Ophthalmology

Epidemiology of Vernal Keratoconjunctivitis (VKC) among children aged (12–15) years - Menofia Governorate, Egypt Samah M.M Ahmed, Khaled El Ghonemy Said Ahmed, Osama A El Morsy, Shaimaa S Soliman Delta Journal of Ophthalmology 2019 20(1):1-6 Purpose The aim of this study was to study the prevalence and risk factors of vernal keratoconjunctivitis (VKC) among children aged 12–15 years in Menoufia Governorate. Patients and methods This was a cross-sectional study that was carried out on 768 children (405 males and 363 females) aged from 12 to 15 years in Menoufia Governorate during the period from September 2016 to the end of August 2017. All participants were asked to answer a questionnaire and were subjected to full ophthalmological examination. Results The mean age of the participants was 13.02±1.00 years. The prevalence of VKC among the studied children was 3.9% (95% confidence interval, 2.6–5.3). Exposure to dust and family history of allergy were the major risk factors (odds ratio, 16.04 and 45.25, respectively). Itching and burning sensation were the most prominent symptoms, whereas hyperemia was the most prominent sign. Conclusion VKC is fairly common among children in Menoufia Governorate as part of the North African region. Exposure to dust and family history were the major risk factors. VKC was associated with other types of allergy like asthma or allergic rhinitis.

Ocular high-order aberrations in monocular anisometropic amblyopia Engy M Mostafa, Amr Mounir Delta Journal of Ophthalmology 2019 20(1):7-11 Objective The aim of this study was to investigate the relationship between high-order aberrations (HOAs) and monocular anisometropic amblyopia with or without strabismus. Patients and methods The medical records of 391 patients with monocular anisometropic amblyopia presenting to Sohag Refractive Center (Sohag, Egypt) were reviewed retrospectively in the period from May 2014 to December 2016. Ocular HOAs were measured using a Hartmann–Shack aberrometer and were used to compare the amblyopic eyes with the fellow eye on one hand and a control group of 380 individuals on the other hand. Results The study included 391 (190 men and 201 women) eyes of patients with anisometropic amblyopia. There was a significant difference between the amblyopic eyes and the control group regarding the total HOA, coma, and trefoil. In addition, hypermetropic amblyopes displayed higher HOA. Conclusion Anisometropic amblyopic eyes revealed higher ocular HOAs than fellow nonamblyopic eyes and the control group. Thus, HOAs should be incorporated in the treatment plan of amblyopia.

Chronic migraine and optical higher-order aberrations: Is there a relationship between them? Ahmed A Alhagaa Delta Journal of Ophthalmology 2019 20(1):12-16 Introduction Migraine is a neurological disorder with a wide spectrum of manifestations, including ocular manifestations. The present study aimed to investigate the relationship between chronic migraine and optical higher-order aberrations. Patients and methods Two hundred eyes of 100 patients with chronic migraine and 200 eyes of 100 controls were studied. Optical higher-order aberrations were measured in all eyes and the results were compared and statistically analyzed between those with migraine and controls. Results A statistically significant difference was found between eyes with chronic migraine and controls as regards total third-order aberrations, coma aberration, spherical aberration, total fifth-order aberrations, and total higher-order aberrations, being higher in eyes with chronic migraine than in controls. Conclusion Optical higher-order aberrations are higher in patients with chronic migraine.

Effect of femtosecond-assisted intrastromal implantation of MyoRing for keratoconus on corneal asphericity Mahmoud M Ismail, Hany O Elsedfy, Khaled Abdelazeem, Momen A.M Aly Delta Journal of Ophthalmology 2019 20(1):17-21 Purpose The aim of this study was to evaluate the effect of implanting MyoRing into a femtosecond-created corneal pocket on corneal asphericity in patients with keratoconus. Patients and methods This prospective, nonrandomized, interventional clinical study included 38 eyes with keratoconus. Femtosecond-assisted implantation of MyoRing was done for all cases. The intrastromal pocket was 7.4 mm in diameter and deep at a level equal to 80% of central corneal thickness. Corneal asphericity, curvature, thickness, and elevations were evaluated 3 months after surgery. Results The mean age of the patients was 24.53±5.18 years at the time of surgery. The same diameter of the MyoRing was used in all cases. Both uncorrected distance visual acuity and corrected distance visual acuity significantly improved after implantation of the MyoRing. Uncorrected distance visual acuity improved from 0.05±0.01 to 0.31±0.01 and corrected distance visual acuity improved from 0.29±0.14 to 0.34±0.10. The postoperative changes in all measured refractive parameters were significantly better in comparison with the preoperative measures. The mean preoperative spherical equivalent of the refractive error was −9.87±2.91 D, whereas the postoperative spherical equivalent was −0.89±0.30 D. The refractive sphere and cylinder improved also from a preoperative value of −8.31±2.55 and −3.11±1.93 D, respectively, to a postoperative value of −0.46±0.21 and −0.86±0.32 D, respectively. The Q value of anterior corneal surface significantly improved to a less prolate shape, from −0.49±0.11 preoperatively to 0.23±0.01 postoperatively. On the contrary, the Q value of the posterior surface of the cornea showed no statistically significant change after MyoRing implantation. Conclusion MyoRing implantation improved the asphericity of the anterior corneal surface from advanced prolate shape to the optimal prolate Q value of −0.52 and ‘spherical aberration free’ Q value of −0.46. This improvement in corneal asphericity may have a role in increasing the postoperative visual acuity.

Amniotic membrane versus corneal stromal lenticule grafting for the management of corneal perforations: a retrospective study Abd Al Khalek I Al Saadany, Sameh M El Gouhary, Mohamed S Abd Elaziz, Ahmed I Basiony, Ahmed Al Sayed Omara Delta Journal of Ophthalmology 2019 20(1):22-27 Purpose The aim of this study was to compare the use of femtosecond laser-assisted small-incision corneal stromal lenticule extraction with amniotic membrane (AM) grafting in the management of corneal perforation. Patients and methods Forty-five eyes with corneal perforation were included in this study after reviewing patients’ records from January 2014 to January 2016. Thirty cases (30 eyes) were treated by AM transplantation and 15 cases (15 eyes) were treated by small-incision corneal stromal lenticule extraction lenticules. The patients were monitored for at least 3 months examining the best-corrected visual acuity, anterior chamber formation, and sealing of the perforation using slit-lamp biomicroscopy. Postoperative complications throughout the follow-up period were recorded. Results Corneal perforations were successfully sealed in all 45 cases (45 eyes), with insignificant difference between both procedures. During the follow-up period of 3 months, no evidence of infection, relapse or perforation was detected in any patient. Conclusion Both AM and stromal lenticule grafting seem to be effective initial emergency treatments for corneal perforation in case of corneal graft shortage, with no complications, relapses nor immunological rejection noted throughout the study period.

Correlation between visual field changes and retinal nerve fiber layer thickness measured by optical coherence tomography in open-angle glaucoma patients Nehal A Hasan, Ahmed H Aldghaimy, Mohamed A Hamed, Basma S Mohamed Delta Journal of Ophthalmology 2019 20(1):28-31 Purpose The aim of this study was to evaluate the retinal nerve fiber layer thickness (RNFLT) as measured by optical coherence tomography (OCT), in patients with primary open-angle glaucoma and to correlate it with the visual field (VF) changes in these patients. Patients and methods This was a prospective observational study done on 60 eyes of 30 patients with primary open-angle glaucoma. All participants underwent VF assessment and OCT assessment of the retinal nerve fiber layer. Results There was a statistically significant correlation when comparing age with mean deviation (r=−0.565), pattern standard deviation (r=0.179), and total deviation average (r=−0.414). In addition, there was a statistically significant correlation when comparing mean deviation, pattern standard deviation, and retinal thickness average (G), with peripapillary RNFLT sectors. Conclusion Correlation between the global indices of the Humphrey VF and the parameters of the OCT showed that there was a relation between the changes in the thickness of the retina, RNFLT, and the changes and defects in the results of Humphrey VF.

Assessment of the changes in anterior segment parameters by ultrasound biomicroscopy after laser peripheral iridotomy Jihan Helal, Hisham Saad, Moataz Sabry, Alaa Eldorghamy Delta Journal of Ophthalmology 2019 20(1):32-42 Purpose The aim of this study was to evaluate the changes in anterior segment parameters by ultrasound biomicroscopy (UBM) after laser peripheral iridotomy (LPI) in eyes with narrow drainage angles. Patients and methods A prospective study was conducted on 20 eyes of 20 different patients with primary angle-closure glaucoma in need for LPI. Patients underwent a detailed ophthalmic examination including slit lamp examination, intraocular pressure measurement, and gonioscopy. UBM was performed before and 1 week after LPI. Quantitative parameters included angle-opening distance (AOD), iris thickness, trabecular-iris angle, trabecular-ciliary process distance, iris-lens contact distance (ILCD), and iridocorneal angle recess area (ICA). Results The mean age of the patients was 55±9.6 years (range: 40–80 years), and 12 patients were females. LPI was performed in the supero-temporal quadrant in 12 eyes and in the supero-nasal quadrant in eight eyes. On gonioscopy, none of the angle structures were seen on primary gaze in the four quadrants in two eyes, in three quadrants in eight eyes, and in two quadrants in 10 eyes. After LPI, ILCD increased significantly in 10 eyes (P<0.001), whereas AOD and ICA widened significantly in all eyes (P<0.0001). Most of the AOD widening was noted in the temporal quadrant followed by the superior quadrant. ICA increase was largest in the temporal quadrant. ILCD increased significantly with flattening of the convex iris. There was no significant change in the anterior chamber depth, lens thickness, trabecular-ciliary process distance, or iris thickness after LPI. Conclusion LPI significantly changed the morphology and parameters of anterior segment in eyes with narrow drainage angles, with obvious widening of the drainage angle. Unlike gonioscopy, these changes could be objectively highlighted and quantified accurately by UBM.

Effect of level of augmentation sutures on vertical muscle transposition for sixth nerve palsy Amr ElKamshoushy Delta Journal of Ophthalmology 2019 20(1):43-46 Background Full tendon transposition remains one of the commonly used procedures for the management of complete sixth nerve palsy. Although many variations in the technique were described, a dose–response nomogram remains evasive. This study aimed at evaluating the effect of the position of the Foster augmentation suture on the effect of transposition. Patients and methods This is a retrospective chart review for cases that underwent full tendon transposition with augmentation sutures (without medial rectus recession). The main outcome measures were improvement in esotropia and improvement in abduction. Results Twenty-four patients were included. Group 1 included 14 patients who underwent anteriorly placed augmentation sutures, while group 2 included 10 patients who underwent posteriorly placed sutures. Assessment at 6 months postoperatively showed a mean improvement of esotropia of 39.29±6.46 prism diopters in group 1 compared with 63.5±12.92 prism diopters in group 2 (P<0.001). Similarly, abduction in group 1 improved by 14.64±6.92° compared with 32.50±7.91° in group 2 (P<0.001). Conclusion Posteriorly placed Foster augmentation sutures resulted in larger improvement of esotropia and abduction limitation.