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   Table of Contents - Current issue
Coverpage
July-December 2020
Volume 7 | Issue 2
Page Nos. 29-51

Online since Monday, February 1, 2021

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ORIGINAL ARTICLES  

Evaluation of macular vascular changes in Behçet's Disease using optical coherence tomography angiography p. 29
Mennatallah G. A. Saleh, Mohamed Tarek Abdelmoneim, Abdelsalam Abdalla, Mohamed Sharaf, Mohamed G. A. Saleh
DOI:10.4103/erj.erj_4_20  
Purpose: The purpose of the study was to describe macular vascular changes in patients with Behcet's disease (BD) using optical coherence tomography angiography (OCTA) and to compare these findings with those of fluorescein angiography (FA). Patients and Methods: This was a comparative, cross-sectional study. Patients with BD presenting with active uveitis were evaluated using FA and swept-source OCTA. 3 mm × 3 mm and 6 mm × 6 mm en-face images were reviewed and analyzed. Foveal avascular zone (FAZ) areas and vessel densities were also reported. Results: Twenty-five patients (39 eyes) were included. OCTA was superior to FA in showing macular microvascular changes which include areas of retinal capillary hypoperfusion, perifoveal capillary plexuses disruption and capillary abnormalities (including rarefied, dilated, or shunting vessels) were observed more frequently using OCTA than FA. Areas of retinal capillary hypoperfusion were more frequently observed in the deep than in the superficial capillary plexus (SCP). Capillary abnormalities and disorganization of the normal architecture of the capillary network were more frequent in the deep than in the SCP. FAZ area measured in the SCP was significantly larger in eyes with BD than in the control group in both the superficial and the deep capillary plexuses (DCPs). Capillary vessel density measured in the SCP was significantly lower in eyes with BD than in control group in all quadrants of the macula except the nasal sector and the central circle. Conclusion: OCTA allows better identification and description of perifoveal microvascular changes than FA in eyes with active BD. The DCP is more severely involved than the SCP.
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Changes in retinal nerve fiber layer thickness after panretinal photocoagulation in diabetic retinopathy p. 36
Ehab Ismail Wasfi, Kamel Abd El-Naser Soliman, Rania Mohammed Mohammed, Ali Natag Ryad
DOI:10.4103/erj.erj_12_20  
Context: Panretinal photocoagulation (PRP) is the gold standard treatment for high risk proliferative diabetic retinopathy. Aim: The evaluation of peripapillary retinal nerve fiber layer (RNFL) thickness changes in eyes undergoing PRP by optical coherence tomography. Materials and Methods: RNFL thickness was measured before PRP, then after PRP by 1, 3, and 6 months, respectively. Results: Mean peripapillary RNFL thickness increased significantly 1 month after P (P = 0.001), then showed insignificant decrease at 3 months' post-PRP (P = 0.1), then it showed significant decrease at 6 months (P = 0.0001) compared to baseline. Conclusions: PRP should be used with a great caution with least number of shots to avoid excessive damage to inner retinal layers.
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Micropulse diode treatment in refractory neovascular glaucoma, high-energy level combined with adjunctive Ranibizumab p. 41
Hazem Helmy
DOI:10.4103/erj.erj_13_20  
Introduction: Neovascular glaucoma is one of the highly refractory glaucoma types that mandates frequent modification of treatment. Micropulse diode cyclophotocoagulation may be a good option, but it may need an adjunctive and modification of parameters away from standard protocol. Design: A prospective, cohort, interventional case study. Purpose: To assess the safety and efficacy of high energy level of micropulse (MP) diode laser application after intravitreal injection of ranibizumab in the treatment of neovascular glaucoma refractory to medical treatment. Patients and Methods: This is a prospective, interventional, cohort, randomized case series study that included patients with neovascular glaucoma refractory to medical treatment. All patients underwent intravitreal injection of ranibizumab and then MP diode transscleral cyclophotocoagulation treatment in a high energy level. All patients were followed up for 24 months. The primary outcome measure was IOP reduction; the secondary outcome measure was stability and number of retreatment sessions; and the third outcome measure was complications. Results: This study included 50 eyes of 50 patients, 52% of them were male while 48% were female. Age of the studied patients ranged between 42 and 74 years with a mean of 60.8 ± 7.6 years. Cause of neovascular glaucoma was diabetes in 31 (62%), RVO in 8 (16%), and ocular ischemic syndrome in 3 (6%) of cases. The mean preoperative IOP was 41.2 ± 5.8 mmHg that decreased to 17.62 ± 2.01, 19 ± 4.05, 18.16 ± 1.96, 18.38 ± 1.96, 18.12 ± 1.98, and 18.3 ± 2.18 mmHg at 1, 3, 6, 12, 18, and 24 months, respectively (P < 0.001). Antiglaucoma treatment significantly decreased from 3.00 to 2.00 (P < 0.001). Success was achieved in 44 (88%) cases, whereas failure was met in 6 (12%) cases. Qualified success was met in 43 (97.2%) succeeded cases, whereas 1 (2.8%) succeeded case was signed under complete success. No major complications were encountered and none of the patients lost vision. Conclusion: Micropulse diode cyclophotocoagulation in high energy level can be a safe and effective noninvasive line of treatment in patients with neovascular glaucoma that may last for up to 24 months. Adjunctive use of intravitreal ranibizumab may improve results and decrease complications.
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NEW INSTRUMENT Top

Mirante: Adding new dimensions to ultra-wide-field imaging system p. 50
Prashant K Bawankule, Shilpi H Narnaware
DOI:10.4103/erj.erj_14_20  
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