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  Most popular articles (Since June 15, 2013)

 
 
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CASE REPORTS
An interesting case of "bear track dystrophy"
Avinash Mishra, Somesh Aggarwal, Sonali Shah, Puja Negi
September-December 2014, 2(3):114-117
DOI:10.4103/2347-5617.164632  
Bear track dystrophy, is a rare condition, which forms part of the disorder known as the grouped congenital hypertrophy of the retinal pigment epithelium (CHRPE), a peculiar congenital anomaly of the retinal pigment epithelium diagnosed by its characteristic ophthalmoscopic appearance. This disorder is usually without any functional consequence with patients typically having a normal vision, color vision, normal visual fields, dark adaptation, electroretinography, and electrooculography findings. The main differential diagnosis of CHRPE includes choroidal naevus, choroidal melanoma, chorioretinal scar, subretinal hematoma, pigmented epiretinal membrane, and reactive retinal pigment epithelial hyperplasia. Since CHRPE, in itself is a totally benign condition with no associated ocular or systemic complications, it becomes that much more important to distinguish it from the more serious vision/life-threatening conditions like choroidal melanoma as well as from the other pigmented ocular fundus lesions associated with familial cancer syndromes like familial adenomatous polyposis.
  17,511 108 -
ORIGINAL ARTICLES
Early versus late silicone oil removal after pars plana vitrectomy for rhegmatogenous retinal detachment in Upper Egypt
Ahmed M Fathalla, Tarek A Mohamed, Dalia M Al-Sebaity
May-August 2015, 3(2):39-44
DOI:10.4103/2347-5617.193468  
Objective: To compare the results of silicone oil removal (SOR) 2 months after vitrectomy for retinal detachment with delayed removal for 6 months or more. Study: Prospective and retrospective study. Patients and Methods: A total of 32 patients (32 eyes) in the prospective series of early SOR and 19 patients (22 eyes) in the retrospective series of late removal. The two groups were compared as to the condition of the eye at the time of SOR and 6 months following SOR. Results: Patient compliance with the scheduled time for SOR was more in the early removal series. The outcome was comparable in the two groups as to the risk of retinal re-detachment, while cataract, increased intraocular pressure, oil emulsification, keratopathy, and anterior segment inflammation were more frequently encountered at the time of removal in the late removal series, particularly when it was delayed beyond 6 months. Conclusion: A protocol of early removal of silicone oil after 2 months did not increase the risk of re-detachment, and ensured a better compliance of the time of removal. It can be particularly recommended when patients are less likely to comply with a protocol for delayed removal.
  15,347 264 1
Bevacizumab as an adjunct to vitrectomy for diabetic retinopathy: A retrospective study
Balbir Khan, Rajwinder Kaur, Mandeep Kaur, Prithpal Singh Matreja
January-June 2018, 5(1):6-11
DOI:10.4103/erj.erj_15_17  
Purpose: The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on the visual and anatomical outcome of patients undergoing 23-gauge pars plana vitrectomy (23G PPV) for proliferative diabetic retinopathy (PDR). Materials and Methods: Medical record from patients undergoing vitrectomy for PDR were retrospectively analyzed for the last 3 years. IVB has been a routine procedure for patients fulfilling eligibility criteria for the past 3 years. Patients who did not receive IVB preoperatively were assigned as control group (Group A). Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to Group B. Medical record of 100 patients who had completed 12-month follow-up were included in each group. Results: The primary outcome measure was visual outcome which was better in Group B as compared to Group A, anatomical outcome observed was 65% patients in Group A and 85% patients in Group B. The secondary outcomes were intraoperative hemorrhage and postoperative vitreous hemorrhage (VH). Intraoperative hemorrhage was seen in 40% patients in Group A and 20% patients in Group B, whereas postoperative VH was seen in 45% patients in Group A and 15% patients in Group B. Conclusion: Preoperative use of bevacizumab achieves excellent anatomical and functional success in majority of patients undergoing PPV for PDR and significantly reduced occurrence of postoperative VH. The results are encouraging when combined with transconjunctival 23 GPPV.
  9,102 924 -
Optical coherence tomography findings in high myopia
Amir Ramadan Gomaa, Mahmoud Alaa Abouhussein
May-August 2013, 1(2):13-17
DOI:10.4103/2347-5617.135241  
Purpose: The purpose of this study is to describe the incidence and features of macular abnormalities in high myopic eyes detected by optical coherence tomography (OCT). Patients and Methods: This was a prospective observational study that involved 100 eyes of 100 patients with high myopia complaining of recent diminution of vision. OCT examination was done through dilated pupils, OCT examination was done through a dilated pupil using commercially available Cirrus HD-OCT Model 4000 - Carl Zeiss Meditec, Inc., Dublin, California, USA or Spectralis OCT Heidelberg Engineering, Heidelberg, Germany. Results: A total of 100 eyes of 100 patients were studied. There were 45 males and 55 females. The mean age of the patients was 52.9 ± 12.9 (range: 33-70) years. Mean spherical equivalent in these eyes was 14.5 ± 5.8 (range: 8.75-22.75) diopters. Epiretinal membrane was present in 65 eyes. Vitreomacular traction (anteroposterior traction) was detected in 10 eyes. Macular retinoschisis was present in 33 eyes. Conclusion: Macular changes detected by OCT are common pathological findings in high myopia.
  8,293 298 1
CASE REPORTS
Chronic alcoholism and central serous chorioretinopathy
Vishal Katiyar, Sanjiv K Gupta, Arun Kumar Sharma, Vinita Singh
May-August 2014, 2(2):79-82
DOI:10.4103/2347-5617.158225  
A 36-year-old alcoholic male suffered from central serous chorioretinopathy (CSCR). Morning serum cortisol was 293.3 ng/ml (normal range: 50-250 ng/ml), which was elevated. After 1-week of treatment with mineralo-corticoid antagonist eplerenone at 25 mg/day, patients witnessed visual acuity in the left eye increased to 6/12, which corroborated with optical coherence tomography showing substantial decrease of sub-retinal fluid. It is first documented case of CSCR associated with chronic use of alcohol that exhibited response to mineralo-corticoid antagonist eplerenone. In this study, though the exact role of alcohol intake in the pathogenesis could not be established, a disturbed the hypothalamic-pituitary-adrenal axis as a connecting link between the two conditions are observed. This will pave the way for larger, controlled studies directed to establish an association between alcohol intake and CSCR.
  8,407 104 -
SYMPOSIUM - DIABETIC RETINOPATHY UPDATE
Current trends in the treatment of diabetic macular edema
Sofia Theodoropoulou, Ahmed Sallam
January-April 2014, 2(1):26-34
DOI:10.4103/2347-5617.150214  
Since the introduction of focal/grid macular laser over 25 years ago and until recently, laser photocoagulation has been the standard of care in the treatment of diabetic macular edema (DME). Whilst laser photocoagulation was shown to halve the risk of moderate visual loss over 3 years, from 24% to 12%, only < 5% of patients achieves better visual acuity. Within the last 5 years, the use of intravitreal corticosteroids and intravitreal anti-vascular endothelial growth factor (VEGF) agents have come into clinical practice for the management of DME and several recent randomized clinical trials have shown superior effectiveness of anti-VEGF treatments compared to conventional macular laser. The introduction of depot steroid injections as flucinolone acetoinde has also lead to a current increase in interest in the use of intravitreal corticosteroids for DME treatment. In this review, we discuss the ocular treatment options currently available for the treatment of DME, mainly focusing on macular laser as well as intravitreal anti-VEGF and corticosteroid treatments.
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ORIGINAL ARTICLE
The relationship between photoreceptor IS/OS junction changes and visual acuity in diabetic macular edema
Nehal M Samy El Gendy, Shaimaa A Arfeen, Karim A Rafaat, Sherief M Sheta
January-April 2013, 1(1):7-13
DOI:10.4103/2347-5617.122817  
Purpose: To evaluate the integrity of the photoreceptor inner segment and outer segment (IS/OS) junction using spectral-domain optical coherence tomography (SD OCT) in patients with diabetic macular edema and to correlate the relationship between the integrity of the IS/OS junction and visual acuity. Design: Observational, prospective study. Materials and Methods: Forty eyes of 22 diabetic patients having diabetic macular edema. The authors performed spectral-domain optical coherence tomography in all eyes before treatment, 1month and 6 months after treatment. Central subfield thickness was defined as the average retinal thickness of the central 1-mm scanned area. The length of disruption of the inner and outer segments of the photoreceptors in the fovea were measured and graded according to their length as follows: Grade 0: Intact IS/OS line (no disruption at all), grade 1: Mild disruption (<400 μm). Grade 2: Moderate disruption (>400 μm but <1400 μm), Grade 3: Severe disruption (>1400 μm )or completely lost. Results: At the baseline, there was no correlation between the visual acuity (VA) and grade of defect (r = 0.214, P-value = 0.190). After 1 month and 6 months of treatment, there was a correlation between the VA and the grade of the defect (r = 0.538, P-value < 0.001) (r =0.603, P-value < 0.001), respectively. There was no significant association between the improvement in the IS/OS and final VA (P-value < 0.385). The mean change in VA from base line to 1 month in those who showed improvement in the defect was better than those in the nonimproved group (P-value = 0.001), and the mean change in the VA values from base line to 6 months in the improved group was better than those in the non improved group (P-value = 0.001). Conclusions: SD OCT showed that the integrity of the inner and outer segments of the photoreceptors was correlated with best-corrected visual acuity only 1 and 6 month after treatment, but not before treatment, so the correlation was not absolute.
  6,613 267 -
ORIGINAL ARTICLES
360° laser retinopexy in preventing retinal re-detachment after 23-gauge vitrectomy for primary repair of retinal detachment
Omar A Barrada, Mostafa H Nabih, Ayman M Khattabm, Ashraf A Nosseir
January-April 2015, 3(1):1-9
DOI:10.4103/2347-5617.179339  
Aims: To evaluate the role of intraoperative 360° laser retinopexy in the prevention of retinal re-detachment in cases of primary rhegmatogenous retinal detachment (RRD). Settings and Design: Prospective randomized controlled trial, 80 eyes of 80 patients with primary RRD. Subjects and Methods: Totally, 80 eyes of 80 patients with primary RRD will be divided into two groups. In Group (A), laser will be applied to all existing breaks as well as 360° laser retinopexy anterior to the equator will be performed while Group (B) laser will be applied only to the retinal breaks and will not receive the 360° laser treatment. Follow-up was for 3 months after clearance of the tamponading agent. Statistical Analysis Used: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474). Results: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474): Duration of detachment and preoperative visual acuity. Specifically, for every day more of duration of detachment, the odds of re-detachment increased by a factor of 1.007 (P < 0.01). Likewise, for every day more of duration of detachment, the odds of re-detachment was increased by a factor of 8.840 if a preoperative visual acuity of hand motion with bad projection (HMBP) or worse was present (P = 0.05). Conclusions: We concluded that prophylactic intraoperative 360° laser retinopexy did not have a statistically significant role in the prevention of retinal re-detachment after primary retinal repair. The statistically significant preoperative risk factors that have a poor prognostic effect on surgical outcomes are preoperative visual acuity of ≤ HMBP or worse and a longer duration of the retinal detachment.
  6,253 135 2
SYMPOSIUM - DIABETIC RETINOPATHY UPDATE
The surgical management of diabetic retinopathy complications: An update
Hazem A El-Sabagh
January-April 2014, 2(1):41-54
DOI:10.4103/2347-5617.150213  
Diabetic complications are known to be one of the leading causes of visual loss in the working age group in the developed world. The vitreous plays an important role in the development and progression of proliferative diabetic retinopathy and its complications. Despite the proper management of diabetics, complications due to disease progression necessitating diabetic vitrectomy occurs at a rate of 0.2% of people with diabetes. Vitrectomy has been used for the management of the complications of proliferative diabetic retinopathy since 1970, since then, the continuing developments in instrumentations and techniques have greatly improved outcome and minimized complications. This article reviews the updates in vitrectomy for the management of diabetic retinopathy, including indications, outcome, instrumentations, techniques and complications. The Medline database was searched for all literatures using the words, proliferative diabetic retinopathy, vitrectomy, diabetic macular edema, and vitreolysis.
  5,865 232 -
Screening for sight-threatening diabetic retinopathy: An update
Peter Henry Scanlon, Mohamed Dirani, Peter van Wijngaarden
January-April 2014, 2(1):3-18
DOI:10.4103/2347-5617.152479  
Aims: To review the literature on Screening for Diabetic Retinopathy. Materials and Methods: A comprehensive review of the English language literature, published from March 1980 to June 2014 using key words in Zetoc. Results: Several methods were found to achieve adequate sensitivities and specificities for diabetic retinopathy screening. Studies were compared with respect to (a) Classifications used to grade diabetic retinopathy (b) The evidence for population-based screening for diabetic retinopathy (c) Alternatives to digital photography for screening (d) Reference standards used to study the effectiveness of screening methods (e) The evidence for mydriatic versus non-mydriatic digital photography, or a combination of the two (f) The number of photographic fields captured (g) Measurement of distance visual acuity (h) Cost-effectiveness of screening for diabetic retinopathy (i) Future developments in screening for diabetic retinopathy Conclusion: Based on an assessment of available studies, the most effective DR screening strategy is the use of mydriatic or staged mydriasis with digital retinal photography. Variables between different screening strategies include whether Visual Acuity is measured and the number of fields captured.
  5,491 232 3
Cataract surgery in diabetic patients
Tarek Hammam
January-April 2014, 2(1):55-61
DOI:10.4103/2347-5617.150212  
Cataract is a common condition observed in patients with diabetes mellitus frequently requiring surgical intervention. Cataract surgery in diabetic patients may result in poor visual outcomes due to the progression of diabetic retinopathy and accelerated development of diabetic macular edema. Researchers and surgeons are interested in learning whether patients with diabetes have increased risks for complications from cataract surgery. In this review, I will evaluate the current management of the adverse events that may occur due to cataract surgery in diabetic patients.
  5,148 230 1
ORIGINAL ARTICLES
Normative macular cirrus spectral domain optical coherence tomography data in Indian pediatric population
Vishal Katiyar, Kumari Mugdha, Sonal Bangwal, Sanjiv Kumar Gupta
September-December 2013, 1(3):50-55
DOI:10.4103/2347-5617.143818  
Aim: Cirrus spectral-domain optical coherence tomography (SD-OCT) being noninvasive is gaining more popularity in identifying, monitoring, and classifying children with vitreo-retinal disorder. Normal values of cirrus SD-OCT from children are currently available from developed countries, but not from India. Objective: The primary objective of this study is to provide a normative pediatric database for macular thickness in healthy Indian children using the cirrus SD-OCT. Materials and Methods: The prospective observational study on 157 consecutive healthy children seen between January 2013 and January 2014. Included in the study were 157 subjects with no ocular abnormality, normal (20/20) visual acuity and normal fundoscopy. Cirrus HD-OCT (Carl Zeiss, Dublin, California, USA) device was used. Outcome: Study patients have a mean age of 12.59 ± 3.5 years, with 112 male (12.88 ± 3.5 years) and 45 female (11.8612.88 ± 3.5 years) children. In the linear regression analysis, changes in central subfield thickness and field of the outer macula were independently affected by increase in the age (β = −1.17-1.7, P = 0.004-0.022) and male are found to have significantly higher value when compared with the female (the t-test; t = 1.9-4.8, P = 0.00-0.24). Conclusion: This study established normal reference values for macular parameters measured by Cirrus SD-OCT in healthy Indian children 6-17 years of age, which is statistically different from the databases from other countries. It establishes the importance of the fact that age and gender warrants special consideration during cirrus SD-OCT interpretations in children.
  5,184 159 1
Combined phacoemulsification and sutureless vitrectomy for treatment of rhegmatogenous retinal detachment
Ahmed Hosni Abd Elhamid
May-August 2014, 2(2):68-73
DOI:10.4103/2347-5617.158223  
Purpose: To report the success rate and possible complications of combined phacoemulsification and sutureless 23 gauge vitrectomy for treatment of rhegmatogenous retinal detachment (RRD). Patients and Methods: Thirty patients with RRD were included in the study. All patients were examined for the extent of detachment, number and location of retinal breaks, and degree of proliferative vitreoretinopathy (PVR). Combined phacoemulsification, intraocular lens implantation, 23 gauge vitrectomy, laser retinopexy, and 12% C3F8 injection were done for all patients. All eyes were followed for 3 months. The primary outcome measures were single operation success rate and change in best-corrected visual acuity (BCVA). Any intraoperative and postoperative complications were reported and analyzed. Results: The mean age of the patients was 43.9 ± 10.11 years; mean duration of detachment was 17.3 ± 5.53 days while mean preoperative BCVA measured by logarithm of the minimum angle of resolution (Log MAR) was 2.1 ± 0.71. Single operation success rate was achieved in 25 eyes (83.3%), 5 eyes (16.7%) showed failure of complete attachment after absorption of gas bubble. The mean postoperative BCVA was significantly better than the preoperative value (1.00, 1.1 after 6 weeks and 3 months, respectively, P < 0.01). The most common postoperative complications were reversible corneal edema that occurred in 11 eyes (36.6%), fibrinous uveitis in 8 eyes (26.6%) and posterior capsular opacification in 16 eyes (53.3%). Preoperatively, 1 eye (3.3%) had BCVA ≤1 (Log MAR) in comparison to 17 eyes (56.7%) and 18 eyes (60%) after 6 weeks and 3 months respectively. Conclusion: Combined phacoemulsification and sutureless vitrectomy with gas tamponade is safe and effective single surgical procedure for selected patients with RRD.
  5,056 106 -
ORIGINAL ARTICLE
Intravitreal double-dose ranibizumab therapy for refractory diabetic macular edema
Ahmed M Abdel Hadi, Abdel Hamid S ElHofy
January-April 2013, 1(1):1-6
DOI:10.4103/2347-5617.122816  
Purpose: To evaluate the efficacy of ranibizumab (1 mg) for the treatment of refractory diabetic macular edema (DME). Materials and Methods: This prospective, consecutive, non-comparative case series included 24 eyes with refractory DME. Patients were included in the study independently of the size of the leakage area, retinal thickness, visual acuity (VA), age, metabolic control and type of diabetes mellitus. Exclusion criteria included presence of a hard exudate at the fovea, macular edema secondary to causes other than diabetic maculopathy, signs of vitreomacular traction clinically or by optical coherence tomography (OCT), proliferative diabetic retinopathy requiring treatment, history of glaucoma or ocular hypertension and macular ischemia. Patients who had intraocular/periocular steroid/antivascular endothelial growth factor injections within 6 months of the enrollment or significant media opacities were excluded. After a written informed consent was obtained, all patients were treated with three intravitreal injections, 1 month apart, of 0.1 mL (1 mg) injection of ranibizumab. Changes of retinal thickness and VA, as measured by the Snellen chart and converted to decimal equivalents, were evaluated. Results: A total of 24 eyes of 24 patients (nine females and 15 males) with non-proliferative diabetic retinopathy (12 patients; 50%) or quiescent diabetic retinopathy (12 patients; 50%) were included in the study. Their mean age and standard deviation (SD) was 45.5 ± 13.1 years (range: 27-71 years). All patients completed 6 months of follow-up. No injection-related side-effects, either locally or systemically, were observed during the follow-up period. All included patients were subjected to at least one method of treatment for DME. At baseline, the mean VA ±SD was 0.015 ± 0.008; after 1 month from the first injection, the mean VA increased to 0.019 ± 0.008 (significant increase, P = 0.0013). The VA remained the same after the second and the third injections. Six months after the third injection, the mean VA ± SD was 0.018 ± 0.009 (significant increase, P = 0.0013). The mean central retinal thickness ± SD by OCT was 526.7 ± 243.4μ at baseline. Four weeks post-operatively, a significant decrease of mean retinal thickness ± SD to 429.7 ± 187.8μ was observed. Eight weeks after the injection, the mean macular retinal thickness ± SD had further decreased to 352.2 ± 142.5μ, which is a significant difference (P = 0.001) compared with the baseline thickness. After 12 weeks, the mean retinal thickness ± SD further decreased to 333.7 ± 114.5μ (P = 0.001). Conclusion: The intravitreal injection of 1 mg of ranibizumab provides a new treatment strategy for refractory DME, which offers patients a true perspective of visual recovery. Further prospective and randomized studies will be needed to better determine which patients benefit the most and how often and in which concentration the drug should be administered.
  4,620 177 -
SYMPOSIUM - DIABETIC RETINOPATHY UPDATE
Ocular imaging in diabetic retinopathy
Quresh A Mohamed
January-April 2014, 2(1):19-25
DOI:10.4103/2347-5617.152481  
Imaging of the fundus has revolutionized our understanding of the pathogenesis of diabetic retinopathy (DR), allowed standardized grading and follow-up with the ability to evaluate treatments in randomized clinical studies. Ocular imaging provides the tools for screening of diabetic individuals to detect and treat changes before vision loss. Modern instruments allow rapid in vivo imaging of the diabetic fundus using multiple modalities with higher resolution. Images can be transmitted, manipulated, analyzed, and graded with increasing ease. These imaging techniques are now entwined in the paradigms for newer treatments for DR. This paper aimed to provide a brief overview of current imaging modalities including conventional and digital fundus imaging, scanning laser ophthalmoscopy, fluorescein angiography, wide-field retinal imaging, and optical coherence tomography. Future developments in these imaging techniques are discussed.
  4,595 162 -
CASE REPORTS
Unusual occurrence of central serous retinopathy after head injury
Shrikant Deshpande, Meghana Deshpande, Neha Dhiware
September-December 2014, 2(3):111-113
DOI:10.4103/2347-5617.164635  
We report a case of a 28-year-old man who developed central serous retinopathy 2 days after he sustained a contused lacerated wound over the right eyebrow in a road traffic accident.
  4,439 107 -
Unilateral acute angle-closure glaucoma as an unusual presentation of Vogt–Koyanagi–Harada disease: A diagnostic challenge
Mohsen Ahmed Abou Shousha, Rowayda Mohamed Amin
September-December 2014, 2(3):108-110
DOI:10.4103/2347-5617.164630  
Vogt–Koyanagi–Harada syndrome is an inflammatory multisystem disorder with ocular, cutaneous and neurological manifestations occurring more commonly in certain dark-skinned ethnic groups such as Asians, patients of Middle-Eastern heritage, and hispanics. Only a few reports have described a masquerade presentation of acute angle closure as an initial manifestation for this uveitic entity, which is typically characterized by panuveitis with serous retinal detachments. This has almost always led to misdiagnosis, unwarranted surgical interventions, and a delay of appropriate timely therapy. In this report, we describe an unusual case of acute unilateral Harada disease presenting as acute angle-closure glaucoma that has remitted following institution of appropriate therapy.
  4,413 108 1
ORIGINAL ARTICLES
Albuminuria as a biomarker for risk of retinopathy in type II diabetic patients in Suez Canal area
Walid Abdelghaffar, Waleed Ghobashy, Mohammed Abdo, Amani El-Baz, Magda Ibrahim
May-August 2013, 1(2):18-22
DOI:10.4103/2347-5617.135243  
Aim: The aim of this study is to estimate the prevalence of albuminuria in type II diabetes mellitus and report its influence, as a risk factor, for the presence and severity of diabetic retinopathy (DR). Subjects and Methods: During the period of January 2012 to May 2013, 420 type II diabetic patients were examined. Albuminuria adjusted for creatinine concentration was measured. Body mass index and hemoglobin A1c were also measured. Patients were evaluated by direct and indirect ophthalmoscopy and were classified as non-retinopathy, non-proliferative, proliferative or diabetic maculopathy. Results: The prevalence of albuminuria among type II diabetic patients in this study was 40.2%. The prevalence of microalbuminuria and macroalbuminuria were 30.7% and 9.5% respectively. The study also showed an association between the degree of albuminuria and severity of retinopathy. Nearly 97.5% of the macroalbuminuric patients had sight threatening forms of retinopathy (proliferative diabetic retinopathy + diabetic maculopathy DM) compared with 87%of the microalbuminuric and only 15% of the normoalbuninuric patients. Conclusion: Micro- or macroalbuminuria are highly prevalent in subjects with type II diabetes. Subjects with micro- and macroalbuminuria are more likely to have DR compared with those without albuminuria.
  4,258 203 -
One-year follow-up of patients after yttrium aluminum garnet laser vitreolysis for vitreous floaters
Amr Saad Bessa
January-June 2019, 6(1):1-4
DOI:10.4103/erj.erj_1_19  
Background: This study was performed to evaluate the efficacy, complications, and patient satisfaction and follow-up for 1 year after neodymium yttrium aluminum garnet (Nd:YAG) laser vitreolysis for visually disturbing vitreous floaters. Aims: To evaluate the role of Nd:YAG laser vitreolysis in visually disturbing vitreous floaters. Settings and Design: This was an institutional, observational, cross-sectional retrospective study. Subjects and Methods: A retrospective observational study was conducted on 86 eyes of 71 patients suffering from persistent vitreous floaters with complete posterior vitreous detachment who underwent laser vitreolysis with the Ultra Q Reflex™ (Ellex Medical Lasers, Adelaide, Australia), in the first half of 2015. Follow-up was done for 1 year. Patient satisfaction was graded from 0% to 100%. Laser settings and complications were recorded. Results: Average subjective symptomatic improvement was 66.23%; 44.2% of patients reported excellent satisfaction (75%–100%) and 32.6% reported good satisfaction (50%–74%). 45.3% of patients required 3–4 sessions. Average power setting was 5.3 mJ. One case of iatrogenic cataract treated by phacoemulsification and intraocular lens implantation occurred. Another case suffered limited vitreous hemorrhage which completely resolved. Conclusions: Laser vitreolysis is a safe, effective method for the treatment of symptomatic visually disturbing floaters.
  4,348 100 -
Comparison between fundus autofluorescence images and color fundus photos in patients with late dry age-related macular degeneration
Ahmed Mahmoud Abdel Hadi, Kyrollos Girgis Andrawos
September-December 2013, 1(3):31-36
DOI:10.4103/2347-5617.143445  
Purpose: The purpose was to compare between color fundus photography (CFP) images and fundus autofluorescence (FAF) images of cases with geographical atrophy (GA) about size. To evaluate the relation between different phenotypes of FAF changes and best corrected visual acuity (BCVA) in cases with late dry age-related macular degeneration (AMD) (GA). Materials and Methods: This study was conducted on 18 eyes of 18 patients aged 55 years. Patients unwilling to participate in the study, suffering from hereditary fundus diseases, had previous laser photocoagulation treatment for any cause, were excluded. BCVA using Snellen chart was measured. Retinal imaging including CFP with 50° field camera: Topcon TRC-50 IX - and FAF using spectralis Heidelberg retinal angiograph (HRA) + optical coherence tomography (HRA, Heidelberg Engineering, Germany) were done. All images were optimized and then manually measured using image analysis software (Adobe Photoshop version CS6; Inc., San Jose, California, USA). Images of fundus autofluorescence in cases of late dry AMD were classified to phenotypes at the junctional zone according to the classification of abnormal FAF patterns. Results: According to sex distribution, 33.3% (6 eyes) were males and 66.7% (12 eyes) were females . The mean age of the study participants was 72.89 ± 9.09 years. About surface area of GA, the mean surface area of GA by FAF was 71094.56 ± 21490.53 pixels and by color fundus camera were 46236.56 ± 13153.46 pixels. About FAF phenotypes in late dry AMD cases, Twelve eyes (66.7%) had diffuse pattern, 11.1% (2 eyes) had a none pattern (no specific pattern), and 22.2% (4 eyes) had focal pattern. Color fundus camera underestimated the surface area of GA in cases of late dry AMD. BCVA was best in cases with no specific pattern of autofluorescence at the junctional zone of the GA, followed by cases with focal pattern of hyperautofluorescence while cases with diffuse increases of autofluorescence at the junctional zone showed the worst VA. Conclusions: CFP underestimated the size of the GA, as compared with FAF measured sizes. BCVA was best in cases with no specific pattern of autofluorescence at the junctional zone of the GA, followed by cases with focal pattern of hyperautofluorescence while cases with diffuse increases of autofluorescence at the junctional zone showed the worst VA.
  4,211 167 -
CASE REPORT
Silicone oil induced high astigmatism in a pseudophakic vitrectomized eye
Mostafa Hamed Nabih, Ahmed Abd Allah Mohalhal
May-August 2013, 1(2):28-30
DOI:10.4103/2347-5617.135245  
A 66-year-old male lawyer with dropped whole nucleus during phacoemulsification procedure. He was hepatitis C virus positive, international normalized ratio 1.5, prothrombin concentration 60%, and coagulation time 15.5 s. Positive predictive value was done, nucleus was removed with sleeveless phaco needle through pars plana, an AcrySof three piece intraocular lens (IOL) was implanted in the ciliary sulcus. Postoperative sustained vitreous haze required silicone oil injection. One day postoperatively, vision was counting fingers again, opened posterior capsule, clear fundus details. Refraction revealed: −8 × 120 astigmatic error correcting the patient to 0.2 vision (decimal fraction) with uniocular diplopia; as the patient claimed. Corneal topography revealed minimal corneal astigmatic error. By revising patient's clinical data, the IOL was perfectly in the sulcus supported by a remarkably thick anterior capsule. The capsulorhexis opening has changed into an oval one with a long axis almost the same as that of negative cylinder, 2 months later silicone oil was removed. The unaided vision of this eye returned to 0.9 to be corrected to 1.0 with +0.75 cylinder at 20.
  4,209 126 -
ORIGINAL ARTICLES
Intravitreal bevacizumab injection for management of macular edema in branch retinal vein occlusion
Wael A Ewais, Malak Ismail Elshazly, Ashraf A Nossair
September-December 2013, 1(3):45-49
DOI:10.4103/2347-5617.143817  
Purpose: The aim was to evaluate visual and anatomical outcome of intravitreal bevacizumab (IVB) in eyes with macular edema (ME) due to branch retinal vein occlusion (BRVO). Methods: Retrospective, consecutive case series. Study was done on 26 eyes of 26 patients. Outcome measures include: Best corrected visual acuity (BCVA), central macular thickness (CMT) by spectral domain optical coherence tomography, and complications. Results: BCVA improved by a mean of 3.2 lines from an initial mean BCVA: 0.1 (counting fingers: 1 m-0.3) to a mean BCVA 0.4 (0.05-0.8) over the follow-up period of 6.9 months (4-12 months). CMT was reduced from an initial mean of 613 (401-959 μ) to the mean of 400 μ (274-623 μ) at the end of the follow-up period. No complications were recorded. This was achieved through a mean number of injections: Four with a range (3-6 injections). Conclusion: IVB is an effective treatment for ME secondary to BRVO. There was a significant improvement of VA and significant reduction in macular thickness in many cases, but not in all cases.
  4,135 127 -
REVIEW ARTICLE
Central serous chorioretinopathy: Recent trends
Abhishek Das, Prapti Chheda
July-December 2019, 6(2):27-32
DOI:10.4103/erj.erj_1_20  
Central serous chorioretinopathy (CSCR) belongs to pachychoroid spectrum of diseases, and the pathogenesis is still not fully understood. It is associated with multiple systemic factors. It is characterized by the collection of fluid between the retinal pigment epithelium (RPE) and the neurosensory retina. It mostly affects young men under perceived stress. The involvement of corticosteroids is undisputed although their exact role has not been clarified; other parts of the underlying mechanism of CSCR have been mainly elucidated by imaging techniques, such as fluorescein and indocyanine green angiography. The course is usually self-limiting and in most cases resolves spontaneously within a 3–6-month period, with visual acuity usually recovering to 20/30 or better. However, chronic CSC may develop as a consequence of recurrences or persistent neurosensory detachment and can result in progressive RPE atrophy and permanent visual loss. We used search terms such as “central serous retinopathy,” “central serous chorioretinopathy,” “CSCR,” “management,” and “treatment” and also the keywords of each type of treatment on PubMed and Medline to retrieve articles for this systematic review.
  4,107 146 -
CASE REPORTS
Conjunctivitis progressing into endophthalmitis in an eye with an old scleral buckle and its managements
Logandran Vijaya Kumar, L M Evelyn Tai, Widad Mohd Yusof, Wan Hazabbah Wan Hitam
January-June 2017, 4(1):23-26
DOI:10.4103/erj.erj_17_16  
Conjunctivitis is a common eye infection but can be sight-threatening in patients with previous sclera buckles. A 73-year-old man who had right eye scleral buckle surgery two decades ago presented with right eye acute conjunctivitis, for which a topical antibiotic was prescribed. The right eye vision was 6/18, the conjunctiva was not chemosed, the anterior chamber remained quiet, and the fundus was unremarkable. A week later, he returned complaining of right eye painful and blurring of vision. The right eye vision had deteriorated to hand movements. Examination showed right lid swelling, chemosed conjunctiva, exposed scleral buckle, anterior chamber cells, and dense vitritis. These clinical features were suggestive of right eye endophthalmitis. Emergency intravitreal injections, early scleral buckle removal, and vitrectomy with silicone oil tamponade were performed. The patient was also treated with intravenous and topical antibiotics. The final right eye vision was preserved to 6/18. Simple conjunctivitis can progress into endophthalmitis in a patient with a scleral buckle. Prompt surgical management gives the best outcome.
  4,163 84 -
ORIGINAL ARTICLES
Optical coherence tomography evaluation of retinal and optic nerve head neovascularization in proliferative diabetic retinopathy
Mahmoud Alaa Aboeuhussein
May-August 2013, 1(2):23-27
DOI:10.4103/2347-5617.135244  
Purpose: The purpose of this study is to describe the in vivo spatial and morphological vitreoretinal relationships associated with diabetic retinal neovascularization (NV) using optical coherence tomography (OCT). Patient and Methods: This was a prospective observational study that involved 50 eyes of 46 patients with proliferative diabetic retinopathy (PDR) documented by fluorescein angiography either treatment naοve or laser treated were included. Qualitative assessment of macula, retina and optic disc head OCT imaging of patients with PDR. The morphology and plane of retinal neovascularization at the disc (NVD) and elsewhere in the retina (NVE) was examined, and the posterior vitreous relationships were evaluated. Results: The mean age of patients was 52.1 years. Ten patients had type 1 diabetes and 36 had type 2 diabetes. It was possible to evaluate changes of retina, vessels and vitreous in the 50 eyes. This study describes OCT characteristics of: NVD in 35 eyes (70%), NVEs in 20 eyes (40%), NV causing traction without retinal detachment in 15 eyes (30%), and NV causing traction with retinal detachment in 10 eyes (20%). Conclusion: It is possible to image NV of proliferative retinopathy using spectral domain OCT and to visualize the retinal, vascular and vitreous changes associated with NV.
  4,024 150 -
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