemic disease. A female diagnosed with fibromyalgia on systemic chloroquine for 9 months presented for an ophthalmic examination. Confocal microscopy was performed using the Confoscan 4 (Nidek Co. Ltd., Gamagori, Japan) and multiple highly reflective deposits in the epithelial basal cells were found, that were consistent with choloquine. Deposits were also present in the wing cell layer. In the anterior stroma these deposits were rare. Atypically shaped and branched nerves were also present in the anterior stroma. Corneal deposits of chloroquine can be evaluated by confocal microscopy. Confocal microscopy provides information on corneal metabolism and physiology. Chloroquine keratopathy can affect the anterior stroma in addition to the epithelium. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/77/106397 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106399 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Microsporidial spores can cross the intact descemet membrane in deep stromal infection Murthy, SI Sangit, VA Rathi, VM Vemuganti, GK We report a rare case of a deep stromal keratitis with a chronic indolent course, diagnosed as microsporidial keratitis from corneal scrapings. The patient's condition worsened despite medical therapy and penetrating keratoplasty was performed. The histopathology of the corneal tissue revealed multiple microsporidial spores in the posterior stroma and the endothelial exudates, whereas there was no clinical or histopathological breach in Descemet's membrane. This is the second report in the literature to report that micropsoridial spores can cross the intact Descemet's membrane. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/80/106399 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:106400 2013-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Transient increased exudation after photodynamic therapy of intraocular tumors Mashayekhi, A Shields, CL Shields, JA To report transient increased exudation after photodynamic therapy (PDT) of three different intraocular tumors (retinal hemangioblastoma, retinal astrocytoma, amelanotic choroidal melanoma). PDT with verteporfin (6 mg/m <sup>[2]</sup> body surface area) was delivered at a dose of 50 J/cm <sup>[2]</sup> and intensity of 600 mW/cm <sup>[2]</sup> over 83 s. All patients experienced decreased vision within a few days following PDT. Optical coherence tomography showed development of subfoveal fluid in all cases and noncystoid intraretinal edema in the eye with juxtapapillary retinal hemangioblastoma. There was complete absorption of retinal/subretinal fluid with improvement of visual acuity to 20/20 in all cases between 3 weeks to 4 months after PDT. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/83/106400 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Acute bilateral endophthalmitis following bilateral intravitreal bevacizumab (avastin) injection Tabatabaii, A Ahmadraji, A Khodabande, A Mansouri, M The clinical presentation and management of two patients who presented with acute bilateral endophthalmitis following bilateral intravitreal bevacizumab injection. Both cases were diagnosed clinically and subsequent to a vitreous sample, intravitreal ceftazidime (2.25 mg/0.1ml) and vancomycin (1 mg/0.1ml) were injected. One patient had a significant improvement in signs and symptoms after intravitreal antibiotics. However, there were was no improvement in the other patient and pars plana vitrectomy was performed bilaterally. Vitreous cultures were positive in both cases for Staphylococcus epidermidis. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/87/106402 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Delayed onset chloroquine retinopathy presenting 10 years after long-term usage of chloroquine Kazi, MS Saurabh, K Rishi, P Rishi, E Chloroquine retinopathy is a known complication of long-term use of chloroquine. This retinopathy can appear even after usage of chloroquine has stopped. The present case report describes the history and clinical features of chloroquine retinopathy developing a decade after discontinuing the drug. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/89/106404 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Bilateral total optic atrophy due to transdermal methanol intoxication Iscan, Y Coskun, & Öner, V Türkçü, FM Tas, M Alakus, MF In this case report, we document a 54-year-old woman with total bilateral optic nerve atrophy after local application of methanol containing spirit. Almost all the reported cases of methanol intoxication in the literature are caused by oral ingestion. In this rare case, we present transdermal absorption of methanol that may cause irreversible blindness in addition to intracerebral lesions. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/92/106406 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Ocular involvement of brucellosis Bazzazi, N Yavarikia, A Keramat, F A 29-year-old male diagnosed with brucellosis a week earlier was referred to the ophthalmology clinic with visual complaints. On examination, visual acuity was 20/25, he had conjunctival injection on slit lamp examination. There was also bilateral optic disk swelling plus retinal hyperemia (optic disc hyperemia and vascular tortuosity) and intraretinal hemorrhage on funduscopy. The patient was admitted and treated with cotrimoxazole, rifampin, doxycycline and prednisolone for 2 months. Ocular manifestations subsided gradually within 6 months after treatment. Brucellosis can affect the eye and lead to serious ocular complications. Early diagnosis and prompt treatment should be considered in endemic areas. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/95/106407 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Surgical technique for excisional bleb revision using a rotational conjunctival flap for a large conjunctival defect Schultz, KL Vajaranant, TS Suhr, K Wilensky, JT Tu, EY Bleb dysesthesia is a common but under recognized late complication of trabeculectomy, sometimes requiring surgical revision if conservative measures fail. We describe in detail a surgical technique for closure of a large conjunctival defect following bleb excision for refractory dysesthesia. Two subconjunctival 5-fluorouracil injections were given to improve bleb function. Eight months post-operatively, the intraocular pressure is well controlled on two agents, and the patient has had resolution of dysesthesia. Medknow Publications 2013-01-01 http://www.meajo.org/text.asp?2013/20/1/98/106409 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Strengthening institutional capacity for glaucoma care in Sub-Saharan Africa Damji, KF Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/107/110601 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Epidemiology of glaucoma in Sub-Saharan Africa: Prevalence, incidence and risk factors Kyari, F Abdull, MM Bastawrous, A Gilbert, CE Faal, H Purpose: The purpose of this study is to review the epidemiology of different types of glaucoma relevant to Sub-Saharan Africa (SSA) and to discuss the evidence regarding the risk factors for onset and progression of glaucoma, including risk factors for glaucoma blindness. Methods: Electronic databases (PubMed, MedLine, African Journals Online- AJOL) were searched using the full text, Medical Subject Headings (MeSH) terms, author(s) and title to identify publications since 1982 in the following areas: population-based glaucoma prevalence and incidence studies in SSA and in African-derived black populations outside Africa; population-based prevalence and incidence of blindness and visual impairment studies in SSA including rapid assessment methods, which elucidate the glaucoma-specific blindness prevalence; studies of risk factors for glaucoma; and publications that discussed public health approaches for the control of glaucoma in Africa. Results: Studies highlighted that glaucoma in SSA is a public health problem and predominantly open-angle glaucoma. It is the second-leading cause of blindness, has a high prevalence, an early onset and progresses more rapidly than in Caucasians. These factors are further compounded by poor awareness and low knowledge about glaucoma even by persons affected by the condition. Conclusion: Glaucoma care needs to be given high priority in Vision 2020 programs in Africa. Many questions remain unanswered and there is a need for further research in glaucoma in SSA in all aspects especially epidemiology and clinical care and outcomes involving randomized controlled trials. Genetic and genome-wide association studies may aid identification of high-risk groups. Social sciences and qualitative studies, health economics and health systems research will also enhance public health approaches for the prevention of blindness due to glaucoma. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/111/110605 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Glaucoma drainage implant surgery - An evidence-based update with relevance to Sub-Saharan Africa Aminlari, AE Scott, IU Aref, AA Glaucoma represents a leading cause of preventable vision loss in Sub-Saharan Africa. Recent studies evaluating outcomes of glaucoma drainage implant (GDI) surgery suggest an important role for this approach in the African patient population. The Tube Versus Trabeculectomy study demonstrated a higher success rate with non-valved GDI surgery compared to trabeculectomy with mitomycin C after five years. The Ahmed Baerveldt Comparison study showed no difference in surgical failure rates between the Ahmed Glaucoma Valve and the Baerveldt Glaucoma Implant (BGI) but better intraocular pressure outcomes with the BGI at one year. The Ahmed Versus Baerveldt study demonstrated a lower failure rate for the BGI, but also a requirement for more post-operative interventions. Further study of GDI surgery in the Sub-Saharan Africa is necessary to determine its optimal place in the treatment paradigm for glaucoma patients in the region. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/126/110607 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Advanced glaucoma: Management pearls Gessesse, GW Damji, KF A significant proportion of glaucoma patients present late, particularly in the developing world, and unfortunately, in an advanced stage of the disease. They are at imminent danger of losing remaining vision, and may also be afflicted with various socioeconomic and health challenges. The encounter with such a patient is typically characterized by anxiety/fear and sometimes hopelessness from the patient's perspective. The physician may also feel that they are in a difficult position managing the patient's disease. When dealing with such cases, we suggest a holistic, individualized approach taking into account the 'biopsychosociospiritual' (BPSS) profile of each patient. The BPSS model takes into account relevant ocular as well as systemic biology (factors such as the mechanism of glaucoma, level of intraocular pressure [IOP], rate of progression, life expectancy, general health), psychological considerations (e.g., fear, depression), socio-economic factors and spiritual/cultural values and beliefs before being able to decide with the patient and their care partner(s) what treatment goals should be and how they can best be approached. Treatment for advanced glaucoma can be highly effective, and patients and their care partners should be informed that aggressive IOP lowering to the low teens or even single digits offers the best chance of protecting remaining vision. This can be achieved safely and effectively in most cases with trabeculectomy (including an antimetabolite), and in some cases with medical and/or laser therapy. Vision rehabilitation and psychosocial support should also be considered in order to optimize remaining vision, replace fear with hope as appropriate, and thus improve the overall quality of life. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/131/110610 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:110619 2013-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Teleglaucoma: Improving access and efficiency for glaucoma care Kassam, F Yogesan, K Sogbesan, E Pasquale, LR Damji, KF Teleglaucoma is the application of telemedicine for glaucoma. We review and present the current literature on teleglaucoma; present our experience with teleglaucoma programs in Alberta, Canada and Western Australia; and discuss the challenges and opportunities in this emerging field. Teleglaucoma is a novel area that was first explored a little over a decade ago and early studies highlighted the technical challenges of delivering glaucoma care remotely. Advanced technologies have since emerged that show great promise in providing access to underserviced populations. Additionally, these technologies can improve the efficiency of healthcare systems burdened with an increasing number of patients with glaucoma, and a limited supply of ophthalmologists. Additional benefits of teleglaucoma systems include e-learning and e-research. Further work is needed to fully validate and study the cost and comparative effectiveness of this approach relative to traditional models of healthcare. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/142/110619 en Copyright 2014 Middle East African Journal of Ophthalmology.
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The muranga teleophthalmology study: Comparison of virtual (teleglaucoma) with in-person clinical assessment to diagnose glaucoma Kiage, D Kherani, IN Gichuhi, S Damji, KF Nyenze, M Purpose: While the effectiveness of teleophthalmology is generally accepted, its ability to diagnose glaucomatous eye disease remains relatively unknown. This study aimed to compare a web-based teleophthalmology assessment with clinical slit lamp examination to screen for glaucoma among diabetics in a rural African district. Materials and Methods: Three hundred and nine diabetic patients underwent both the clinical slit lamp examination by a comprehensive ophthalmologist and teleglaucoma (TG) assessment by a glaucoma subspecialist. Both assessments were compared for any focal glaucoma damage; for TG, the quality of photographs was assessed, and vertical cup-to-disk ratio (VCDR) was calculated in a semi-automated manner. In patients with VCDR > 0.7, the diagnostic precision of the Frequency Doubling Technology (FDT) C-20 screening program was assessed. Results: Of 309 TG assessment photos, 74 (24%) were deemed unreadable due to media opacities, patient cooperation, and unsatisfactory photographic technique. While the identification of individual optic nerve factors showed either fair or moderate agreement, the ability to diagnose glaucoma based on the overall assessment showed moderate agreement (Kappa [κ] statistic 0.55% and 95% confidence interval [CI]: 0.48-0.62). The use of FDT to detect glaucoma in the presence of disc damage (VCDR > 0.7) showed substantial agreement (κ statistic of 0.84 and 95% CI 0.79-0.90). A positive TG diagnosis of glaucoma carried a 77.5% positive predictive value, and a negative TG diagnosis carried an 82.2% negative predicative value relative to the clinical slit lamp examination. Conclusion: There was moderate agreement between the ability to diagnose glaucoma using TG relative to clinical slit lamp examination. Poor quality photographs can severely limit the ability of TG assessment to diagnose optic nerve damage and glaucoma. Although further work and validation is needed, the TG approach provides a novel, and promising method to diagnose glaucoma, a major cause of ocular morbidity throughout the world. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/150/110604 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Dynamic contour tonometry in primary open angle glaucoma and pseudoexfoliation glaucoma: Factors associated with intraocular pressure and ocular pulse amplitude Moghimi, S Torabi, H Fakhraie, G Nassiri, N Mohammadi, M Purpose: To compare the intraocular pressures (IOP) and ocular pulse amplitudes (OPAs) in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG), and to evaluate ocular and systemic factors associated with the OPA. Materials and Methods: In this prospective study, on 28 POAG and 30 PXG patients, IOP was measured with the Goldmann applanation tonometry (GAT) and the Pascal dynamic contour tonometry (DCT). Other measurements included central corneal thickness (CCT), vertical cup-to-disc ratio (CDR), and systolic and diastolic blood pressure. Statistical significance was defined as P < 0.05. Results: In each of the POAG and PXG groups, GAT IOP was correlated with CCT (r = 0.40, P = 0.03 and r = 0.35, P = 0.05, respectively), whereas DCT IOP and CCT were not correlated. In all patients and in the POAG group, OPA was positively correlated with DCT IOP (r = 0.39, P = 0.002). OPA was not correlated with CCT in the POAG (P = 0.80), nor in the PXG (P = 0.20) group, after adjusting for DCT IOP. When corrected for DCT IOP and CCT, there was a significant negative correlation between OPA and vertical CDR in all patients (r = −0.41, P = 0.002). There was no significant difference in OPA between groups (P = 0.55), even when OPA was adjusted for IOP and systolic and diastolic pressure (P = 0.40), in a linear regression model. Conclusion: DCT IOP and OPA are not correlated with CCT. There is no significant difference between the OPA of PXG and POAG eyes. OPA is correlated with DCT IOP, and is lower in eyes with more advanced glaucomatous cupping. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/158/110606 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Awareness and knowledge of glaucoma among workers in a nigerian tertiary health care institution Komolafe, OO Omolase, CO Bekibele, CO Ogunleye, OA Komolafe, OA Omotayo, FO Purpose: The aim of this study reports the level of awareness and knowledge of glaucoma among selected health care personnel at a health institution in southwestern Nigeria. Materials and Methods: Health personnel at the Federal Medical Centre, Owo, Nigeria, a tertiary health care institution were stratified into a clinical and an administrative directorate. One-hundred twenty participants were selected from each directorate by a random sampling technique. A structured questionnaire was used to collect sociodemographic data and data on the level of knowledge and awareness of glaucoma. Statistical analyses included the independent t-test and Pearson's chi-square test for categorical variables. Statistical significance was indicated by P < 0.05. Results: From the target population of 240 participants, 216 (98 males; 118 females) completed the questionnaire. The mean age of the participants was 35.07 ± 07 years. A total of 148 (68.6%) participants had heard of glaucoma comprising all participants from the clinical directorate and 28 participants from the administrative directorate. There was no statistically significant difference between the clinical and administrative directorates about the knowledge of the aspect of vision that is first affected by glaucoma, the painless nature of glaucoma among most Africans and the irreversible nature of glaucoma-related blindness (P > 0.05, all comparisons). Conclusion: There is the need to update the knowledge base of these workers if they are to be useful in propagating information of the irreversible blindness that could arise from delay in glaucoma diagnosis and treatment. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/163/110609 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Patient refusal of glaucoma surgery and associated factors in lagos, Nigeria Adekoya, BJ Akinsola, FB Balogun, BG Balogun, MM Ibidapo, OO Purpose: To determine the prevalence of patient refusal of glaucoma surgery (GSR) and the associated factors in Lagos, Nigeria. Materials and Methods: A multicenter cross-sectional survey was conducted in Lagos state, Nigeria. Twelve centres were invited to participate, but data collection was completed in 10. Newly diagnosed glaucoma patients were recruited and interviewed from these sites over a four week period on prior awareness of glaucoma, surgery refusal, and reason(s) for the refusal. Presenting visual acuity was recorded from the patient files. The odds ratio and 95% confidence intervals (CI) were calculated. Results: A total of 208 newly diagnosed glaucoma patients were recruited. Sixty-five (31.2%) patients refused surgery. Fear of surgery (31 (47.7%) patients), and fear of going blind (19 (29.2%) patients) were the most common reasons. The odds ratio of surgery refusal were marital status - not married versus married (2.0; 95% CI, 1.02-3.94), use of traditional medication - users versus non users (2.4; 95% CI, 1.1-5.2), perception of glaucoma causing blindness - no versus yes (3.7; 95% CI, 1.3-10.5), type of institution - government versus private (5.7; 95% CI, 1.3-25.1), and visual acuity in the better eye - normal vision versus visual impairment (2.3; 95% CI, 1.1-4.9). Age, gender, level of education, family history of glaucoma, and prior awareness of the diagnosis of glaucoma, were not significantly associated with surgery refusal. Perception of patients concerning glaucoma blindness was the strongest factor on multivariate analysis. Conclusion: GSR was relatively low in this study. Unmarried status, use of traditional medications, perception that glaucoma cannot cause blindness, government hospital patients, and good vision in the better eye were associated with GSR. These factors might help in the clinical setting in identifying appropriate individuals for targeted counseling, as well as the need for increased public awareness about glaucoma. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/168/110612 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Ocular blood flow velocity in primary open angle glaucoma - A tropical african population study Adeyinka, OO Olugbenga, A Helen, OO Adebayo, AV Rasheed, A Purpose: To assess blood flow velocity in newly diagnosed indigenous black-skinned Africans with primary open angle glaucoma (POAG). Materials and Methods: Prospective case-control study at Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria on 50 newly diagnosed POAG patients (POAG group) and 50 control patients (control group). Ocular Doppler Color Imaging was performed on subjects in the supine position using 9 MHz linear array transducer of a Fukuda Denshi Ultrasound. The Peak Systolic Velocity (PSV) and End Diastolic Velocity (EDV) values were obtained by finding the average of two readings each for the ophthalmic artery (OA) and central retinal artery (CRA). Resistive Index (RI) was calculated as (PSV − EDV)/PSV. Data were analyzed and statistical significance was defined at P < 0.05. Results: The mean intraocular pressure (IOP) for the POAG group and control group was 28.1 ± 7.4 mmHg and 16.6 ± 2.0 mmHg, respectively (P < 0.001). The mean PSV for OA was 31.35 cm/s in POAG group and 37.61 cm/s for the control group (P < 0.001). The EDV for both OA and CRA were significantly lower in glaucoma patients as compared with the corresponding values in the control group (P < 0.001, both comparisons). The mean RI in the OA was 0.71 ± 0.05 and 0.63 ± 0.03 for the POAG and control group groups, respectively (P < 0.001). The increase in IOP in the POAG group was statistically significantly negatively correlated with PSV and EDV and positively correlated with RI for both OA and CRA. Conclusion: The outcomes of this study indicate that ocular blood flow alterations including reductions in PSV and EDV and increase in RI of the OA and CRA are present in black-skinned Africans with POAG. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/174/110617 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Postoperative suprachoroidal hemorrhage in a glaucoma patient on low molecular weight heparin AlHarkan, DH AlJadaan, IA Suprachoroidal hemorrhage is a complication associated with intraocular surgery that can occur both intraoperatively and postoperatively. Several intraoperative or postoperative risk factors have been indentified . The use of low-molecular weight heparin (LMWH) is considered one of the risk factors in surgical cases (ocular or non ocular) and non-surgical cases. Here we present a case of suprachoroidal hemorrhage in a glaucoma patient that occurred after preoperative prophylactic LMWH for deep venous thrombosis. The use of LMWH has been reported to cause suprachoroidal hemorrhage even in patients without any risk factors. The use of LMWH continues to increase, hence it is important to be aware of the possibility of suprachoroidal hemorrhage and to determine the risk/benefit ratio, especially in patients with other risk factors. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/179/110618 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Glycopyrrolate induced bilateral angle closure glaucoma after cervical spine surgery Jaroudi, M Fadi, M Farah, F To report a case of bilateral acute angle closure glaucoma (AACG) that occurred after cervical spine surgery with the use of glycopyrolate. A 59-year-old male who presented with severe bilateral bifrontal headache and eye pain that started 12 h postextubation from a cervical spine surgery. Neostigmine 0.05 mg/kg (4.5 mg) and glycopyrrolate 0.01 mg/kg (0.9 mg) were used as muscle relaxant reversals at the end of the surgery. Ophthalmic examination revealed he had bilateral AACG with plateau iris syndrome that was treated medically along with laser iridotomies.Thorough examination of anterior chamber should be performed preoperatively on all patients undergoing surgeries in the prone position and receiving mydriatic agents under general anesthesia. Medknow Publications 2013-04-01 http://www.meajo.org/text.asp?2013/20/2/182/110620 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Beyond a typical thyroid eye disease Kashkouli, MB Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/185/114787 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Eyelid masses: A 10-year survey from a tertiary eye hospital in Tehran Bagheri, A Tavakoli, M Kanaani, A Zavareh, RB Esfandiari, H Aletaha, M Salour, H Purpose: The purpose of this study was to evaluate the demographics and clinical features of eyelid masses in a tertiary eye hospital over a 10-year period. Materials and Methods: A retrospective chart review was performed for patients admitted with eyelid tumors from 2000 to 2010. Data were collected and analyzed on the demographic features, location of the tumor, types of treatment, and pathologic findings. Results: A total number of 182 patients were evaluated of which, 82 cases were benign and 100 cases were malignant neoplasms. The most common benign tumors included melanocytic nevi (35%), papilloma (19.5%), and cysts (11%). The most frequent malignant tumors included basal cell carcinoma (BCC) (83%), squamous cell carcinoma (8%) and sebaceous gland carcinoma (6%). The most common site for malignancy was the lower lid followed by the upper lid. BCC recurred in 16 cases that were most frequent in the lower lid. Conclusion: Melanocytic nevus, papilloma and cysts are the most common benign lesions and BCC is the most common malignant lesion in the eyelids. Recurrence is a feature of BCC especially in the lower lid. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/187/114788 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Anterior orbit and adnexal amyloidosis Al, HH Edward, DP Purpose: To describe six cases of anterior orbital and adnexal amyloidosis and to report on proteomic analysis to characterize the nature of amyloid in archived biopsies in two cases. Materials and Methods: The clinical features, radiological findings, pathology, and outcome of six patients with anterior orbit and adnexal amyloidosis were retrieved from the medical records. The biochemical nature of the amyloid was determined using liquid chromatography/mass spectroscopy archived paraffin-embedded tissue in two cases. Results: Of the six cases, three had unilateral localized anterior orbit and lacrimal gland involvement. Four of the six patients were female with an average duration of 12.8 years from the time of onset to presentation eyelid infiltration by amyloid caused ptosis in five cases. CT scan in patients with lacrimal gland involvement (n = 3) demonstrated calcified deformable anterior orbital masses and on pathological exmaintionamyloid and calcific deposits replaced the lacrimal gland acini. Ptosis repair was performed in three patients with good outcomes. One patient required repeated debulking of the mass and one patient had recurrenct disease. Proteomic analysis revealed polyclonal IgG-associated amyloid deposition in one patient and AL kappa amyloid in the second patient. Conclusion: Amyloidosis of the anterior orbit and lacrimal gland can present with a wide spectrum of findings with good outcomes after surgical excision. The nature of amyloid material can be precisely determined in archival pathology blocks using diagnostic proteomic analysis. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/193/114789 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Etiology of tearing in patients seen in an oculoplastic clinic in Saudi Arabia Bukhari, A Aim: To determine the prevalence of various causes of tearing among patients referred to an oculoplastic clinic. Materials and Methods: A prospective study on all patients seen in an oculoplastic clinic with a chief complaint of tearing. The cause of tearing was determined on the basis of the anatomical location of the primary etiology. Results: This study included 357 patients with a mean age 53.9 years. Punctal stenosis was the most common etiology, affecting 37.8% of the patients. Among patients with punctual stenosis, 63.4% were women over 50-year-old (P = 0.001); 55.6% had tearing for less than 6 months (P = 0.038), and all of them had associated chronic blepharitis. The remaining study participants had dry eye with reflex tearing (27.7%), nasolacrimal duct obstruction (10.1%), canalicular obstruction (4.2%), entropion or ectropion (3.4%), pterygium (1.7%), megalo-caruncle (1.7%), and functional tearing (1.7%). Conclusion: The outcomes of this study indicate the most common cause of tearing is punctal pathology. Therefore, slit lamp evaluation with careful attention to the punctum is warranted in all patients with tearing. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/198/114790 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114791 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparison of corneal curvature and anterior chamber depth measurements using the manual keratometer, lenstar LS 900 and the pentacam Uçakhan, && Akbel, V Biyikli, Z Kanpolat, A Purpose: The purpose of this study was to compare keratometry and anterior chamber depth (ACD) measurements from the Lenstar LS 900 (Haag-Streit AG, Switzerland) and the Pentacam (Oculus, Weltzar, Germany), and compare the keratometry readings of these two systems to a manual keratometer (MK), (Haag-Streit, Switzerland). Materials and Methods: In this prospective study, keratometry and ACD measurements were obtained in 50 eyes of 50 normal subjects with the Lenstar and the Pentacam. Keratometry was also measured using a MK. Correlation, comparison, and interdevice agreement was evaluated using intraclass correlation analysis, Wilcoxon test, and Bland-Altman plots. Results: The keratometry and ACD measurements obtained from the Lenstar and the Pentacam showed excellent correlation. The mean interdevice differences in mean keratometry (Km) for the Lenstar and the Pentacam, the Lenstar and the MK, and the Pentacam and the MK were 0.39 D, 0.10 D, and 0.30 D respectively; and the 95% limits of agreement (LoA) for Km were 0.04-0.82 D; −1.90-2.10 D; and −2.30-1.70 D, respectively. The mean interdevice difference in ACD for the Lenstar versus the Pentacam was 0.09 mm, with 95% LoA of 0.23-0.05 mm. Conclusions: The ACD measurements obtained using the Lenstar and the Pentacam seem to be interchangeable, whereas, the keratometry measurements obtained using the Lenstar, Pentacam, and MK differ considerably, and are not interchangeable. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/201/114791 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114792 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Diffractive multifocal intraocular lens compared to pseudo-accommodative intraocular lens implant for unilateral cataracts in pre-presbyopic patients Joshi, RS Purpose: To evaluate the efficacy of diffractive multifocal and pseudo-accommodative IOLs in pre-presbyopes with cataract. Materials and Methods: A prospective randomized control study was performed on patients with cataract in the pre-presbyopic age group. Patients were randomly allocated to 2 groups: Group 1 comprised 12 patients who underwent implantation of a diffractive multifocal IOL and Group 2 comprised 13 patients who underwent implantation of a pseudo-accommodative IOL after standard phacoemulsification. Efficacy was measured by postoperative distance and near uncorrected visual acuity, contrast sensitivity, spectacle independence, and glare and halo. Between-group comparison was performed with the unpaired t test. Fisher's exact test was used for categorical variables. All the tests were two-sided with confidence interval set at 95%. Results: The study patients were aged 22-35 years and included 14 females and 11 males. All examinations were performed 6 months postoperatively by a second observer unaware of the study objectives. Mean uncorrected distance visual acuity was 0.125 ± 0.1 LogMAR in Group 1 and 0.1385 ± 0.1 in Group 2 (P = 0.7993). Near visual acuity was 0.0917 ± 0.1 in Group 1 and 0.386 ± 0.2 in Group 2 (P < 0.0001). Contrast sensitivity was good in both groups based on the Pelli-Robson chart (P = 0.3919). Night-time glare was present in 3 (25%) patients in Group 1 and in 2 (15.4%) patients in Group 2. No patients in either group had difficulty driving during the day or night. Ten patients in Group 1 (83.3%) and 7 patients in Group 2 (53.85%) had spectacle independence (P = 0.1249). Conclusion: Greater proportions of patients who underwent diffractive multifocal implantation achieved functional distance and near vision as compared to those in the pseudo-accommodative IOL group. There was greater variability in near vision in patients who received the pseudo-accommodative IOL as compared to those in the multifocal IOLs. Contrast sensitivity remained adequate in both the groups. There were more glare and halos in the multifocal group as compared to those in the pseudo-accommodative group. More patients achieved spectacle independence with multifocal IOLs. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/207/114792 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114793 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Anterior segment study with the pentacam scheimpflug camera in refractive surgery candidates Hashemi, M Falavarjani, KG Aghai, GH Aghdam, KA Gordiz, A Purpose: The purpose of this study was to evaluate the anterior segment measurements according to refractive status in a sample of the Iranian population. Setting: Rassoul Akram Hospital, Tehran University of Medical Sciences. Material and Methods: In this study, refractive surgery candidates were assigned according to the refractive error to one of three groups : emmetropia, myopia, and hyperopia. Myopic eyes were further divided to four subgroups : simple myopic group, simple myopic astigmatism group, high myopic group, and high myopia with astigmatism group. Anterior segment measurements with the Pentacam Scheimpflug system were performed in the right eye of all subjects. Results: The study sample was comprised of 283 subjects with a mean age of 29.1 ± 7.5 (standard deviation) years. Mean keratometry reading, Anterior chamber depth (ACD) and volume measurements were significantly higher in the myopic group and mean keratometry reading and anterior chamber angle measurements were significantly lower in the hyperopic group (P < 0.05, all comparisons). Maximum anterior elevation (AE <sub>max</sub> ) and maximum posterior elevation (PE <sub>max</sub> ), Q value, progression index, minimum corneal thickness, and corneal volume measurements were similar for all groups (P > 0.05, all comparisons). In the myopic subgroups, AE <sub>max</sub> and PE <sub>max</sub> and maximum keratometry (K <sub>max</sub> ) were significantly higher, and ACD was lower in the astigmatic groups (P < 0.05, all comparisons). The Q value was less negative in low myopia (P < 0.05). Conclusions: Myopic eyes had steeper corneas than hyperopic eyes and anterior chamber measurements were significantly higher in the myopic eyes. In myopic eyes, AE <sub>max</sub> and PE <sub>max</sub> and K <sub>max</sub> measurements were higher, and ACD measurements were lower in the astigmatic groups. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/212/114793 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114794 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous Sinha, R Bali, SJ Kumar, C Shekhar, H Sharma, N Titiyal, JS Vajpayee, RB Purpose: To report the feasibility and outcome of lens aspiration, and Fugo blade-assisted capsulotomy and anterior vitrectomy in eyes with anterior persistent hyperplastic primary vitreous (PHPV). Materials and Methods: In this case series, 10 eyes of 10 patients with anterior PHPV underwent lens aspiration. The vascularized posterior capsule was cut with a Fugo blade (plasma knife) and removed with a vitrector. A foldable posterior chamber intraocular lens (IOL) was implanted in eight eyes and the outcomes were evaluated. Results: The mean age of patients was 16.8 ± 6.37 months (range: 5 to 28 months). The surgery was completed successfully in all eyes. There were no cases of intraocular hemorrhage intraoperatively. Foldable acrylic IOL was implanted in the bag in 3 eyes and in the sulcus in 5 eyes. Two eyes were microphthalmic and did no undergo IOL implantation (aphakic). None of the eyes had a significant reaction or elevated intraocular pressure postoperatively. The follow-up ranged from 4 to 21 months. All the pseudophakic eyes achieved a best corrected visual acuity of ≥20/200 with 50% (4/8) of these eyes with ≥20/60 vision. Conclusion: Lens aspiration followed by posterior capsulotomy with Fugo blade-assisted plasma ablation is a feasible technique for performing successful lens surgery in cases with florid anterior PHPV. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/217/114794 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114795 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
A single drop of 0.5% proparacaine hydrochloride for uncomplicated clear corneal phacoemulsification Joshi, RS Purpose: The purpose of this study was to compare the efficacy of a single drop of 0.5% proparacaine hydrochloride in uncomplicated cataract surgery with phacoemulsification. Materials and Methods: Two hundred and ninety five patients scheduled for the phacoemulsification were divided into 2 groups based on the anesthetic agents they were to receive: 146 patients who received a single drop of 0.5% proparacaine 2 min before the start of the surgery (proparacaine group) and; 149 patients who received supplementation of 0.5% intracameral preservative free xylocaine (xylocaine group). A single surgeon performed all surgeries. Intraoperative and post-operative pain scores were evaluated on a visual analog scale. The surgeon noted his subjective impression of corneal clarity, discomfort while performing the surgery any supplemental anesthesia required and intraoperative complications. An anesthetist noted vital parameters and the need for intravenous sedation. Total surgical time was noted. Comparison of parameters was performed with the Chi-square test, and A P value less than 0.05 was considered as statistically significant. Results: No statistically significant difference was seen in the intraoperative (P = 0.24) and post-operative (P = 0.164) pain scores between groups. There was no pain (0 score) in 41.8% of patients in the proparacaine group and 46.3% of patients in the xylocaine group. The average surgical time (P = 0.279) and surgeon discomfort (P = 0.07) were not statistically significantly different between groups. No patients required supplemental anesthesia. There were no surgical complications that could compromise the visual outcome. An equal number of patients in both groups preferred same type of anesthetic technique for the fellow eye cataract surgery (89.11% for the proparacaine group and 90.18% for the xylocaine group). No patients in either group had changes in vital parameters or required intravenous sedation. Conclusion: A single drop pre-operatively, of proparacaine hydrochloride was comparable to the intracameral supplementation of preservative free xylocaine for phacoemulsification in uncomplicated cataract surgery without compromising the visual outcome. However, we recommend individualizing the anesthetic technique according to the requirements of the surgeon. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/221/114795 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114797 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Loop suture technique for optional adjustment in strabismus surgery Parikh, RK Leffler, CT Purpose: To describe a loop suture technique that allows intraoperative conjunctival closure and later optional suture adjustment in strabismus surgery in uncooperative patients. Materials and Methods: This retrospective case series comprised 25 patients. After a recessed or resected horizontal muscle was secured to the sclera with a primary suture suspended back 2 mm, a second loop suture was passed through the body of the muscle and under the primary suture knot. The loop suture could be removed later while the patient was awake, or it could be tied to advance the muscle. Success was defined as a residual deviation of 10 prism diopters (PD) or less at 2 months postoperatively. Results: In the study cohort, 20 patients had successful alignment at 2 months (80%). Six patients (24%) underwent postoperative suture tightening by the loop technique, and each muscle affected the alignment an average of 7.7 PD (±3.8 PD). No patients underwent a reoperation within the first 2 months. One patient had a pyogenic granuloma (4%). Conclusions: The loop suture technique permits optional postoperative tightening of muscles and avoids sedation in children or uncooperative patients not requiring adjustment. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/225/114797 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114798 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Barriers to cataract surgical uptake in central ethiopia Mehari, ZA Gulilat, FB Purpose: The aim of this study was to assess the factors that delay surgical intervention in patients suffering from age related mature cataract in Ethiopia. Materials and Methods: A short term descriptive study was performed that evaluated patients with mature cataract presenting to outreach eye care clinics in rural central Ethiopia. Patients were interviewed to determine the reasons for delay in their cataract surgeries. Result: A total of 146 subjects (57 male and 89 females) with operable age related cataract were evaluated at 31 outreach clinics. Over 86% of the respondents were above 55 years of age, (range, 45-78 years). The male to female ratio was 1:1.5 and 30.2% of the subjects were blind bilaterally (best corrected visual acuity <3/60). The majority of the respondents were farmers (53.4%) and 86.3% were illiterate. The major factors that delayed cataract surgery included: Cost of surgery (91.8%), insufficient family income (78.1%), good vision in the fellow (unaffected) eye (39.7%), and the distance to hospital from their village (47.9%). Conclusion: Surgical cost, insufficient family income, and the distance to an eye care centre were the major factors delaying cataract surgery in rural Ethiopia. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/229/114798 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114800 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Efficacy of intacs intrastromal corneal ring segment relative to depth of insertion evaluated with anterior segment optical coherence tomography Hashemi, H Yazdani-Abyaneh, A Beheshtnejad, A Jabbarvand, M Kheirkhah, A Ghaffary, SR Aim: To evaluate the effect of implantation depth of Intacs microthin prescription inserts (Addition Technology Inc, Fremont, California) on visual and topographic outcomes in patients with post- laser-assisted in situ keratomileusis (LASIK) ectasias. Settings and Design: Retrospective, observational case series. Materials and Methods: In this case series, 16 eyes of 12 patients were evaluated. All cases were post-LASIK ectasia that had undergone intrastromal corneal ring segment (ICRS) implantation. The planned insertion depth was 70% of stromal thickness using a manual dissector. At least 12 months postoperatively, all eyes underwent Visante (Carl Zeiss Meditec) AS-OCT to determine insertion depth. Cases were categorized into 3 groups based on the measured implantation depth: 40-59% thickness; 60-79% thickness; and ≥80% thickness. Visual, refractive and topographic outcomes were evaluated relative to implantation depth. Results: The lowest improvement in the study parameters ocurred when the implantation depth was ≥80%. In this group, uncorrected visual acuity (UCVA) and best spectacle corrected VA (BSCVA) improved less than 0.5 lines. Manifest refractive spherical equivalent (MRSE) and mean keratometry (Km) change was less than 0.5 diopters (D). The greatest improvements were observed with implantation depth of 60-79% where UCVA and BSCVA increased by 4.5 and 2.5 lines respectively, and MRSE and Km changed by approximately 2.00 D. Less improvement was found when ICRS were implanted between 40-59% of stromal thickness. Conclusion: Implantation of ICRS greater than 80% of stromal thickness may have no effect on visual and topographic status. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/234/114800 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114801 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Autologous cryoprecipitate for attaching conjunctival autografts after pterygium excision Anbari, AA Purpose: To report the efficacy, safety, and reliability of autologous cryoprecipitate in pterygium excision surgery and to compare it with the traditional method of using absorbable sutures, in regard to surgical time and the patient comfort. Materials and Methods: A prospective interventional clinical study was carried out in a specialized eye clinic. A total of 54 patients (90 eyes) underwent surgical excision of the nasal pterygium (whether primary or recurrent) with conjunctival autograft obtained from the same eye. Patients were divided into two groups. Autologous cryoprecipitate was used in 47 eyes (glue group), and absorbable sutures (8/0 vicryl) were used in 43 eyes (suture group) to attach the free conjunctival graft. There were 42 primary and 48 recurrent nasal pterygia that were included in the study. The surgical time was noted, and post-operative pain was graded. Follow-up period ranged from 6 months to 18 months (mean 12 months). P< 0.05 was statistically significant. Results: The medians of the visual analogue scale values were significantly lower in the glue group (P< 0.05). The median surgical time was statistically significantly lower at 11 min (range 9 min to 15 min) in the glue group, compared to 21 min (range 12 min to 28 min) for the suture group (P< 0.05). No significant intraoperative or post-operative complications were noted. Recurrence rate was 12%, and all recurrence cases occurred in the sutures group. Conclusions: Application of autologous cryoprecipitate glue instead of sutures for attaching the free conjunctival graft in pterygium surgery resulted in less post-operative pain and shorter surgical time. Additionally, there were no cases of recurrence during the follow-up in patients who received autologous cryoprecipitate glue during pterygium surgery. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/239/114801 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114803 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Vitrectomy for posterior segment intraocular foreign bodies, visual and anatomical outcomes Falavarjani, KG Hashemi, M Modarres, M Parvaresh, MM Naseripour, M Nazari, H Fazel, AJ Purpose: To evaluate the visual and anatomic results and determine the prognostic factors after pars plana vitrectomy and posterior segment intraocular foreign body (IOFB) removal. Materials and Methods: This retrospective study reviews the patients' charts of 48 consecutive patients with posterior segment IOFB who underwent pars plana vitrectomy and IOFB removal over a 4-year period, recently. Association between visual outcome and various preoperative, operative, and postoperative variables was statistically analyzed. Data were analyzed with the paired t-test and the chi square test. Statistical significance was indicated by P < 0.05. Results: The mean interval between the time of injury and IOFB removal was 24 ± 43.1 days and 27 (53%) eyes underwent IOFB removal within 7 days of the injury. Nine (19.1%) patients achieved a visual acuity of 20/40 or better. An improvement of visual acuity of at least three lines occurred in 21 (44.6%) eyes and the vision remained unchanged in 15 (31.9%) eyes. Postoperative retinal detachment occurred in five (10.6%) eyes. Visual improvement was more likely to occur in eyes with lower levels of presenting visual acuity (P = 0.2). Visual improvement was not associated with an entry site and IOFB location, lens injury, time to surgery, and pre- and post-operative retinal detachment. At the end of follow up, anatomical success was achieved in 97.9% of eyes. Conclusions: High anatomical success could be achieved after the removal of posterior segment IOFBs by vitrectomy, despite a delay in surgery. Poor visual outcome may be mainly due to the initial ocular injury. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/244/114803 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114804 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Albinism: Particular attention to the ocular motor system Hertle, RW The purpose of this report is to summarize an understanding of the ocular motor system in patients with albinism. Other than the association of vertical eccentric gaze null positions and asymmetric, (a) periodic alternating nystagmus in a large percentage of patients, the ocular motor system in human albinism does not contain unique pathology, rather has "typical" types of infantile ocular oscillations and binocular disorders. Both the ocular motor and afferent visual system are affected to varying degrees in patients with albinism, thus, combined treatment of both systems will maximize visual function. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/248/114804 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114805 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Successful use of intravitreal bevacizumab and pascal laser photocoagulation in the management of adult Coats' disease Raoof, N Quhill, F Traditional methods of managing exudative retinal detachment secondary to Coats' disease have been associated with varying degrees of success. We describe a case of a 34 year-old male who presented with a sub-total exudative retinal detachment of the right eye that encroached upon the macula, associated with a vasoproliferative tumor secondary to Coats' disease. The patient under-went successful treatment with two intravitreal injections of bevacizumab (Avastin, Genetech Inc., San Francisco, CA, USA) combined with targeted laser photocoagulation with a 532 nm Pascal laser (Topcon Corp., Tokyo, Japan). The visual acuity improved 5 days after the second intravitreal injection from 6/18 to 6/5, with no residual macular edema and complete regression of the vasoproliferative tumor. The improvement in visual acuity was maintained at 12 months post-treatment. We believe this is the first case report describing the successful use of Pascal laser photocoagulation with intravitreal bevacizumab in the treatment of Coats' disease. Our aim was to defer laser treatment until 'near total' retinal reattachment and regression of the vasoproliferative tumor was achieved. There are, however, reports of vitreous fibrosis in patients with Coats' disease treated with intravitreal bevacizumab. This suggests further long-term follow-up studies are required in patients treated with this approach. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/256/114805 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114806 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Eyelid angiosarcoma: A case report and review of the literature Demirci, H Christanson, MD A 77-year-old woman presented with a 3-month history of a lesion on her left lower eyelid. External examination showed a tan-colored nodule with an overlying crust-covered ulcer on the left lower eyelid, nasally. The ulcer measured 12 mm × 7 mm. Complete surgical excision with a frozen section margin control was performed. Histopathological examination showed islands and sheets of spindle and epithelioid cells with little intervening stroma. The cells had copious amounts of either rounded or tapered eosinophilic cytoplasm with occasional intracytoplasmic lumina and large vesicular nuclei with prominent nucleoli. There was intense immunoreactivity for CD34, CD31, factor VIII, and Ki-67. The diagnosis was eyelid angiosarcoma. The patient refused any further therapy. At 1-year follow-up, there was no recurrence or development of metastasis. In conclusion, tan-colored eyelid nodules with overlying ulcer are usually a basal cell carcinoma; however, rarely it can be an eyelid angiosarcoma. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/259/114806 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114807 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral congenital lacrimal fistula in down syndrome Singh, M Singh, U Congenital lacrimal fistulae are rare in Down syndrome and bilateral presentation is very unusual. It can be associated with nasolacrimal duct obstruction. We report a 3-year-old female with Down syndrome who presented with watering and discharge from both eyes and bilateral fistulous openings present inferonasal to the medial canthus. Upon examination, the lacrimal sac regurgitation test was positive on both sides. Our case report documents a distinctive case of bilateral congenital lacrimal fistulae in association with Down syndrome. It was managed successfully by primary fistulectomy and nasolacrimal duct probing. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/263/114807 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114808 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Acute hydrops in the donor cornea graft in non-keratoconus patients Cason, JB Yiu, SC A 44-year-old Hispanic male and 91-year-old Caucasian male presented to the clinic with acute vision loss and pain years after penetrating keratoplasty (PKP). Neither patient had a history of keratoconus. Both patients had a history of eye rubbing and intraocular device present in the anterior chamber. The first patient had a history of a glaucoma drainage tube and the second patient had an anterior chamber intraocular lens implanted. Anterior segment ocular coherence tomography showed deep stromal cystic cavities. Both patients exhibited breaks in the endothelium by ultrasound biomicroscopy and the histopathologic examination after repeat PKP. Those findings were most consistent with acute corneal hydrops in the donor graft. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/265/114808 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:114810 2013-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Oculocardiac reflex in a medial orbital wall fracture without clinically evident entrapment Swamy, L Phan, LT Sadah, ZM McCulley, TJ Warwar, RE In this report, we describe a patient with a medial wall orbital fracture, who presented with vasovagal-like symptoms secondary to an oculocardiac reflex. This case is unusual because the patient had no other clinical evidence of muscle entrapment. A 15-year-old male presented with daily 5-10 min episodes of dizziness, light headedness, and nausea consistent with a vasovagal reaction. On examination, the patient had full extra ocular motility and was orthotropic in all fields of gaze. On computed tomography a comminuted medial orbital wall fracture was identified. The adjacent medial rectus muscle was in normal position, but was "rounded" relative to the contralateral side. The patient underwent fracture repair with immediate resolution of all symptoms. Symptoms related to a vasovagal response may occur with orbital fractures despite normal extra ocular motility. Presumably this relates to tension or pulling on an extra ocular muscle, which is not to a degree that alteration in function is appreciable clinically. Medknow Publications 2013-07-01 http://www.meajo.org/text.asp?2013/20/3/268/114810 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:119991 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
New insights into the management of diabetic retinopathy Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/271/119991 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:119993 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Evolving strategies in the management of diabetic retinopathy Diabetic retinopathy (DR), the most common long-term complication of diabetes mellitus, remains one of the leading causes of blindness worldwide. Tight glycemic and blood pressure control has been shown to significantly decrease the risk of development as well as the progression of retinopathy and represents the cornerstone of medical management of DR. The two most threatening complications of DR are diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR). Focal/grid photocoagulation and panretinal photocoagulation are standard treatments for both DME and PDR, respectively. Focal/grid photocoagulation is a better treatment than intravitreal triamcinolone acetonide in eyes with DME. Currently, most experts consider combination focal/grid laser therapy and pharmacotherapy with intravitreal antivascular endothelial growth factor agents in patients with center-involving DME. Combination therapy reduces the frequency of injections needed to control edema. Vitrectomy with removal of the posterior hyaloid seems to be effective in eyes with persistent diffuse DME, particularly in eyes with associated vitreomacular traction. Emerging therapies include fenofibrate, ruboxistaurin, renin-angiotensin system blockers, peroxisome proliferator-activated receptor gamma agonists, pharmacologic vitreolysis, and islet cell transplantation. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/273/119993 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:120003 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Surgical management of diabetic retinopathy Gupta, V Arevalo, JF Surgery for late complications of proliferative diabetic retinopathy remains the cornerstone of management even in patients who have received optimal laser photocoagulation and medical therapy. With improvisation in the surgical techniques and development of micro-incision surgical techniques for vitrectomy, the indications for surgical intervention are expanding to include diabetic macular edema with a greater number of patients undergoing early intervention. This review describes the current indications, surgical techniques, adjunctive anti-vascular endothelial growth factor therapy, surgical outcomes, and postoperative complications of pars plana vitrectomy for proliferative diabetic retinopathy and macular edema. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/283/120003 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:120007 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Epidemiological issues in diabetic retinopathy Scanlon, PH Aldington, SJ Stratton, IM There is currently an epidemic of diabetes in the world, principally type 2 diabetes that is linked to changing lifestyle, obesity, and increasing age of the population. Latest estimates from the International Diabetes Federation (IDF) forecasts a rise from 366 million people worldwide to 552 million by 2030. Type 1 diabetes is more common in the Northern hemisphere with the highest rates in Finland and there is evidence of a rise in some central European countries, particularly in the younger children under 5 years of age. Modifiable risk factors for progression of diabetic retinopathy (DR) are blood glucose, blood pressure, serum lipids, and smoking. Nonmodifiable risk factors are duration, age, genetic predisposition, and ethnicity. Other risk factors are pregnancy, microaneurysm count in an eye, microaneurysm formation rate, and the presence of any DR in the second eye. DR, macular edema (ME), and proliferative DR (PDR) develop with increased duration of diabetes and the rates are dependent on the above risk factors. In one study of type 1 diabetes, the median individual risk for the development of early retinal changes was 9.1 years of diabetes duration. Another study reported the 25 year incidence of proliferative retinopathy among population-based cohort of type 1 patients with diabetes was 42.9%. In recent years, people with diabetes have lower rates of progression than historically to PDR and severe visual loss, which may reflect better control of glucose, blood pressure, and serum lipids, and earlier diagnosis. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/293/120007 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Systemic medical management of diabetic retinopathy Lingam, G Wong, TY Diabetes mellitus (DM) has assumed epidemic proportions and as a consequence, diabetic retinopathy is expected to be a major societal problem across the world. Diabetic retinopathy (DR) affects the vision by way of proliferative disease that results in vitreous hemorrhage and traction retinal detachment or by way of diabetic maculopathy (DME). The present-day management of diabetic retinopathy revolves around screening the diabetics for evidence of retinopathy and treating the retinopathy with laser photocoagulation. DME is treated with laser photocoagulation and/or intra- vitreal injection of anti-vascular endothelial growth factor (VEGF) agents or steroids. Laser remains the mainstay of treatment and is potentially destructive. Systemic management aims at preventing or delaying the onset of retinopathy; reversing the early retinopathy; or delaying the progression of established retinopathy. Evidence from multiple studies has confirmed the protective role of rigid control of blood glucose and blood pressure. The evidence for lipid control versus maculopathy was less definitive. However, the use of fenofibrates (originally used for lowering serum lipids) has shown a benefit on both proliferative disease and maculopathy outside their lipid-lowering effect. Other drugs being tried are the Protein Kinase C (PKC) inhibitors, other peroxisome proliferator-activated receptors (PPAR) agonists, Forsoklin (which binds GLUT 1 receptor), minocycline (for its anti inflammatory effect), and Celecoxib (Cox-2 inhibitor). Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/301/120010 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Should we start all patients with diabetic retinopathy on fenofibrates? Koshy, J Koshy, JM Thomas, S Kaur, G Mathew, T There remains a need for strategies that are effective in preventing diabetic retinopathy (DR) or slowing down its progression, which is safe, well-tolerated, and more effective, have a lower risk profile, easy to perform, have more predictable results with less morbidity than the current regimens. Physicians caring for diabetic patients not only need to maximize glycemic control, but also closely monitor and treat other systemic conditions. The consistency of clinical data from the fenofibrate studies showed consistent beneficial effects with fenofibrate in slowing the progression of DR. They demonstrated significant benefit on micro-vascular (i.e., retinopathy and nephropathy) outcome, possibly independent of lipid levels. Can we combine the effectiveness of the current standard procedures with the prevention and slowing down of progression of DR that fenofibrates can offer? Knowledge of the primary mode of action of fenofibrate will be useful for both physicians and patients in determining how best to use this drug as an adjunct in the management of DR and ultimately facilitating the translation of clinical trial data to clinical practice. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/309/120012 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Combined therapy for diabetic macular edema Al, RS Arevalo, JF Diabetic macular edema (DME) is the main cause of visual impairment in diabetic patients. Macular edema within 1 disk diameter of the fovea is present in 9% of the diabetic population. The management of DME is complex and often multiple treatment approaches are needed. This review demonstrates the benefits of intravitreal triamcinolone, bevacizumab and ranibizumab as adjunctive therapy to macular laser treatment in DME. The published results indicate that intravitreal injections of these agents may have a beneficial effect on macular thickness and visual acuity, independent of the type of macular edema that is present. Therefore, pharmacotherapy could complement focal/grid laser photocoagulation in the management of DME. For this review, we performed a literature search and summarized recent findings regarding combined therapy for DME. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/315/120014 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Diabetic retinopathy and its risk factors at the University Hospital in Jamaica Mowatt, L Purpose: To determine the frequency of diabetic retinopathy and its risk factors in diabetic patients attending the eye clinic at the University Hospital of the West Indies (UHWI). Materials and Methods: This was a prospective cohort study of diabetic outpatients attending the Eye Clinic at the UHWI. Data were collected on age, gender, type of diabetes mellitus (DM), type of diabetic retinopathy, other ocular diseases, visual acuity, blood glucose and blood pressure. Statistical Package for Social Sciences (SPSS version 19.0) was used for data analysis. Results: There were 104 patients (208 eyes) recruited for this study. There were 58.6% (61/104) females (mean age 53.6 ± 11.9 years) and 41.4% (43/104) males (mean age 61.7 ± 12.1 years). Type II DM was present in 68.3% (56% were females) of the patients and Type I DM was present in 31.7% (69.7% were females). Most patients (66%) were compliant with their diabetic medications. The mean blood glucose was 11.4 ± 5.3 mmol/L. Elevated blood pressure (>130/80) was present in 82.7% of patients. The mean visual acuity was 20/160 (logMAR 0.95 ± 1.1). The frequency of diabetic retinopathy was 78%; 29.5% had background retinopathy, and 50.5% of eyes had proliferative diabetic retinopathy (PDR) of which 34% had tractional retinal detachments. The odds ratio of developing PDR was 1.88 (95% confidence intervals (CI): 1.02-3.3) for Type I DM compared to 0.74 (95% CI: 0.55-0.99) for Type II DM. PDR was more prevalent in females (χ<sup>2</sup> , P = 0.009) in both Type I and II DM. Conclusions: Jamaica has a high frequency of PDR which is more common in Type I diabetics and females. This was associated with poor glucose and blood pressure control. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/321/120017 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:120019 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Posterior vitreous detachment and retinal detachment after implantation of the visian phakic implantable collamer lens Bamashmus, MA Al-Salahim, SA Tarish, NA Saleh, MF Mahmoud, HA Elanwar, MF Awadalla, MA Introduction: To evaluate the vitreoretinal complications in myopes after Visian implantable collamer lenses (ICL) implantation. Materials and Methods: This is a retrospective, observational, non-comparative clinical study that evaluated 617 consecutive myopes who underwent ICL implantation at the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen between July 2006 and May 2010. Follow up ranged from 6 months to 40 months. Preoperative and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected (UCVA) and best spectacle-corrected visual acuity (BSCVA), slit-lamp biomicroscopy, intraocular pressure and dilated retinal examination. Investigations included corneal topography, central corneal thickness, anterior chamber depth and white to white diameter. Retinal diseases and complications were recorded and analyzed preoperatively and postoperatively. Results: Preoperatively, 61 (9.9%) eyes had posterior segment pathology requiring prophylactic laser photocoagulation. One eye developed spontaneous rhegmatogenous retinal detachment (RRD), one eye developed traumatic retinal detachment and two eyes required laser treatment postoperatively. The overall retinal detachment rate post-ICL was 0.32%. Conclusions: Posterior segment complications are rare after ICL implantation but dilated vitreoretinal assessment is important before and after the procedure. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist. If a patient develops floaters or blurry vision he/she requires further assessment by a vitreoretinal specialist. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/327/120019 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:120021 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Long-term change in intraocular pressure after extracapsular cataract extraction with posterior chamber intraocular lens implantation versus phacoemulsification with posterior chamber intraocular lens implantation in Indians Pal, VK Agrawal, A Suman, S Pratap, VB Purpose: The purpose of the study is to evaluate the long-term changes in intraocular pressure (IOP) after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation versus phacoemulsification with PCIOL implantation in otherwise normal cataract patients in India. Materials and Methods: The study was conducted in the Department of Ophthalmology, King George's Medical College, Lucknow between August 2000 and August 2001. One hundred and seventeen eyes of 115 patients were included in the study. 84 patients were randomly selected for ECCE with PCIOL implantation (ECCE group) and 31 patients were selected for phacoemulsification with PCIOL implantation (Phaco group). IOP was measured pre-operatively and post-operatively, from the 1 <sup>st</sup> month to the 12 <sup>th</sup> month. Statistical significance was indicated by P < 0.05. Results: There was a mean fall in IOP of 2.70 mm Hg (19.74%) in the ECCE group and 2.74 mm Hg (20.57%) in the phaco group. The decrease in the mean post-operative IOP from baseline was statistically significant (P < 0.01) at the end of 2 months in both groups. There was no statistically significant difference in post-operative IOP at any visit between groups (P > 0.05, all post-operative visits). After 4 <sup>th</sup> monthpost-operatively, the IOP was mostly stable, but it was significantly lower than the pre-operative IOP. Conclusion: Significant IOP reduction may be expected after cataract surgery with either ECCE or phacoemulsification with IOL implantation. The lowering of IOP became statistically significant at about 2 months post-operatively, but became almost stable after the 4 <sup>th</sup> month. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/332/120021 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:120023 2013-10-01 all journal:Middle_East_Afr_J_Ophthalmol
Topical ocular anesthetic abuse among Iranian welders: Time for action Sharifi, A Sharifi, H Karamouzian, M Mokhtari, M Esmaeili, HH Nejad, AS Rahmatian, M Purpose: The purpose of this study is to estimate the prevalence of topical ocular anesthetic abuse among welders in Iran and suggest public health solutions for this issue. Methods: In this cross-sectional study, 390 welders were randomly recruited and queried on the use of anesthetic drops. A questionnaire was administered through structured one-on-one interviews conducted by the first author. Results: A total of 314 welders (80.5%) declared that they had used topical anesthetics at least once during their working lives. Almost 90% of them stated a preference for self-treatment over seeking help from a physician due to cultural and financial reasons. The most commonly used topical anesthetic was tetracaine. Most of the subjects (97.4%) had obtained the drugs from pharmacies without a prescription. Conclusions: The prevalence of topical ocular anesthetic abuse among welders in Iran is alarmingly high and may partially be due to cultural issues. Although most physicians are aware that topical anesthetics should only be used as a diagnostic tool, there is a crucial need to re-emphasize the ocular risks associated with chronic use of these medications. Educational programs for both physicians and the public are necessary to address the problem. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/336/120023 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Current practice of ophthalmic anesthesia in Nigeria Adekoya, BJ Onakoya, AO Balogun, BG Oworu, O Purpose: To assess the current techniques of ophthalmic anesthesia in Nigeria. Materials and Methods: A cross sectional survey among Nigerian ophthalmology delegates attending the 36 <sup>th</sup> Annual Scientific Congress of the Ophthalmology Society of Nigeria. Self administered and anonymous questionnaires were used and data were collected to include details of the institution, preferred local anesthesia techniques, the grade of doctor who administers the local anesthesia, complications, preferred facial block techniques (if given separately), and type of premedication (if used). Results: Out of the 120 questionnaires distributed, 81 forms were completed (response rate 67.5%). Out of the 74 who indicated their grade, 49 (66.2%) were consultants, 22 (29.7%) were trainees, and 3 (7.1%) were ophthalmic medical officers. For cataract surgery, peribulbar anesthesia was performed by 49.1% of the respondents, followed by retrobulbar anesthesia (39.7%). Others techniques used were topical anesthesia (5.2%), subtenon anesthesia (4.3%), subconjunctival anesthesia (2.6%), and intracameral anesthesia (0.9%). For glaucoma surgery, 47.2% of the respondents use peribulbar anesthesia, 32.1% use retrobulbar anesthesia, 9.4% used general anesthesia, and 6.6% used subconjunctival anesthesia. Among the trainees, 57.8% routinely perform retrobulbar anesthesia while 55.6% routinely perform peribulbar anesthesia. At least one complication from retrobulbar anesthesia within 12 months prior to the audit was reported by 25.9% of the respondents. Similarly, 16.1% of the respondents had experienced complications from peribulbar anesthesia within the same time period. Retrobulbar hemorrhage is the most common complication experienced with both peribulbar and retrobulbar anesthesia. Conclusion: Presently, the most common technique of local anesthesia for an ophthalmic procedure in Nigeria is peribulbar anesthesia, followed by retrobulbar anesthesia. Twelve months prior to the study, 25.9% of the respondents had experienced at least one complication from retrobulbar anesthesia and 16.1% from peribulbar anesthesia. Retrobulbar hemorrhage was the most common complication reported. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/341/120022 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Comparison of visual acuity results in preschool children with lea symbols and bailey-lovie e chart Sanker, N Dhirani, S Bhakat, P Purpose: To compare visual acuity with two visual acuity charts in preschool children. Materials and Methods: Visual acuity measurement with Lea symbols and Bailey-Lovie tumbling E chart was performed on children between 3 and 6 years of age. Visual acuity data from the two charts were analyzed with Bland-Altman plot to determine the limits of agreement. The Wilcoxon signed test was performed in children aged 3-4 years and in children aged 5-6 years separately to evaluate the influence of age. The inter-eye difference between the two charts were further analyzed with the paired t-test. A p value < 0.05 was considered statistically significant. Results: A total of 47 children were enrolled for the study. The average logarithm of the Minimum Angle of Resolution (LogMAR) monocular visual acuity with Lea symbols (0.17 ± 0.13) was better than the Bailey-Lovie tumbling E chart (0.22 ± 0.14). The mean difference between Bailey-Lovie tumbling E chart and Lea symbol chart was 0.05 ± 0.12 in logMAR units. A second analysis eliminating outliers showed the same result but lower differences (n = 43, 0.05 ± 0.05 logMAR units). Visual acuity results between the two charts in children aged 3-4 years showed a significant difference (p = 0.000), but not for children aged 5-6 years (p = 0.059). Inter-eye differences between the two charts was not statistically significant (p = 0.77). Conclusion: Bailey-Lovie tumbling E chart is comparable to the Lea symbols chart in pre-school children. But preference should be given to Lea symbols for children aged 3-4 years as the symbols are more familiar than a directional test for this age group. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/345/120020 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Probing for congenital nasolacrimal duct obstruction in older children Eshragi, B Fard, MA Masomian, B Akbari, M Purpose: The purpose of this study was to evaluate the role of probing in congenital nasolacrimal duct obstruction in children age 2 years and older and to establish factors predictive of the outcome. Materials and Methods: A prospective study was conducted on consecutive patients older than 24 months with congenital nasolacrimal duct obstruction. All patients were treated with a simple nasolacrimal duct probing as primary treatment. Outcome measures included an ophthalmologic examination plus a parental history of residual symptoms at one and 6 months after surgery. Results: A total of 82 children with a mean age of 34.5 months (range, 24 months to 60 months) underwent nasolacrimal duct probing. The complete response rate was 54%. Partial response and failure were observed in 25% and 20.8% of the eyes, respectively. Bilateral obstruction was associated with failure of probing (P = 0.007, Odds Ratio: 5.76). However, age older than 36 months was not associated with the failure rate. Conclusion: Primary probing maintains a high success rate without any age related decline in congenital nasolacrimal duct obstruction. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/349/120018 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Bilateral proliferative retinopathy as the initial presentation of chronic myeloid leukemia Ferreira, NN Gomes, MP The authors report a rare case of a 48-year-old male with chronic myeloid leukemia (CML) who initially presented with a bilateral proliferative retinopathy. The patient complained of recent visual loss and floaters in both eyes (BE). Ophthalmologic evaluation revealed a best corrected visual acuity (BCVA) of 20/50 in the right eye and 20/200 in the left eye (LE). Fundoscopy showed the presence of bilateral peripheral capillary dropout with multiple retinal sea fan neovascularisations, which were confirmed on fluorescein angiography. Full blood count revealed hyperleukocytosis, thrombocytosis, anemia, and hyperuricemia. Bone marrow aspiration and biopsy showed the reciprocal chromosomal translocation t (9;22), diagnostic of CML. The patient was started on hydroxyurea, allopurinol and imatinib mesylate. He received bilateral panretinal laser photocoagulation and a vitrectomy was performed in the LE. The patient has been in complete hematologic, cytogenetic, and major molecular remission while on imatinib and his BCVA is 20/25 in BE. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/353/120016 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Inverted autologous internal limiting membrane for management of optic disc pit with macular detachment Mohammed, OA Pai, A Macular detachment causes visual deterioration in 25-75% of patients with congenital optic disc pit. A number of treatment options have been reported to manage the macular detachment in optic pit. An optic disc pit represents a defect in the lamina cribrosa; theoretically, an ideal procedure to treat optic pit associated macular detachment would be one that prevents the flow of fluid across the pit by creating an additional barrier. We present a new surgical technique that employs an autologous internal limiting membrane (ILM) to create this barrier. The technique involves standard vitrectomy along-with ILM peeling. Subsequently, the peeled ILM was inverted and transplanted onto the optic disc pit to close the optic nerve pit. This technique showed satisfactory anatomic result with good functional improvement in visual acuity. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/357/120008 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Long term result of intravitreal bevacizumab in a patient newly transformed to proliferative macular telangiectasia type 2 Ozkaya, A Alkin, Z Karakucuk, Y Yazici, AT Demirok, A The clinical and imaging findings and therapeutic outcomes of intravitreal bevacizumab injection in a patient with macular telangiectasia type 2 are described. The patient first presented with the non-proliferative stage of the disease for 4 months, then the disease transformed to the proliferative stage. In the proliferative period, the patient was treated with intravitreal bevacizumab injections as-clinically warranted. Over a follow up period lasting 26 months, the patient received 6 intravitreal bevacizumab injections, the visual acuity improved from 20/100 to 20/40, the central retinal thickness decreased from 318 microns to 198 microns. This case implies that the patients with non-proliferative macular telangiectasia type 2 should be followed carefully for proliferative transformation, and intravitreal bevacizumab treatment seems to be effective for proliferative macular telangiectasia type 2. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/360/120005 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Recurrent central serous chorioretinopathy with dexamethasone eye drop used nasally for rhinitis Prakash, G Shephali, J Tirupati, N Ji, PD Central serous chorioretinopathy (CSC) is characterized by serous retinal detachment at the posterior pole. Several factors have been implicated in the pathogenesis, and endogenous or exogenous corticosteroids are thought to play a major role. Here we present a case of a 35-year-old male with complaints of a dark circle in front of his right eye. Fundus examination, optical coherence tomography and fundus fluorescein angiography were performed. The patient was diagnosed with CSC. CSC resolved completely within seven weeks. Four weeks later the CSC recurred and spontaneously resolved over eight weeks. Overall, the patient had three additional recurrences of CSC in the same eye over the next year. A detailed history taking revealed the patient was using 0.1% dexamethasone eye drops nasally for recurrent rhinitis for few days prior to each episode of CSC. This indicates the strong correlation between steroids given by any route and the pathogenesis of CSC. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/363/120001 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Trichilemmal cyst of the bulbar conjunctiva: A rare presentation Kadri, R Parameshwar, D Ilanthodi, S Hegde, S We report a rare case of trichilemmal cyst involving the bulbar conjunctiva. A 55-year-old female presented with a history of a painless, progressive swelling in the left bulbar conjunctiva adjacent to the nasal limbus of 3 years duration. Wide excision biopsy was performed. Histopathologic examination findings were consistent with those of trichilemmal cyst. Trichilemmal cyst should be considered as differential diagnosis in a case of limbal nodule. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/366/119999 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Visual hallucinations (Charles Bonnet syndrome) associated with neurosarcoidosis Zhang, J Waisbren, E Hashemi, N Lee, AG The Charles Bonnet syndrome (CBS) refers to lucid and complex visual hallucinations in cognitively normal patients with acquired vision loss. It can be associated with any type of vision loss including that related to macular degeneration, corneal disease, diabetic retinopathy, and occipital infarct. Neurosarcoidosis, a multi-systemic inflammatory granulomatous disease affecting both the central and peripheral nervous systems, is rarely associated with CBS. We report a patient with biopsy-confirmed neurosarcoidosis who experienced visual hallucinations following the development of a right seventh-nerve palsy, right facial paresthesia, and bilateral progressive visual loss. This case highlights the importance of recognizing that the CBS can occur in visual loss of any etiology. Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/369/119997 en Copyright 2014 Middle East African Journal of Ophthalmology.
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FIESTA imaging for problem-solving in early Duane's retraction syndrome Peter, P Peter, S Thomas, S Medknow Publications 2013-10-01 http://www.meajo.org/text.asp?2013/20/4/372/119994 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Refractive surgery: The never-ending task of improving vision correction Al-Swailem, SA Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/1/124075 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Current management of presbyopia Papadopoulos, PA Papadopoulos, AP Presbyopia is a physiologic inevitability that causes gradual loss of accommodation during the fifth decade of life. The correction of presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. Different approaches on the cornea, the crystalline lens and the sclera are being pursued to achieve surgical correction of this disability. There are however, a number of limitations and considerations that have prevented widespread acceptance of surgical correction for presbyopia. The quality of vision, optical and visual distortions, regression of effect, complications such as corneal ectasia and haze, anisometropia after monovision correction, impaired distance vision and the invasive nature of the currently techniques have limited the utilization of presbyopia surgery. The purpose of this paper is to provide an update of current procedures available for presbyopia correction and their limitations. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/10/124080 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Refractive surgery in systemic and autoimmune disease AlKharashi, M Bower, KS Stark, WJ Daoud, YJ Patients with underlying systemic disease represent challenging treatment dilemma to the refractive surgeon. The refractive error in this patient population is accompanied by a systemic disease that may have an ocular or even a corneal component. The literature is rather sparse about the use of laser refractive surgery (LRS) and such procedure is not approved by the United States Food and Drug Administration (FDA) in this patient population. Patients with collagen vascular disease, diabetes mellitus (DM), allergic and atopic disease, or human immunodeficiency virus (HIV) are never ideal for LRS. Patients with uncontrolled systemic disease or ocular involvement of the disease should not undergo LRS. However, a patient with well-controlled and mild disease, no ocular involvement, and not on multidrug regimen may be a suitable candidate if they meet stringent criteria. There is a need for a large, multicenter, controlled trial to address the safety and efficacy of LRS in patients with systemic disease before such technology can be widely adopted by the refractive surgery community. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/18/124082 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Clear corneal incision in cataract surgery Al-Swailem, SA Behrens, A Since the introduction of sutureless clear corneal cataract incisions, the procedure has gained increasing popularity worldwide because it offers several advantages over the traditional sutured scleral tunnels and limbal incisions. Some of these benefits include lack of conjunctival trauma, less discomfort and bleeding, absence of suture-induced astigmatism, and faster visual rehabilitation. However, an increasing incidence of postoperative endophthalmitis after clear corneal cataract surgery has been reported. Different authors have shown a significant increase up to 15-fold in the incidence of endophthalmitis following clear corneal incision compared to scleral tunnels. The aim of this report is to review the advantages and disadvantages of clear corneal incisions in cataract surgery, emphasizing on wound construction recommendations based on published literature. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/25/124084 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124076 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Intrastromal corneal ring segments: How successful is the surgical treatment of keratoconus? Alio, JL Vega-Estrada, A Esperanza, S Barraquer, RI Teus, MA Murta, J This review evaluates the outcomes of intrastromal corneal ring segment (ICRS) implantation for the treatment of keratoconus considering a new grading system based on the preoperative visual impairment of the patient. Additionally, a five-year follow-up analysis of patients with stable and progressive keratoconus is performed in order to assess the long term stability of the surgical procedure. Corrected distance visual acuity decreased statistically significantly in patients with mild keratoconus (P < 0.01) but statistically significantly increased in all other grades (P < 0.05). The improvement in visual acuity and the decrease of keratometric and aberrometric values were stable throughout a long period of time in patients with stable keratoconus. In patients with progressive form keratoconus, a significant improvement was found immediately after the procedure, however clinically relevant regression greater than 3 D was observed at the end of the follow up period. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/3/124076 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124086 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Gradient refractive index optics IOL: Theoretical background and clinical results Malyugin, B Morozova, T Cherednik, V Purpose: To present the theoretical optical background and clinical results of a new multifocal intraocular lens (MIOL) concept-gradient refractive index optics (Gradiol). Patients and Methods: Original mathematical modeling software was used to calculate optimal construction of the MIOL optic constructed from two polymer materials with different refractive indices. Gradiol lenses were manufactured from hydrophobic acrylic utilizing original step-by-step polymerization technology with the final power difference of of 3.5 D between optic components. Non-comparative prospective clinical study included 26 patients (29 eyes) who were candidates for MIOL implantation. All surgeries were performed at the S. Fyodorov Eye Microsurgery Complex State Institution, Moscow, Russia. After implantation of the Gradiol lenses, the postoperative evaluations included distance (best corrected visual acuity (BCVA)) and near visual acuity (NVA), contrast sensitivity (CS), and amplitude of pseudoaccommodation. Subjective patient's satisfaction was assessed using a questionnaire (VF-14). Results: The mean age of the patients was 62.5 ± 5.7 years (range 27-82 years). All surgical procedures were uneventful. At 6 months postoperatively, the mean uncorrected distance VA was 0.73 ± 0.18, mean uncorrected near VA was 0.57 ± 0.19, mean corrected distance VA was 0.89 ± 0.15, mean corrected near VA was 0.84 ± 0.07, and amplitude of pseudoaccommodation was 4.75 ± 0.5 D. Eighty-six percent of patients were spectacle independent for daily activities and reading. Optical disturbances that were functionally significant were reported by 10.7% of patients postoperatively. Conclusion: The clinical outcomes of this study confirmed the theoretical calculations of constructing MIOL optics from materials with different refractive indices. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/32/124086 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124090 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Pigmented hypopyon in association with Listeria monocytogenes endopthalmitis: An interesting case report following refractive surgery procedure with literature review Alkatan, HM Al-Dhibi, HA Edward, DP Al-Rajhi, AA Purpose: Listeria monocytogenes is an aerobic, motile, gram positive bacillus recognized as an intercellular pathogen in human where it most frequently affects neonates, pregnant women, elderly patients, and immunosuppressed individuals as well as healthy persons. Ocular listeriosis is rare, most frequently in the form of conjunctivitis, but has been also shown to cause rarely endophthalmitis with pigmented hypopyon and elevated intraocular pressure such as in our case. Materials and Methods: We are reporting one immunocompetent patient presenting with dark hypopyon following laser refractive procedure. His clinical findings, investigations, and further management are all described with relevant literature review of similar cases. Results: Diagnosis of ocular listeriosis was confirmed by positive culture of anterior chamber (AC) aspirate with identification of the above organism. His visual outcome was satisfactory with good preserved vision. Conclusion: We believe that his ocular infection was exogenous and that ophthalmologists should be aware of the causative organisms of colored hypopyon to avoid delayed diagnosis. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/40/124090 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124093 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Primary and secondary implantation of scleral-fixated posterior chamber intraocular lenses in adult patients Yalniz-Akkaya, Z Burcu, A Uney, GO Abay, I Eksioglu, U Acar, MA Ornek, F Purpose: The purpose of this study is to evaluate and to compare the results of primary and secondary scleral-fixated posterior chamber intraocular lens (PCIOL) implantations in adult patients. Materials and Methods: A retrospective analysis of scleral-fixated PCIOLs-implanted during (primary group) or after (secondary group) cataract surgery was performed. The median follow-up time of 96 patients was 6 months (minimum: 6; maximum: 35 months). Outcome measures were indications, corrected distance visual acuity (CDVA), change in visual acuity and complications. Results: A total of 37 patients (38.5%) had primary implantations and 59 (61.5%) had secondary implantations. Penetrating keratoplasty was combined with secondary implantation in 13 cases. The median post-operative CDVA was 0.5 in decimal notation in both groups (P = 0.576). The CDVA improved by at least one Snellen line or remained unchanged in 35 eyes (94.6%) in the primary group and in 52 eyes (88.1%) in the secondary group (P = 0.263). Eyes with CDVA of 0.5 or higher were 62.2% (n = 23) in the primary group and 67.8% (n = 40) in the secondary group post-operatively (P = 0.066). The difference in early and late complications were not statistically significant between groups (P = 0.637, P = 0.154, respectively). Regarding late complications, 30 eyes (81%) in the primary group and 40 eyes (67.9%) in the secondary group had no complications (P = 0.154). Conclusion: Both primary and secondary scleral-fixated PCIOL implantations can provide favorable visual outcomes with lower complication rates. An important consideration is the appropriate timing for scleral fixation, taking into account the patient's characteristics and the course of the operation. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/44/124093 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124095 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Rose-K versus soper contact lens in keratoconus: A randomized comparative trial Gupta, R Sinha, R Singh, P Sharma, N Tandon, R Titiyal, JS Purpose: To perform a comparative evaluation of the efficacy and acceptability of Rose-K and Soper contact lenses in Keratoconus. Setting: Dr. Rajendra Prasad Center for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi. Materials and Methods: A randomized comparative clinical trial was performed in keratoconic eyes fitted with Rose-K (Rose-K group) and Soper (Soper group) contact lenses. Patients data were evaluated for best spectacle corrected visual acuity, best contact lens corrected visual acuity (BCLCVA), corneal topography, glare acuity, contrast sensitivity, tear function tests and specular microscopy. Patients were also asked to complete a self-reported comfort questionnaire at each visit. Results: Sixty eyes were randomized to the Rose-K and Soper groups. The two groups were comparable in all the baseline parameters. There was a statistically significant improvement in BCLCVA in both groups at 3 months (P < 0.01, both groups). The difference between in BCLCVA in both groups was not statistically significant. In both groups, there was a significant improvement in the comfort score at 3 months compared to baseline (P < 0.05, both group). The Rose-K group had statistically significantly better scores at 1 and 3 months compared with the Soper group (P = 0.006 and P < 0.001 respectively). Both groups were associated with a significant (P < 0.01), but comparable improvement in glare acuity at 3 months. There was a significant improvement in contrast sensitivity at 3 months in both groups (P < 0.01); the Rose-K group was significantly better than the Soper group at 1 and 3 months (P = 0.001 and 0.002 respectively). The mean number of trial lenses required for fitting Rose-K lens (2.00 ± 0.59) was significantly lower than the Soper lens (3.43 ± 0.82; P < 0.001). Conclusion: Both the contact lens designs provide an equal improvement in visual acuity in patients with Keratoconus. However, Rose-K contact lens provides greater comfort, better quality of vision and requires less chair time compared with the Soper lens and hence may possibly have a greater acceptability. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/50/124095 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124098 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Comparison of morphological and functional endothelial cell changes after cataract surgery: Phacoemulsification versus manual small-incision cataract surgery Ganekal, S Nagarajappa, A Purpose: To compare the morphological (cell density, coefficient of variation and standard deviation) and functional (central corneal thickness) endothelial changes after phacoemulsification versus manual small-incision cataract surgery (MSICS). Design: Prospective randomized control study. Materials and Methods: In this prospective randomized control study, patients were randomly allocated to undergo phacoemulsification (Group 1, n = 100) or MSICS (Group 2, n = 100) using a random number Table. The patients underwent complete ophthalmic evaluation and specular microscopy preoperatively and at 1and 6 weeks postoperatively. Functional and morphological endothelial evaluation was Noncon ROBO PACHY SP-9000 specular microscope. Phacoemulsification was performed, the chop technique and MSICS, by the viscoexpression technique. Results: The mean difference in central corneal thickness at baseline and 1 week between Group 1 and Group 2 was statistically significant (P = 0.027). However, this difference at baseline when compared to 6 week and 1 week, 6 weeks was not statistically significant (P > 0.05). The difference in mean endothelial cell density between groups at 1 week and 6 weeks was statistically significant (P = 0.016). The mean coefficient of variation and mean standard deviation between groups were not statistically significant (P > 0.05, both comparisons). Conclusion: The central corneal thickness, coefficient of variation, and standard deviation were maintained in both groups indicating that the function and morphology of endothelial cells was not affected despite an initial reduction in endothelial cell number in MSICS. Thus, MSICS remains a safe option in the developing world. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/56/124098 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124100 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Prickly pear spine keratoconjunctivitis Al-Tawara, MJ Hammouri, EH Objectives: To study the ocular and extra-ocular features, clinical presentation, and treatment of prickly pear glochids. Materials and Methods: This retrospective study included 23 eyes of 21 patients with ocular prickly pear spines who were seen between August and October 2011 in the outpatient ophthalmic clinic at Prince Rashid Bin Al Hassan military hospital in Jordan. Medical records of patients including age, gender, history of exposure to prickly pear plants, and ocular examination were reviewed. All glochids were localized and removed with forceps under topical anesthesia with the patient at the slit lamp. Patients were followed up after one week. Results: The mean age of patients was 37.1 years with a male to female ratio of 1.6: 1. Involvement of the right eye was seen in 61.9% patients, left eye in 28.6% patients, and bilateral involvement in 9.5% patients. Glochids were most commonly found in the upper subtarsal conjunctival space (47.6%) followed by inferior palpebral conjunctiva in 23.8% eyes. The most common complaint was eye irritation in 95.2% patients. Pain was a complaint in 57.1% patients. Superior corneal epithelial erosions or ulcer were found in 33.3% patients, inferior corneal epithelial erosions in 19.1% patients, and diffuse epithelial erosions in 9.5% patients. Glochids were found in other parts of the body in 38.1% patients. Conclusion: Although prickly pear glochid ocular surface injury is not uncommon in the region during summer, it should be considered in patient with eye pain during that period. Farmers who are in close contact with prickly pears should use protective eyeglasses and gloves. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/61/124100 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124103 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Modulatory effect of different riboflavin compositions on the central corneal thickness of African keratoconus corneas during collagen crosslinking Mark, T Ngounou, F Tamon, J Marx-Gross, S Preussner, P Purpose: A pilot investigation to transfer the established corneal collagen crosslinking (CXL) procedure in European eyes into clinically affected African eyes and to optimize the treatment by adapting the riboflavin composition. Materials and Methods: CXL was performed in 15 eyes (11 patients) with advanced stages of keratoconus in the Eye Clinic of Bafoussam in the West Region of Cameroon. The following six riboflavin compositions with different portions of active swelling additives were applied: Solution 1 (0.5% methylhydroxypropylcellulose [MHPC]), solution 2 (1.0% MHPC), solution 3 (1.7% MHPC), solution 4 (5% dextran), solution 5 (10% dextran) and solution 6 (no active swelling ingredient). The central corneal thickness (CCT) was measured by ultrasound pachymetry before and after de-epithelialization and at least every 10 min during CXL. Results: The application of the riboflavin solutions resulted in the following mean final CCT values: 172 ± 15% using solution 1 (60 min/n = 5); 183 ± 8% using solution 2 (60 min/n = 5); 170% using solution 3 (60 min/n = 1); 80% using solution 4 (45 min/n = 1); 99% using solution 5 (45 min/n = 1) and 150 ± 13% using solution 6 (50 min/n = 2). Conclusions: The combination of riboflavin compositions with swelling and stabilizing effects on the corneal stroma seems necessary in African eyes with advanced keratoconus. Further studies are required to confirm these primary results. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/66/124103 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124107 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Corneal topography patterns in the Tehran eye study: Warning about the high prevalence of patterns with a skewed radial axis Hashemi, H Beiranvand, A Khabazkhoob, M Fotouhi, A Purpose: The purpose of this study is to determine the distribution of corneal topography patterns in Tehran. Materials and Methods: In this population-based study, a total of 442 individuals were randomly selected by cluster sampling for complete ophthalmologic examination. A total of 404 (788 eyes) met the inclusion criteria and were enrolled in this study. Orbscan II (Bausch and Lomb Surgical, Salt Lake City, USA) was used to determine the anterior segment indices and axial power maps for each eye. Results: On the basis of the axial power maps, the symmetric bowtie (SB) (29.0%) and asymmetric bowtie with inferior steepening (16.7%) patterns were the most prevalent and the irregular (3.3%) and superior steepening (1.5%) patterns the least prevalent. Asymmetric bowtie pattern with a skewed radial axis (AB-SRAX) was seen in 7.6% of eyes. These cases had both thinner and steeper corneas compared with round and SB ones (P < 0.014 and P < 0.006). Maximum anterior elevation in 5 mm zone, of AB-SRAX corneas were higher than other patterns (P < 0.01) except for superior steepened and inferior steepened ones. Conclusions: The distribution of corneal topographic patterns in Iranians seems like other Asian population on the whole. The 7.6% prevalence of AB-SRAX patterns may be a warning on keratoconus prevalence in our population. This is in line with recent regional reports. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/72/124107 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124110 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Manual suture less small incision cataract surgery in patients with uveitic cataract Bhargava, R Kumar, P Bashir, H Sharma, SK Mishra, A Purpose: The purpose of this study is to evaluate the outcome of manual small incision cataract surgery (SICS) in eyes with uveitic cataract. Setting: Medical college hospital of the subcontinent. Design: Retrospective case series. Materials and Methods: In this retrospective study, patients who underwent SICS with posterior chamber intraocular lens implantation for uveitic cataract from 2006 to 2009 were evaluated. Patients with less than 3 months follow-up were excluded. Post-operative vision and complications were analyzed. Results: A total of 54 patients completed the study. The mean age was 52.3 ± 9.3 years. The mean follow-up was 11.53 ± 5.05 months. The mean surgical time was (10.2 ± 3.8 min). Etiological diagnosis was possible in 31.41% (17/54) of patients. There was a statistically significant improvement in vision after surgery (P < 0.001). When uveitis was well-controlled, pre-operative corticosteroids did not change post-operative inflammation (P = 0.796). However, pre-operative corticosteroids were statistically significantly associated to final best corrected visual acuity (BCVA) (P = 0.010). Conclusion: SICS with posterior chamber intraocular lens implantation is safe in most cataracts due to uveitis and improves BCVA at 6 months. Inflammation should be well-controlled pre-operatively for at least 3 months. Posterior capsule opacification, macular edema and persistent uveitis were the main factors affecting visual outcome. SICS requires minimal instrumentation, surgical time is short and can also be performed in rural clinics and eye-camps, where phacoemulsification machines are unavailable. SICS may be a more practical and cost-effective technique for uveitic cataract, in such circumstances. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/77/124110 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124114 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Severe bilateral paralimbal sterile infiltrates after photorefractive keratectomy Al-Amry, MA This study presents a case report of the clinical presentation and management of a 47-year-old male myope who underwent photorefractive keratectomy (PRK) and developed bilateral sterile corneal infiltrates at 1 day post-operatively. The patient was successfully treated with aggressive topical antibiotic and topical steroid therapy. The final corrected distance visual acuity (CDVA) was 20/25 with faint corneal scarring. Peripheral sterile corneal infiltrate can occur after PRK with excellent prognosis. Infectious causes should be suspected in all cases of corneal infiltrate. The most likely cause of peripheral sterile corneal infiltrate in this case was pooling of the tear film containing antigens under the bandage contact lens. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/83/124114 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124116 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Intraoperative fracture of phacoemulsification tip Angmo, D Khokhar, SK Ganguly, A Phacoemulsification (phaco) is an established procedure for cataract extraction and has undergone a significant advances in techniques, machines and phaco tips. The Aspiration Bypass System (ABS) phaco tip was introduced for phacoemulsification in 1998. The ABS tip allows fluid to be drawn through the opening when the phaco tip is occluded by nuclear material. The ABS tip allowed the safe use of high vacuum and flow rates and improved chamber stability by decreasing surge and therefore reducing intraoperative complications. To date, no disadvantages of ABS tips have been reported. We report a unique case of an intraoperative break of an ABS phaco tip during routine cataract surgery. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/86/124116 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124118 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Repositioning of pedicle conjunctival flap performed for refractory corneal ulcer Sharma, A Mohan, K Sharma, R Nirankari, VS A 50-year-old male was referred with a previous history of conjunctival flap (CF) for a nonhealing fungal corneal ulcer with extreme corneal thinning in the right eye. The peritomy for the CF extended from 6:30 to 9:30 clock h on the cornea. The CF was disengaged, peritomy area deepithelialized, and CF was repositioned. He later underwent penetrating keratoplasty and achieved 20/40 best corrected visual acuity. The authors present a new concept for surgically repositioning CF s to the original site immediately after healing of the corneal ulcer. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/89/124118 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124121 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Alternaria keratitis after deep anterior lamellar keratoplasty Naik, M Mohd., S Sheth, J Sunderamoorthy, SK To describe a case of Alternaria keratitis in a 30-year-old male patient who presented with bilateral vascularised central corneal opacity and underwent deep anterior lamellar keratoplasty (DALK) in the left eye. Patient was treated for recurrent epithelial defect with a bandage contact lens in the follow-up visits after DALK. Subsequently, patient presented with pigmented fungal keratitis, which on culture examination of the corneal scrapping demonstrated Alternaria species. Patient had to undergo a repeat DALK as the keratitis did not resolve with medical therapy alone. Patient did not have a recurrence for 11 months following the regraft. This case report highlights the importance of considering the Alternaria species as a possibile cause of non-resolving fungal keratitis after DALK. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/92/124121 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:124131 2014-01-01 all journal:Middle_East_Afr_J_Ophthalmol
Alopecia following oral acyclovir for the treatment of herpes simplex keratitis Sharma, A Mohan, K Sharma, R Nirankari, VS The authors report acyclovir-induced alopecia in a patient treated for herpetic keratouveitis. A 32-years-old female was diagnosed with herpetic keratouveitis. She was placed on prednisolone acetate (1%) suspension four times a day, atropine sulfate (1%) thrice a day, and oral acyclovir 400 mg twice-daily. Three weeks following oral acylovir, keratouveitis improved, but she developed alopecia without any drug eruptions. Oral acyclovir was discontinued. Three months later, alopecia completely resolved. Alopecia may be considered a possible complication following oral acyclovir. Medknow Publications 2014-01-01 http://www.meajo.org/text.asp?2014/21/1/95/124131 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Teaching does not equal learning: The need for more effective education Golnik, KC Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/101/129743 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129744 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Structured curricula and curriculum development in ophthalmology residency Lee, AG Chen, Y There has been a shift in graduate medical education (GME) from the traditional "apprenticeship" model to a more curriculum-based and competency driven model. Reflecting a global trend towards residency education reform, the International Council of Ophthalmology (ICO) introduced a resident and specialist curriculum and several live educational programs to promote standardization and more effective GME and continuing professional training. Implementation of these educational innovations will require efforts by local educator champions; modification and customization of teaching and assessing tools to the local learning environment; alignment of the implementation blueprint with available resources; and creation of accountability and sustainability mechanisms to insure long-term viability of the educational reforms. An ultimate goal of the ICO curriculum is to allow real world testing and modification so that the ideas generated in one part of the world might be applicable and generalizable in other areas. We aim to describe the Accreditation Council of Graduate Medical Education (ACGME) competencies in the United States (US) and ICO curriculum, as well as to provide a step-by-step plan for implementation of an ophthalmology residency curriculum. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/103/129744 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Assessment principles and tools Golnik, KC The goal of ophthalmology residency training is to produce competent ophthalmologists. Competence can only be determined by appropriately assessing resident performance. There are accepted guiding principles that should be applied to competence assessment methods. These principles are enumerated herein and ophthalmology-specific assessment tools that are available are described. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/109/129746 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129748 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Adult learning principles and presentation pearls Palis, AG Quiros, PA Although lectures are one of the most common methods of knowledge transfer in medicine, their effectiveness has been questioned. Passive formats, lack of relevance and disconnection from the student's needs are some of the arguments supporting this apparent lack of efficacy. However, many authors have suggested that applying adult learning principles (i.e., relevance, congruence with student's needs, interactivity, connection to student's previous knowledge and experience) to this method increases learning by lectures and the effectiveness of lectures. This paper presents recommendations for applying adult learning principles during planning, creation and development of lectures to make them more effective. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/114/129748 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129756 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Webinar software: A tool for developing more effective lectures (online or in-person) Mayorga, EP Bekerman, JG Palis, AG Purpose: To describe the use of online seminars (webinars) to improve learning experience for medical residents and fostering critical thinking. Materials and Methods: Sixty-one online seminars (webinars) for residents were developed from April 2012 to February 2013. Residents attended the lectures in the same room as the presenter or from distant locations. Residents interacted with the presenter using their personal computers, tablets, or smartphones. They were able to ask questions and answer the instructor's multiple choice or open-ended questions. The lecture dynamics consisted of: (1) The presentation of a clinical case by an expert on the clinical topic; (2) the instructor asked open-ended and multiple-choice questions about the problem-resolution process; (3) participants responded questions individually; (4) participants received feedback on their answers; (5) a brief conference was given on the learning objectives and the content, also fostering interactive participation; (6) lectures were complemented with work documents. Results: This method allowed for exploration of learning of scientific knowledge and the acquisition of other medical competences (such as patient care, interpersonal and communication skills, and professionalism). The question-and-answer activity and immediate feedback gave attendees the chance to participate actively in the conference, reflect on the topic, correct conceptual errors, and exercise critical thinking. All these factors are necessary for learning. Conclusions: This modality, which facilitates interaction, active participation, and immediate feedback, could allow learners to acquire knowledge more effectively. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/123/129756 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129757 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Training the eye care team: Principles and practice Garg, P Reddy, S Nelluri, C One of the crucial factors to make high quality eye care services available, accessible and affordable to all is the availability of appropriately trained human resources. Providing health through a health care team is a better and cost effective alternative. The concept of the team approach is based on the principles of working together; task shifting; and ensuring continuity of care. Composition of a team varies based on the community needs, population characteristics and disease burden. But for it to be effective, a team must possess four attributes - availability, competency, productivity, and responsiveness. Therefore, training of all team members and training the team to work together as a unit are crucial components in the success of this concept. Some of the critical attributes include: Training across the health spectrum through quality and responsive curricula administered by motivated teachers; accreditation of programs or institutions by national or international bodies; certification and recertification of team members; and training in working together as a team through inter- and intra- disciplinary workshops both during training and as a part of the job activity. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/128/129757 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Continuing professional development: Best practices Filipe, HP Silva, ED Stulting, AA Golnik, KC Continuing professional development (CPD) involves not only educational activities to enhance medical competence in medical knowledge and skills, but also in management, team building, professionalism, interpersonal communication, technology, teaching, and accountability. This paper aims at reviewing best practices to promote effective CPD. Principles and guidelines, as already defined by some professional societies and world organizations, are emphasized as core actions to best enhance an effective lifelong learning after residency. The personal learning plan (PLP) is discussed as the core of a well-structured CPD and we describe how it should be created. Fundamental CPD principles and how they are integrated in the framework of every physician's professional life will be described. The value of systematic and comprehensive CPD documentation and assessment is emphasized. Accreditation requirements and professional relationships with commercial sponsors are discussed. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/134/129760 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Resources for eye care at secondary and tertiary level government institutions in Saudi Arabia Al, MS Khandekar, R Al-Towerki, A Purpose: To evaluate the number of healthcare personnel and equipment resources for eye care at government institutions in different administrative zones of the Kingdom of Saudi Arabia (KSA) and to recommend measures for increasing resources to address deficiencies. Materials and Methods: Data on resources (personnel and equipment) for eye care were collected from all governmental eye units in 2012. The data was regrouped by zones and administrative areas. The mid-2012 population projections were used to calculate the ophthalmologist to population ratio and optometrist to population ratio. The equipment available for eye care was reviewed. Results: All 60 institutions in 13 administrative areas and five zones of KSA participated in this study. There were 407 ophthalmologists and 147 optometrists. The ophthalmologist to population ratio was 1:43,000 (1:12,900 in the northern zone to 1:80,300 in the western zone). By 2015, 700 ophthalmologists will be required, and by 2020, 1,100 ophthalmologists will be required. The optometrist to population ratio was 1:95,000 (1:34,100 in the northern zone to 1:146,700 in the western zone). Nearly 2,800 and 4,400 allied eye care personnel will be needed by 2015 and 2020. Diagnostic and treatment equipment such as lasers, electrophysiologic and ultrasound equipment, and fundus cameras were not available at all institutions. Conclusions: Data from the private sector need to be included to draw conclusions on the human resource index for eye care in the Kingdom. An unequal distribution of resources in different zones and administrative areas requires attention. Better utilization of available resources is recommended before fulfilling the demand for additional resources. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/142/129761 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129764 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
The Sokoto blind beggars: Causes of blindness and barriers to rehabilitation services Balarabe, AH Mahmoud, AO Ayanniyi, AA Purpose: To determine the causes of blindness and the barriers to accessing rehabilitation services (RS) among blind street beggars (bsb) in Sokoto, Nigeria. Materials and Methods: A cross-sectional survey of 202 bsb (VA < 3/60) using interviewer administered questionnaire. The causes of blindness were diagnosed by clinical ophthalmic examination. Results: There were 107 (53%) males and 95 (47%) females with a mean age of 49 years (SD 12.2). Most bsb 191 (94.6%) had non-formal education. Of 190 (94.1%) irreversibly bsb, 180/190 (94.7%) had no light perception (NPL) bilaterally. The major causes of blindness were non-trachomatous corneal opacity (60.8%) and trachoma corneal opacity (12.8%). There were 166 (82%) blind from avoidable causes and 190 (94.1%) were irreversibly blind with 76.1% due to avoidable causes. The available sub-standard RS were educational, vocational and financial support. The barriers to RS in the past included non-availability 151 (87.8%), inability to afford 2 (1.2%), unfelt need 4 (2.3%), family refusal 1 (0.6), ignorance 6 (3.5%) and being not linked 8 (4.7%). The barriers to RS during the study period included inability of 72 subjects (35.6%) to access RS and 59 (81.9%) were due to lack of linkage to the existing services. Conclusion: Corneal opacification was the major cause of blindness among bsb. The main challenges to RS include the inadequate services available, societal and users factors. Renewed efforts are warranted toward the prevention of avoidable causes of blindness especially corneal opacities. The quality of life of the blind street beggar should be improved through available, accessible and affordable well-maintained and sustained rehabilitation services. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/147/129764 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129767 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Blindness and cataract surgical services in Atsinanana region, Madagascar Randrianaivo, J Anholt, RM Tendrisoa, DL Margiano, NJ Courtright, P Lewallen, S Purpose: To assess the prevalence and causes of avoidable blindness in Atsinanana Region, Madagascar, with the Rapid Assessment of Avoidable Blindness (RAAB) survey. We analyzed the hospital records to supplement the findings for public health care planning. Materials and Methods: Only villages within a two-hour walk from a road, about half of the population of Atsinanana was included. Seventy-two villages were selected by population-proportional-to-size sampling. In each village, compact segment sampling was used to select 50 people over age 50 for eye examination using standard RAAB methods. Records at the two hospitals providing cataract surgery in the region were analyzed for information on patients who underwent cataract surgery in 2010. Cataract incidence rate and target cataract surgery rate (CSR) was modeled from age-specific prevalence of cataract. Results: The participation rate was 87% and the sample prevalence of blindness was 1.96%. Cataract was responsible for 64% and 85.7% of blindness and severe visual impairment, respectively. Visual impairment was due to cataract (69.4%) and refractive error (14.1%). There was a strong positive correlation between cataract surgical rate by district and the proportion of people living within 2 hours of a road. There were marked differences in the profiles of the cataract patients at the two facilities. The estimated incidence of cataract at the 6/18 level was 2.4 eyes per 100 people over age 50 per year. Conclusions: Although the survey included only people with reasonable access, the main cause of visual impairment was still cataract. The incidence of cataract is such that it ought to be possible to eliminate it as a cause of visual impairment, but changes in service delivery at hospitals and strategies to improve access will be necessary for this change. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/153/129767 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129768 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Change-readiness of the blind: A hospital based study in a coastal town of South India Shetty, R Kulkarni, UD Purpose: Blindness is a devastating condition with psychosocial and economic effects. The shortcomings result in a burden to the blind person, the family and society. Rehabilitation of the blind can transform their lives. The aim of this study was to assess the "change-readiness" of the blind to undergo a "change-management." Materials and Methods: The study was a semi-structured pre-tested questionnaire-based study of 50 blind subjects in a medical college hospital. The blind participants were assessed for depression using the Beck Depression Inventory II, for the perceived effect of blindness on family, social life and occupation. The participants were counseled to undergo psychiatric management, vocational training, use blind aids and learn Braille. The willingness of the participants with reasons was assessed using a verbal analogue scale. Pearson Chi-square test, ANOVA and the t-test were used for statistical analysis. Results: Over two-thirds of the subjects were depressed. Family life, social life and occupation were perceived to be affected by 44%, 66% and 74%, respectively. Change-readiness scores were low for low vision and blind aids, vocational training, psychiatric management, change of job and learning Braille. The low score was due to the associated taboo, dependence, lack of skills, embarrassment, etc., The most valuable feature was the family cohesiveness. Conclusion: The results suggest that there is a need to modify health policy to include blind rehabilitation, to improve visibility of blind rehabilitation centers, to include family members and co-professionals while managing the blind so that we treat the "blind person" and not a "pair of blind eyes." Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/158/129768 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129769 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Awareness of and attitude towards glaucoma among an adult rural population of Osun State, Southwest Nigeria Isawumi, MA Hassan, MB Akinwusi, PO Adebimpe, OW Asekun-Olarinmoye, EO Christopher, AC Adewole, TA Purpose: To obtain baseline data and assess the level of awareness and attitudes towards glaucoma among rural communities of Osun State, Nigeria. Materials and Methods: This was a community-based study that involved interviews and descriptive cross-sectional analysis. Serial-recruitment was performed of consenting participants who presented at a community-based screening service in March 2011. Socio-demographic data and information about glaucoma were obtained through face-to-face semi-structured questionnaires. Results: The study population comprised 259 respondents (mean age 49.73 ± 16.6 years; range 18 to 90 years). There were 159 females (61.4%). Skilled workers were the most common 130/259 (50.3%) participants. Only 41 (15.8%; 95% CI: 11.4-20.2) participants had ever heard of glaucoma. Sources of information were from visits to an eye clinic for 21/41 (51.2%; 95% CI: 35.9-66.5) participants and 15/41 (36.6%) participants who know someone with glaucoma. Reponses to the causes of glaucoma included 20/41 (48.8%; 33.5-64.1) participant who said 'I don't know' and 24.4% of participants who responded 'curse-from-God'. Responses to questions on treatment included 20/41 (48.8%) participants who responded 'I don't know how it can be treated' and 10/41 (36.6%) said 'medically'. Thirty 30/41 (73.2%) participants would refuse surgery, half of them because 'it cannot cure or reverse the disease' while (26.7%) would refuse out of 'fear'. Only 8/41 (19.5%; 95% CI: 7.4-31.6) would accept surgery for maintenance. Statistically significant predictors of glaucoma awareness were older participants, males and skilled workers (teachers) (P = 0.028, P = 0.018, P = 0.0001, respectively). Conclusions: The outcomes of study indicate a low level of awareness of glaucoma. Health education at all levels of health and eye care services is required to prevent ocular morbidity and irreversible blindness from glaucoma. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/165/129769 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129770 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
A 3-year review of cranial nerve palsies from the University of Port Harcourt Teaching Hospital Eye Clinic, Nigeria Pedro-Egbe, CN Fiebai, B Awoyesuku, EA Purpose: To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital. Materials and Methods: A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cerebrovascular disease. Exclusion criteria included medical charts with incomplete data. Data was analyzed using Epi-info Version 6.04D. Statistical significance was indicated by P < 0.05. Results: Twenty-four patients had cranial nerve palsies. There were 11 males and 13 females with a mean age of 34.50 ± 18.41 years. Four patients (26.6%) had exotropia while three patients (20%) had esotropia. Complete ophthalmoplegia was noted in two patients (13.3%). The 3 <sup>rd</sup> and 6 <sup>th</sup> cranial nerves were affected in seven patients each (29.2%) and five patients (20.8%) had 7 <sup>th</sup> cranial nerve palsy. Approximately 38% of patients with cranial nerve palsies had systemic disorders (16.7% systemic hypertension; 12.5% DM). The relationship between cranial nerve palsy and systemic disorder was statistically significant (P < 0.01). Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6 <sup>th</sup> cranial nerve palsy. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/170/129770 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129772 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
The prevalence of astigmatism and its determinants in a rural population of Iran: The "Nooravaran Salamat" mobile eye clinic experience Hashemi, H Rezvan, F Yekta, AA Hashemi, M Norouzirad, R Khabazkhoob, M Purpose: The prevalence of astigmatism, and the astigmatic axis, and their determinants were evaluated in a rural population of Iran. Materials and Methods: In a cross-sectional study conducted from May to August 2011, 13 villages in the vicinity of the city of Khaf in northeast Iran were investigated in this study. All the examinations including visual acuity, refraction, slit-lamp biomicroscopy and fundoscopy were performed in a Mobile Eye Clinic. Written informed consent was obtained from all participants. Only phakic eye that could be reliably refracted without a previous history of ocular surgery were included. Results: Out of 2635 participants who were screened, 2124 were analysed for this study of whom 52% were female. The prevalence of astigmatism was 32.2% (95% confidence intervals (CI): 30.2-34.2). Astigmatism significantly increased from 14.3% in the under 15-year-old age group to 67.2% in the age group of over 65-years old (P < 0.001). The prevalence of With-The-Rule (WTR), Against-The-Rule (ATR), and oblique astigmatism was 11.7%, 18.1%, and 2.4 %, respectively. ATR significantly increased with age (P < 0.001). The mean corneal astigmatism was 0.73 D which linearly increased with age (P < 0.001). Conclusion: Attention must be paid to astigmatism in rural areas due to the high prevalence. Further studies are suggested to discover the role of the environmental and genetic factors. It seems that environmental and occupational factors in the villages cause a significant increase in the prevalence of astigmatism with age. A high percentage of participants had ATR astigmatism, which was more common at older ages. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/175/129772 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129773 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Development of a web-based glaucoma registry at King Khaled Eye Specialist Hospital, Saudi Arabia: A cost-effective methodology Zaman, B Khandekar, R Al, SS Song, J Al, JI Al, JL Owaydha, O Asghar, N Hijazi, A Edward, DP In this brief communication, we present the steps used to establish a web-based congenital glaucoma registry at our institution. The contents of a case report form (CRF) were developed by a group of glaucoma subspecialists. Information Technology (IT) specialists used Lime Survey softwareTM to create an electronic CRF. A MY Structured Query Language (MySQL) server was used as a database with a virtual machine operating system. Two ophthalmologists and 2 IT specialists worked for 7 hours, and a biostatistician and a data registrar worked for 24 hours each to establish the electronic CRF. Using the CRF which was transferred to the Lime survey tool, and the MYSQL server application, data could be directly stored in spreadsheet programs that included Microsoft Excel, SPSS, and R-Language and queried in real-time. In a pilot test, clinical data from 80 patients with congenital glaucoma were entered into the registry and successful descriptive analysis and data entry validation was performed. A web-based disease registry was established in a short period of time in a cost-efficient manner using available resources and a team-based approach. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/182/129773 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129774 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Detailed ophthalmologic evaluation of posterior microphthalmos Alkin, Z Ozkaya, A Karakucuk, Y Demirok, A We performed various ophthalmic investigations in order to confirm the diagnosis and document the various features of posterior microphthalmos in a 21-year-old male. Ophthalmic examination revealed low vision with high hyperopia, papillomacular folds, midperipheral pigmentary changes and crowded optic discs. The optic discs were small and crowded with increased nerve fiber layer thickness. Fundus fluorescein angiography showed reduced diameter of a capillary free zone. Anterior segment (AS) optical coherence tomography demonstrated near normal anterior chamber depths, but markedly diminished anterior chamber angles. In spite of the increased corneal thickness and steep corneas, lens thickness and endothelial cell counts were normal. Sclerochoroidal thickening and foreshortening of the globes were detected with B-scan ultrasonography. Electroretinographic findings and visual field tests were similar to those in pigmentary retinopathy. Posterior microphthalmos is a complex eye disorder, which affects predominantly the posterior segment but also involves the AS of the eye. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/186/129774 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129775 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Management of paradoxical response in pediatric tubercular meningitis with methylprednisolone Nema, N Verma, A Singh, K Mehar, V Paradoxical response to anti-tubercular drugs remains a diagnostic dilemma. In India where tuberculosis is quite prevalent, paradoxical response to anti-tubercular treatment (ATT) is either misdiagnosed or under-diagnosed. We report two cases of optochiasmatic arachnoiditis due to paradoxical response in children suffering from tuberculous meningitis. Visual acuity was recorded as no light perception in all eyes of both patients while they were taking 4-drug ATT (isoniazid, rifampicin, pyrazinamide and ethambutol). However their systemic conditions did not worsen. They were treated with intravenous methylprednisolone for five days followed by systemic corticosteroids on a tapering dose for four weeks along with ATT. This case report highlights the importance of early recognition of this sight-threatening complication and timely, effective treatment to prevent permanent blindness. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/189/129775 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129776 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Autologous serum for anterior tissue necrosis after porous orbital implant Kamal, S Kumar, S Goel, R Orbital implants are now routinely used after enucleation and evisceration. However exposure of the implant can lead to infection and extrusion. Hence, early repair of larger exposure with graft material is required. We describe three cases where early postoperative mucosal dehiscence was successfully managed with autologous serum. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/193/129776 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129777 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Rethinking airbag safety: Airbag injury causing bilateral blindness Ogun, OA Ikyaa, SY Ogun, GO A healthy 40-year-old man, restrained in the front passenger seat, suffered visually disabling blunt ocular trauma following spontaneous release of the passenger side air-bag module, during vehicular deceleration, without an automobile crash. Though the driver-side airbag was also released, the driver was unharmed. The passenger suffered bilateral hyphema, bilateral vitreous hemorrhage and suspected posterior scleral rupture in the left eye and also had an eyebrow laceration, from impact with the dashboard panel covering the air-bag module, which was detached by the force of airbag deployment. This is the first reported case from West Africa and the first case in which part of the airbag module detached to cause additional trauma. This report adds to the growing burden of evidence world-wide, for a review of the safety aspects of the automobile airbag. This case clearly illustrates that although airbags reduce mortality, they carry a high risk of ocular morbidity, even with seat belt restraint. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/196/129777 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:129780 2014-04-01 all journal:Middle_East_Afr_J_Ophthalmol
Ankyloblepharon filiforme adnatum: Report of two cases Chakraborti, C Chaudhury, KP Das, J Biswas, A Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly characterized by partial or complete adhesion of upper and lower eyelids, usually seen as an isolated finding but often associated with other anomalies or a well-defined syndrome. We report two cases of AFA who presented at a tertiary eye care center of West Bengal. Family history of consanguinity was absent. One baby had abnormal tuft of hair over the small of the back. No other congenital abnormalities were detected in any of them. The adhesions of the eyelids were divided by a number 15 blade after crushing with mosquito forceps in both cases without any anesthesia. Subsequent ocular examinations following separation and during follow-up revealed normal eyelid function, ocular motility, and fundus. In a case of AFA, timely separation of the eyelids is crucial to avoid the development of occlusion amblyopia. Cases of AFA reported in the literature are reviewed. Medknow Publications 2014-04-01 http://www.meajo.org/text.asp?2014/21/2/200/129780 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134667 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmia neonatorum prophylaxis and the 21 <sup>st</sup> century antimicrobial resistance challenge Meyer, D Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/203/134667 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134668 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Repeat selective laser trabeculoplasty can be effective in eyes with initial modest response Khouri, AS Lin, J Berezina, TL Maltzman, B Fechtner, RD Purpose: To evaluate the effectiveness of repeat selective laser trabeculoplasty (SLT) in eyes exhibiting only a modest response upon initial treatment. Materials and Methods: Retrospective chart review was conducted of 51 eyes that received initial 360 degree SLT (SLT1) and subsequent SLT (SLT2) from 2003-2011 at a large academic ophthalmology practice. Successful response (S) was a post-treatment 12 month mean IOP reduction ≥20% from baseline, while modest response (M) was <20% reduction over the same time. Chi-squared and log rank analyses were used to determine if success after SLT2 depended on having successful (S1) or modest (M1) response after SLT1. Results: IOP was significantly reduced from baseline in both SLT1 and SLT2. The proportion of eyes with S2 was not significantly different between those with initial M1 or S1 (36.67% vs. 52.38%, respectively; P = 0.26). Log rank analysis revealed no differences between M1 and S1 in determining SLT2 success (P = 0.41). This outcome was similar when the analyses were performed for the right and left eye independently. Conclusion: The proportion of eyes that successfully responded to repeat SLT did not differ based upon whether the response to initial SLT was successful or modest. This raises the possibility that repeat SLT should not be excluded as an option for those eyes that have only a modest initial response. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/205/134668 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134669 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Proparacaine hydrochloride topical drop and intracameral 0.5% lignocaine for phacotrabeculectomy in patients with primary open angle glaucoma Joshi, RS Aim: To compare the efficacy and safety of 0.5% intracameral lignocaine to 1% intracameral lignocaine prior to phacotrabeculectomy. Study Design: Prospective, comparative, observational, and interventional study. Setting: Tertiary eye care center in central India. Materials and Methods: This study was comprised of 79 patients (79 eyes) with primary open angle glaucoma scheduled for phacotrabeculectomy. Patients were assigned to 1 of 2 Groups receiving proparacaine 0.5% eye drops and 1% intracameral lignocaine just prior to phacotrabeculectomy (Group 1, n = 39) and 0.5% intracameral lignocaine after completion of phacoemulsification just prior to trabeculectomy (Group 2, n = 40). The visual analogue scale was used to record intraoperative and postoperative pain. Patient comfort, intraoperative painful sensations perceived by the patient, supplemental anesthesia, complications, and surgeon discomfort were noted. An anesthetist also noted the vital parameters and the requirement for intravenous medications. Results: There was no significant difference in the intraoperative pain score (P = 0.0733) or supplemental anesthesia (P = 0.372) between Groups. Postoperative pain score was statistically significant in Group 2 (P < 0.0001). The overall operating conditions in both Groups were comparable (P = 0.7389). A greater number of patients in Group 2 (88.57%) preferred the same anesthetic technique for combined surgery in the fellow eye. There was no difference in inadvertent eye movements and lid squeezing between Groups and they did not interfere with surgery. Conclusion: Topical anesthetic drops supplemented with 0.5% intracameral lignocaine before performing trabeculectomy is as effective as 1% intracameral lignocaine given at the beginning of phacotrabeculectomy for primary open angle glaucoma. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/210/134669 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134671 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Effect of yellow-tinted intraocular lens on standard automated perimetry and short wavelength automated perimetry in patients with glaucoma Nilforushan, N Parsamanesh, M Yu, F Nassiri, N Miraftabi, A Coleman, AL Purpose: To investigate the effect of cataract surgery and yellow-tinted intraocular lens (IOLs) implantation on perimetry indices of short-wavelength automated perimetry (SWAP) and standard automated perimetry (SAP) testing in patients with coexisting cataract and glaucoma. Materials and Methods: In this prospective comparative case series, phacoemulsification with implantation of yellow-tinted Acrysof Natural IOL was performed in 16 eyes of 16 patients with visually significant cataract (best-corrected visual acuity (VA) better than 20/120) and mild to moderate glaucoma. Pre- and postoperative values for VA and for perimetry indices including mean deviation (MD), pattern standard deviation (PSD), and foveal threshold (FT) from both SAP and SWAP testing were compared. Results: Postoperative VA improved significantly after cataract surgery and yellow-tinted IOL implantation (P < 0.001). After cataract extraction and IOL implantation, MD and FT on SWAP testing improved significantly (P = 0.001); however, there was no statistically significant change with SAP testing between the pre- and postoperative perimetry indices. There was no statistically significant change in PSD with either SAP or SWAP testing postoperatively. The differences between pre- and postoperative values for all perimetry indices under study were not significant when comparing SAP with SWAP tests, except for MD which had improved statistically significantly in SWAP testing (P = 0.03). Conclusions: In mild to moderate glaucoma patients with cataracts, the perimetry indices of SWAP testing improved after phacoemulsification and yellow-tinted IOL implantation. This suggests that the yellow-tinted IOLs have less effect on SWAP testing than visually significant cataracts. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/216/134671 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134673 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Limitations in imaging common conjunctival and corneal pathologies with Fourier-domain optical coherence tomography Demirci, H Steen, DW Purpose: To describe the limitations of Fourier-domain optical coherence tomography (OCT) in imaging common conjunctival and corneal pathology. Materials and Methods: Retrospective, single-center case series of 40 patients with conjunctival and cornea pathology. Results: Fourier-domain OCT imaged laser in situ keratomileusis (LASIK) flaps in detail, including its relation to other corneal structures and abnormalities. Similarly, in infectious or degenerative corneal disorders, Fourier-domain OCT successfully showed the extent of infiltration or material deposition, which appeared as hyper-reflective areas. In cases with pterygium, the underlying cornea could not be imaged. All cases of common conjunctival pathologies, such as nevus or pinguecula, were successfully imaged in detail. Nevi, scleritis, pterygium, pinguecula, and subconjunctival hemorrhage were hyper-reflective lesions, while cysts and lymphangiectasia were hyporeflective. The details of the underlying sclera were not uniformly imaged in conjunctival pathologies. Fourier-domain OCT imaged the trabeculectomy bleb in detail, whereas the details of structures of the anterior chamber angle were not routinely visualized in all cases. Conclusions: Light scatter through vascularized, densely inflamed, or thick lesions limits the imaging capabilities of Fourier-domain anterior segment OCT. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/220/134673 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134675 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Quality of life in non-infectious uveitis patients on immunosuppressive therapy Kaleemunnisha, S Sudharshan, S Biswas, J Purpose: To assess visual function and vision related quality of life in patients with non-infectious posterior or panuveitis treated with immunosuppressives. Materials and Methods: Forty-three patients with non-inflammatory posterior or panuveitis were enrolled in this prospective study. All subjects underwent a detailed interview, complete ophthalmic examination, quality of life assessment using National Eye Institute Visual Function Questionnaire (VFQ-25), visual function evaluation (visual acuity and visual field) at baseline and at a sixth month follow up visit. Results: The mean NEI-VFQ 25 composite score of the subjects with posterior or panuveitis was 58.0 (±24.1). There was a statistically significant improvement (P = 0.004) in the composite score following treatment from 58.0 (±24.1) to 74.3 (±22.0) with effect size of 1.03. The psychological well-being and general health subscales showed significant improvement in the mean score following immunosuppressive therapy. While considering the visual function tests, there was a three-line improvement in the visual acuity score and changeover in the visual field severity from moderate to early defect with corresponding improvement in the visual field pattern. Though most of the patients complained of side effects such as tiredness, gastrointestinal upset and weight gain, there was improvement in the general health subscale. Conclusion: The significant improvement in the general health subscale despite side-effects shows that the benefit of immunosuppressive outweighs the risks of the therapy and this may also reflect the relatively low impact of these side-effects on the quality of life. This study shows that the use of immunosuppressives improves the quality of life of the individual. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/225/134675 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Cosmetic soft contact lens associated ulcerative keratitis in Southern Saudi Arabia Abdelkader, A Purpose: To review the microbiologic profile, clinical course, treatment, and outcome of patients with cosmetic contact lens (CL)-associated ulcerative keratitis. Materials and Methods: Observational noncomparative case series selected from an ongoing prospective series. Forty-six subjects examined at a corneal specialty practice in Abha, southern Saudi Arabia between April 2012 and June 2013, who presented with corneal stromal infiltrate on slit-lamp examination, were included in the study. Results: All patients were emmetropic, and lenses were worn solely for cosmetic purposes. Nine (19.5%) of 46 CL-wearing patients presented with laboratory-proven infectious keratitis. Pseudomonas was the most common organism (6/9; 66.6%). Staphylococcus species were the second most common, occurring in two (22.2%) of the nine cases. Streptococcus viridans in one case (11%). Laboratory-based medical therapy led to the healing of ulcers in all cases. Thirty-seven (80.4%) patients had sterile infiltrates. Conclusions: Over-the-counter use of cosmetic lenses is rapidly increasing. The easy availability of these lenses is resulting in severe sight-threatening complications in some young emmetropic individuals. Prompt treatment of microbial keratitis is important to prevent vision loss. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/232/134677 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134678 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Orbito-oculoplastic diseases in Lagos: A 4-year prospective study Balogun, BG Adekoya, BJ Balogun, MM Ehikhamen, OA Aims: To determine the prevalence of orbito-oculoplastic diseases and thereby contributing a data base to the emerging orbito-oculoplastics subspecialty in the sub-Saharan region. Settings and Design: A tertiary eye care centre. Materials and Methods: A descriptive prospective study was done in a tertiary eye care center. Demographic and clinico-pathological diagnoses of 269 patients presenting to the oculoplastics clinic over a 4-year period (January 2008 -December 2011) were collected at entry and during follow-up visits. These were patients referred from the general ophthalmology clinics of the study center, secondary eye care centers within and from neighboring states. Patients were categorized based on the primary diagnosis after examination by the oculoplastics surgeon. Ethical issues were considered though data collection did not involve direct patient participation. Statistical Analysis Used: Microsoft Excel 2007 software. Results: Two hundred and sixty-nine patients were seen with 141 (52.4%) females. Leading etiological factors were trauma; 81 (30.0%), congenital anomalies 55 (21.0%) and tumors 44 (16.0%). Eyelid diseases were the most frequent 115 (42.8%), with ectropion 36 (31.0%) and ptosis 33 (29.0%) being the most common. Orbital and peri-orbital lesions 44 (16.4%) were mainly dermoids 12 (27.3%) and capillary heamangioma 4 (9.1%) in the pediatric age while thyroid orbitopathy 11 (25.0%) was predominant in adults. Ocular and degenerative diseases were retinoblastoma in 4 (16.7%) and phthisis bulbi in 10 (33.3%). Contracted socket was 22 (84.0%) of socket pathologies. Primary conjunctival diseases occurred less often, rather Stevens-Johnson syndrome in 9 (30.0%) and its ocular complications were more frequent. Conclusions: It is expected that this survey will provide a database for oculoplastics surgeons and ophthalmologists in an emerging subspecialty and thus enhance training focus and equipment acquisition. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/236/134678 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134684 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Maternal and neonatal risk factors associated with vertical transmission of ophthalmia neonatorum in neonates receiving health care in Blantyre, Malawi Ranjit, R Menezes, L Drucker, M Msukwa, G Batumba, N Context: Neonatal conjunctivitis is associated with poor prenatal care worldwide. Purpose: Data on neonatal conjunctivitis is scarce in Malawi. This study describes risk factors associated with conjunctivitis in neonates born in a large tertiary care hospital in Blantyre, Malawi. Materials and Methods: Medical records of a retrospective cohort of 231 neonates diagnosed with conjunctivitis from January 2006 to December 2009 at a large tertiary hospital in Malawi were reviewed. All subjects were clinically diagnosed with ophthalmia neonatorum. Data were collected on patient demographics and clinical features. The frequencies were calculated of various risk factors in neonates with ophthalmia neonatorum and their mothers as well as the treatments administered. Results: Mean age of the mother was 23.45 years (range, 15-40 years), and the mean number of previous deliveries was 2.3 (range, 1-7) children. Nearly, 80% of mothers delivered preterm infants via spontaneous vaginal delivery. The mean birth weight of neonates was 2869.6 grams (1100-5000 grams). Among mothers, premature rupture of membranes was the leading risk factor (24%) followed by sepsis during labor (9%), and history of sexually transmitted infections (STI) (7%). Neonates presented with low Apgar scores (19%), fever (8%), and/or meconium aspiration (5%). Providers treated patients empirically with a varied combination of benzyl penicillin, gentamicin, tetracycline eye ointment, and saline eye wash. Tetracycline with a saline eyewash was used frequently (34%) compared with combinations of benzyl penicillin and gentamicin. Conclusions: Improving prenatal care to reduce sepsis, traumatic deliveries, and early diagnosis of STI with appropriate treatment may potentially reduce vertical transmission of neonatal conjunctivitis in this understudied population. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/240/134684 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134686 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Review of choroidal osteomas Alameddine, RM Mansour, AM Kahtani, E Choroidal osteomas are rare benign ossifying tumors that appear as irregular slightly elevated, yellow-white, juxtapapillary, choroidal mass with well-defined geographic borders, depigmentation of the overlying pigment epithelium; and with multiple small vascular networks on the tumor surface. Visual loss results from three mechanisms: Atrophy of the retinal pigment epithelium overlying a decalcified osteoma; serous retinal detachment over the osteoma from decompensated retinal pigment epithelium, and most commonly from choroidal neovascularization. Recent evidence points to the beneficial effects of intravitreal vascular endothelial growth factor antagonists in improving visual acuity in serous retinal detachment with or without choroidal neovascularization. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/244/134686 en Copyright 2014 Middle East African Journal of Ophthalmology.
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A systematic approach to emergencies in uveitis Al-Dhibi, HA Al-Mahmood, AM Arevalo, JF Uveitis is a common cause of preventable blindness although it is consider a sight-threatening condition particularly in cases with posterior segment inflammation. To deal with emergency conditions in uveitis, we must aware of the essential signs and symptoms that reflect a true uveitic emergency. Failure to recognize these essential signs and symptoms of a true uveitic emergency may result in a devastating visual outcome. This review provides general ophthalmologists and residents, clinical guidelines for the main uveitic entities that require immediate recognition and urgent intervention in the emergency room to prevent severe permanent visual loss. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/251/134687 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134689 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Ophthalmia due to spitting cobra venom in an urban setting - A report of three cases Ang, LJ Sanjay, S Sangtam, T To describe three presentations of spitting cobra venom induced ophthalmia in urban Singapore. Case notes and photographs of three patients with venom ophthalmia who presented to our clinic between 2007 and 2012 were reviewed. Two patients encountered the spitting cobra while working at a job site while the third patient had caught the snake and caged it. The venom entered the eyes in all 3 cases. Immediate irrigation with tap water was carried out before presenting to the Accident and Emergency department. All patients were treated medically with topical antibiotic prophylaxis and copious lubricants. The use of anti-venom was not required in any case. All eyes recovered with no long-term sequelae. If irrigation is initiated early, eyes can recover with no significant complications or sequelae. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/259/134689 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Bilateral optic nerve aplasia: A rare isolated central nervous system anomaly Khandgave, TP Kulkarni, VN Muzumdar, DV Puthran, N Optic nerve (ON) aplasia is a rare developmental anomaly comprising of absence of the ON, ganglion cells and the central retinal vessels. It is usually accompanied by a variety of central nervous system (CNS) malformations. We report an extremely rare case of bilateral true ON aplasia occurring as an isolated CNS anomaly. A 10-month-old female child was detected with bilateral absence of fixation, associated with multiple ocular findings of microcornea, anterior embryotoxon, pupillary corectopia, partial aniridia and lens coloboma. The optic disc locations were visible as avascular whitish areas. There were no retinal vessels seen in the disc area or elsewhere. There were bilateral multiple chorioretinal atrophic patches present. B-scan ultrasonography showed bilateral absence of ONs. Magnetic resonance imaging showed thinned out bilateral ONs with a hypoplastic optic chiasma and optic tract. There were no other CNS anomalies. Flash visually evoked potential was unrecordable. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/262/134690 en Copyright 2014 Middle East African Journal of Ophthalmology.
oai:medknow.com:134692 2014-07-01 all journal:Middle_East_Afr_J_Ophthalmol
Bilateral choroidal osteoma with choroidal neovascular membrane treated with bevacizumab in a child Agarwal, M Kantha, M Mayor, R Venkatesh, R Shroff, CM Choroidal osteoma is a rare benign tumor. We report a male child diagnosed with bilateral choroidal osteoma, high myopia and secondary choroidal neovascularization (CNV) membrane in one eye. Co-existence of posterior staphyloma made the clinical diagnosis of choroidal osteoma difficult due to the osteoma filling the depression of the posterior staphyloma. Typical findings on fundus fluorescein angiography, optical coherence tomography, B-scan and indocyanine green angiography confirmed the diagnosis. A review of literature was performed. CNV secondary to choroidal osteoma was treated with intravitreal bevacizumab and it responded well. Regular follow-up is essential for recurrence of CNV and decalcification of the osteoma. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/265/134692 en Copyright 2014 Middle East African Journal of Ophthalmology.
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Rare association of familial aniridia, microcornea with myopia and aphakia Biswas, J Chakrabarti, A Das, D Aniridia is a rare congenital malformation that may be associated with various ocular and systemic manifestations. We describe two cases of familial total aniridia associated with microcornea, high myopia and dislocated lens. No systemic abnormality was noted in any of the cases. Medknow Publications 2014-07-01 http://www.meajo.org/text.asp?2014/21/3/268/134693 en Copyright 2014 Middle East African Journal of Ophthalmology.