Ophthalmology

Management of restrictive strabismus Karim Gaballah Journal of the Egyptian Ophthalmological Society 2019 112(1):1-8 Aim of the study This study aimed to target a special type of strabismus, the restrictive type, with prediction of its problems, diagnostic, management, and results. Patients and methods This is a prospective randomized study performed in Alexandria. The participants of this study were 42 patients having restricted strabismus, with different diagnostic criteria, such as abnormal ocular deviation with the movement of the globe defective and not reaching the midline, abnormal position of the head, forced duction test, and anatomical changes found during surgery. Results The cases of restrictive strabismus included congenital cases including monocular elevation deficit, Brown’s syndrome, congenital fibrosis of extraocular muscles, oculomotor nerve palsy, and long-standing strabismus, especially unilateral presenting in old age. Cases needed specific diagnostic procedure such as forced duction test to be performed preoperatively and intraoperatively, and postoperative results were satisfactory in most cases except cases that underwent previous surgery with muscle resection, aggravating the condition and leading to more restrictions. Conclusion Cases of restrictive strabismus, when properly diagnosed, with special considerations, could arrive at a postoperative satisfactory outcome.

Effect of Ex-PRESS glaucoma filtration device on corneal endothelium in primary open-angle glaucoma Dina Abd El Fattah Abd El Rehim, Abd-Almonem Abo-Alfotouh El-Hessy, Sherif El-Saeed El-Kholy, Ehab Hassan Nematalla, Eglal Mohamed El-Saeed Journal of the Egyptian Ophthalmological Society 2019 112(1):9-13 Purpose The aim of this study is to compare the effect of Ex-PRESS minishunt versus standard trabeculectomy on corneal endothelial cell count (ECC) in cases of primary open-angle glaucoma. Setting This comparative prospective nonrandomized study was conducted at Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. Patients and methods The study included 36 eyes of 25 patients with uncontrolled primary open-angle glaucoma. Nineteen eyes had Ex-PRESS glaucoma minishunt and 17 eyes had trabeculectomy. Specular microscopy was used to measure ECC using TOMEY EM-3000. ECC was measured preoperatively and compared with postoperative values at 6 and 12 months. Results The mean endothelial cell density was 2493.2±246.8 cells/mm2 before the surgery in the Ex-PRESS group and 2473.8±259.8 cells/mm2 in the trabeculectomy group (P=0.82). This value decreased significantly in both groups at 12 months postoperatively to 2348.1±309.5 in the Ex-PRESS group and 2276.1±342.4 in the trabeculectomy group. ECC loss at 1 year was less in the Ex-PRESS group at 5.7 versus 8% in the trabeculectomy group (P=0.051). Conclusion Ex-PRESS minishunt is considered a safe procedure regarding corneal endothelium, showing less decrease in ECC than conventional trabeculectomy.

Comparative study between the effects of different concentrations of methylcellulose on the corneal endothelium during phacoemulsification Sherif M Akef Saleh, Rafiq M.F ELGhazawy, Amr I.S ElAwamry, Rania G Zaki Afifi Journal of the Egyptian Ophthalmological Society 2019 112(1):14-24 Purpose To study the effect of different concentrations of methylcellulose on the corneal endothelium during phacoemulsification using specular microscopy. Patients and methods Sixty patients with immature senile cataract were equally distributed into two groups according to the concentrations of hydroxypropyl methylcellulose (HPMC) used during phacoemulsification surgeries. In the first group, HPMC 2% was used, and in the second group, HPMC 2.4% was used. Preoperative and 1-month postoperative evaluations were done including visual acuity testing, slit lamp examination using Topcon SL-3C, intraocular pressure measurement using Goldmann Applanation Tonometer, fundus examination, and corneal endothelium assessment by Tomey Specular Microscope EM-3000. Results Preoperatively, no significant difference was recorded in age, sex, visual acuity, intraocular pressure, and endothelial cell count among the two groups. Postoperatively, the two groups had a significant decrease in endothelial cell count, but the decrease was less in group 2 using methylcellulose 2.4% (13.494%) than in group 1 using methylcellulose 2% (14.515%). There was an equal and significant improvement in visual acuity in the two groups. Conclusion Methylcellulose 2.4% and methylcellulose 2% were comparable in their ability to protect the corneal endothelium during phacoemulsification; in general, both viscoelastics can be effeciently and safely used in performing phacoemulsification.

Visual and keratometric outcomes in eyes undergoing small incision lenticule extraction for compound myopic astigmatism Ashraf H Soliman Journal of the Egyptian Ophthalmological Society 2019 112(1):25-29 Context The use of small incision lenticule extraction (SMILE) for compound myopic astigmatism has been subject to experimentation in the recent years. Furthermore, examination of corneal alterations has revealed conflicting conclusions, which could be attributable to demographic variation. Aims The aim of this study was to measure visual and keratometric efficacy of SMILE and correlate spherical equivalent (SE) decrements to keratometric alterations. Settings and design This was a prospective nonrandomized study. Thirty eyes of 15 patients were included in the study. Preoperative assessment included oculus Pentacam analysis. Patients were followed-up for up to 3 months, after which tomography was repeated. Statistical analysis used Descriptive statistics, t test, and linear regression analysis were carried out. Results There was a statistically significant improvement in postoperative uncorrected distance visual acuity and SE and a statistically significant change in Q value (P<0.001). The mean residual SE postoperatively was −0.14 D. A highly statistically significant negative correlation existed between SE difference and mean K difference with r=−0.980 and P value less than 0.001, and a highly statistically significant positive correlation existed between SE difference and Q value difference, with r=0.787 and P value less than 0.001. Conclusion SMILE is a safe and effective technique to correct cases with myopic astigmatism with an SE of up to −10 D, and a predictable positive correlation could be established between decrements in SE and decrements in anterior corneal steepening.

Correlation between axial length and anterior chamber depth in short eyes, normal eyes, and long eyes Rafik M.F El-Ghazawy, Amr I El-Awamry, Rania G Zaki, Joseph H.F Aziz Journal of the Egyptian Ophthalmological Society 2019 112(1):30-33 Context Accurate intraocular lens (IOL) power calculation is mandatory to achieve satisfactory refractive outcomes. Axial length, keratometric readings, anterior chamber depth, and other measurements are utilized to estimate postoperative effective lens position. Selecting the formula of IOL calculation depends mainly on axial length (AL) and anterior chamber depth (ACD). Aims To study the correlation between AL and ACD in short, normal, and long eyes. Settings and design The study was conducted at Ain Shams University Hospitals after the approval of the research ethics committee in the Faculty of Medicine, Ain Shams University. Study period: 6 months. Patients and methods The study included 90 eyes of patients presented for IOL or phakic lens implantation. They were divided into three groups according to the AL. Group A included 30 patients with short AL of less than or equal to 22 mm. Group B included 30 patients with normal AL of more than 22 mm and less than 24.50 mm. Group C included 30 patients with long AL of more than or equal to 24.50 mm. The AL and ACD of each patient were measured using The ZEISS IOL Master 500. Statistical analysis used The Statistical Package for the Social Sciences, version 24. Results The results of our study showed that the correlation between the axial length and the anterior chamber depth among short eyes was statistically significant and they were negatively correlated, while no statistically significant correlation existed between AL and ACD in normal and long eyes. Conclusion The AL and ACD are inversely related in short eyes with an AL of less than or equal to 22 mm, while no correlation exists in normal and long eyes with an AL of more than 22 mm.

Early detection of glaucoma suspect by pattern electroretinogram Heba A.M Hassan, Reham F Abdelrazek El-Shinawy, Abd El R.G Salman, Marwa E Elsbaay Journal of the Egyptian Ophthalmological Society 2019 112(1):34-38 Aim This study was intended to estimate the significance of pattern electroretinogram (PERG) in evaluation of the retinal ganglion cell function in patients with glaucoma. Patients and methods An observational case–control study was done on 40 eyes of individuals whose age ranged between 30 and 65 years of age. They were divided into two equal groups. Control group had normal visual field and optical coherence tomography optic nerve, intraocular pressure (IOP) less than 21 mmHg, visual acuity more than 0.3, and cup disc ratio (C/D) less than 0.5. The case group was divided into two equal subgroups: group A had IOP more than 21 mmHg and C/D less than 0.5, and group B had IOP less than 21 mmHg and C/D more than 0.5. We excluded all cases with ocular or systemic diseases with negative effect on retinal function such as retinal detachment, retinitis pigmentosa, rheumatoid arthritis on hydroxychloroquine, diabetic patients on insulin or oral hypoglycemic, or cases with abnormal optic disc appearance such as optic disc drusen, coloboma, or tilted disc. All cases underwent full ophthalmological examination, including best-corrected visual acuity, complete anterior segment examination with slit-lamp biomicroscopy, and posterior segment examination using volk 90 D lens, along with IOP measurement using Goldmann applanation tonometer. Visual field assessment was done using Heidelberg Edge Perimeter, optical coherence tomography optic nerve using Heidelberg engineering, and glaucoma screening with ERG using glaucoma screening program. Results There was a highly statistically significant difference between the groups regarding C/D and IOP. Regarding the PERG and different visual fields parameters, there was a highly statistically significant difference between the groups. There was a statistically significant negative correlation between PERG and both IOP and VF parameters in all different groups. No statistically significant correlation was found between PERG and C/D in all different groups. Conclusion PERG has a prognostic value in recognition of retinal ganglion cell dysfunction, as an early indication for glaucoma development.