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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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   Table of Contents - Current issue
July-December 2018
Volume 25 | Issue 3-4
Page Nos. 119-172

Online since Friday, January 4, 2019

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Comparative clinical study of medically controlled nonsevere chronic primary angle-closure glaucoma with coexisting cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy Highly accessed article p. 119
Vidya Chelerkar, Puja Parekh, V K S Kalyani, Madan Deshpande, Rajiv Khandekar
PURPOSE: Comparative clinical study of medically controlled non-severe chronic Primary Angle Closure Glaucoma (PACG) with co-existing cataract surgically managed by phacoemulsification as against combined phacotrabeculectomy. METHODS: This randomized clinical trial was conducted between December 2011 and December 2013. Patients were randomly assigned to Phacoemulsification (PE) and Phacotrabeculectomy (PT) groups for surgery. Intraocular pressure, anti-glaucoma medications, Best Corrected Visual Acuity, anterior chamber angle widening and post-operative complications in both groups were compared after 12 months. RESULTS: There were 46 eyes with PACG in PE group and 45 in PT group. The IOP at 12 months in PE group was 11.5±1.3mmHg and 11.8±1.2mmHg in PT gr. (p = 0.28). The eyes requiring single anti-glaucoma medications at 12months in PE group was 0, PT group was 1 (p = 0. 495). The post op BCVA at 12months in PE group 0.3+-0.12 and 0.33±0.15 in PT group (p = 0.22). 3 cases in PT group required additional intervention whereas no additional intervention was required in PE group and this difference was statistically significant (p = 0.116). CONCLUSION: Phacoemulsification is equally effective in terms of intraocular pressure control and visual outcome as phacotrabeculectomy with better safety and less post-operative complication.
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Knowledge and attitude toward eye donation among adults, Northwest Ethiopia: A community-based, cross-sectional study p. 126
Mohammed Seid Hussen, Gizachew Tilahun Belete
BACKGROUND: In developing countries, the leading cause of childhood blindness is corneal scarring. Although the service of corneal transplantation depends on several factors, availability of potential donors is of paramount importance. Attitude of eligible donors is the main factor that affects corneal supply. However, limited data exist on eye donation. Hence, this study intended to assess the knowledge and attitude toward eye donation and its associated factors. SUBJECTS AND METHODS: A community-based, cross-sectional study was conducted on 760 adults aged ≥18 years selected using multistage systematic random sampling in Gondar town, Northwest Ethiopia. A face-to-face structured questionnaire interview in home-to-home visit was applied to collect the data. Descriptive and analytical tests were performed. A binary logistic regression was fitted. Those variables with P < 0.05 were considered statistically significant. RESULTS: This study comprised 760 adults with a median age of 30 years. The proportion of overall level of good knowledge and favorable attitude toward eye donation was 8.4% and 59.9%, respectively. It has been also recognized that attitude was positively associated with educational level of high school (adjusted odds ratio [AOR] = 2.41, 95% confidence interval [CI]: 1.41–4.14) and college/university (AOR = 2.73, 95% CI: 1.53–4.89) and awareness (AOR = 1.50, 95% CI: 1.05–2.03). CONCLUSIONS: Although the overall level of knowledge about eye donation was poor, the proportion of favorable attitude toward eye donation was fair. Since it was associated with educational level and awareness, it is strategic to follow multidisciplinary approaches to facilitate multi-stakeholder partnerships and to motivate the people to donate their eyes.
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Estimation of morphological characteristics in asymmetrical myopic posterior staphyloma using optical coherence tomography p. 131
Georgios Bontzos, Miltiadis Tsilimbaris, Efrosini Papadaki, Thomas G Maris, Michael Mazonakis, Efstathios T Detorakis
PURPOSE: Posterior staphyloma is an ocular complication associated with high myopia and reflects degenerative changes on the sclera. Its morphology is associated with chorioretinal atrophy and myopic maculopathy. The purpose of this study was to validate the efficacy of optical coherence tomography (OCT) in providing a simple estimation of the staphyloma pattern. MATERIALS AND METHODS: Observational case-series study of high myopic patients with posterior staphylomas. Patients were examined using the star scan pattern OCT in different radial planes. Three-dimensional (3D) magnetic resonance tomography was also performed to visualize the anatomical characteristics of the posterior pole. 3D-segmentation and curvature analysis were also performed. RESULTS: Eight patients were totally enrolled in this pilot study. Our study pool consisted of 2 wide macular staphylomas, 2 narrow macular staphylomas, and 4 barrel-shaped staphylomas. Our preliminary results revealed that patients displayed mirror-image distortion in the steeper staphyloma axis. In the barrel-shaped subtype, no image distortion was displayed in any plane. CONCLUSION: We estimated the axis of the smaller base curvature by noting the distortion pattern in the different radial axis. The recognition of pathologic axial myopia is important since there is a risk of permanent vision loss from vision to threatening sequelae.
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Transition to ophthalmology residency program and the role of basic science course p. 137
Moustafa Sameer Magliyah, Saad Hamdan AlEnezi, Abdullah M AlFawaz
BACKGROUND: Residency training is a difficult and a highly stressful task, especially at the beginning of the training. The aim of this study is to assess the roles of the Basic Science Course (BSC) and independent preparation on the transition to ophthalmology residency in Saudi Arabia. METHODOLOGY: A cross-sectional study was conducted among ophthalmology program residents. The questionnaire was administered to 100 residents. Responses were analyzed for association using univariate analysis. RESULTS: Nearly 88% of residents were satisfied with their knowledge exposure during the BSC, while 67% thought that the majority of the BSC was dedicated to theoretical lectures. Surgical exposure was limited to attending surgeries for 38% of residents before joining residency programs, and 91% thought that there was little time dedicated for hands-on surgical skills training during the BSC, while only 11% thought that their surgical exposure was beneficial. Almost half of the beginning residents were accompanied by senior colleagues during their initial calls. More than 50% of residents felt that their transition to ophthalmology residency was more stressful than the transition to internship. CONCLUSION: The knowledge exposure from the BSC was helpful to facilitate the transition to ophthalmology residency program, especially for the ones who prepared well before. Improvement in surgical skills training should be aimed to further facilitate transition to ophthalmology residency program.
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Perceptions and career expectation in ophthalmology among saudi undergraduate medical students p. 142
Firas Mohamed Madani, Reem Alasiri, Sara Howldar, Faisal Zagzoog, Nizar Alhibshi
PURPOSE: To assess the perceptions about ophthalmology as a career among undergraduate medical students and to investigate the determinants of career choice in ophthalmology. METHODS: A questionnaire was administered to all medical students (from 4th year to interns) in King Abdulaziz University, Jeddah, Saudi Arabia. A total of 519 students were included in the study. Students who aspire for ophthalmology as a career, i.e., those who mentioned it in their top three choices (Group A), were compared to those who did not (Group B) regarding demographic and academic factors, factors generally influencing career choice and perception about and experience in ophthalmology. RESULTS: Among 519 included students, ophthalmology was the first career choice of 5.6% and in the top three choices of 13.5% of students. Students from Group A had female preponderance and comparable academic skills, by reference to Group B. Group A reported to have a better experience in ophthalmology, including conference attendance, research activity, and community services related to ophthalmology, as well as greater advantage from ophthalmology rotation. Determinants of career choice in ophthalmology included giving importance for workload during their residency (odds ratio [OR] = 3.38; P = 0.021), having concern about challenging instrumental features (OR = 0.29, P = 0.012), believing that ophthalmology should be included in primary care (OR = 13.60, P = 0.002), and having participated in community service activity in ophthalmology (OR = 10.10, P = 0.005). CONCLUSION: Students who aspire for a career in ophthalmology showed to have an early involvement in related academic activities and less concern about instrumental and intellectual challenges, as compared to their counterparts. The formal ophthalmology rotation is the key step to recruit future ophthalmologists by correcting misconceptions and enhancing interest about the specialty.
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Predictors of ocular surface squamous neoplasia and conjunctival squamous cell carcinoma among ugandan patients: A hospital-based study p. 150
Harrison-Williams C M Lloyd, Simon Arunga, Amos Twinamasiko, Meier A Frederick, John Onyango
AIM: The aim of the study was to assess the predictors of ocular surface squamous neoplasia (OSSN) and conjunctival squamous cell carcinoma (SCC) among Ugandan patients. MATERIALS AND METHODS: Patients presenting for removal of ocular surface lesions received human immunodeficiency virus (HIV) testing, completed questionnaires about demographic, behavioral, and historical potential risk factors for conjunctival neoplasia, and had lesions examined for interpalpebral versus other locations, rough versus smooth texture, and number of feeder vessels. Biopsies were classified pathologically using standard definitions classified OSSN and SCC. HIV rates were calculated for patients: with OSSN, SCC, and benign lesions. Potential risk factors and gross findings were tested for abilities to predict OSSN and SCC. RESULTS: One hundred and ninety-five patients presented with 212 lesions in 203 eyes. Nearly 34% of the patients were more than 60 years old, 67% were peasants, 88% spent more than 20 h/week outdoors, and only 10% wore sun protection. No potential risk factors predicted neoplasia. HIV prevalence was 17.1% among patients with OSSN compared to 11.1% among those without OSSN; 42.9% among SCC patients compared to 12.0% among those without SCC. Rough tumor surface (adjusted odds ratio [aOR] = 4.4 and 95% confidence interval [CI]: 2.2–9.1), six or more feeder vessels (aOR = 2.6, 95% CI: 1.3–5.2), and interpalpebral tumor location (aOR = 3.3, 95% CI: 1.5–7.1) predicted OSSN. Only a rough tumor surface (aOR = 34.6, 95% CI: 7.8–153.4) predicted SCC. CONCLUSION: HIV infection remained a risk factor for OSSN and particularly, SCC, but less so than in the past. Lesions' rough surface, six or more feeder vessels, and interpalpebral location increased OSSN risk. Only a rough tumor surface increased risk for SCC.
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Unilateral congenital nasolacrimal duct obstruction, is it an amblyogenic factor? p. 156
Fatimah AlHammad, Elham Al Tamimi, Sanaa Yassin, Khadija AlBadri, Saleh AlJarudi, Mohammed AlShawaf, Rajiv Khandekar
BACKGROUND/AIMS: To evaluate the refractive status, axial length, and prevalence of amblyopia among Saudi children with unilateral congenital nasolacrimal duct obstruction (UCNLDO) compared to the unaffected fellow eye. METHODS: A retrospective chart review was performed for children with UCNLDO at two eye institutes in Eastern Saudi Arabia from 2009 to 2015. The outcomes of syringing determined UNCLDO. The risk factors for amblyopia were defined as anisometropia of (spherical equivalent) >1.5 D, hyperopia >3.5 D, myopia >3.0 D, astigmatism >1.5 D at 90° or 180°, >1.0 D, any manifest strabismus, any media opacity >1 mm, or ptosis 1 mm or less margin reflex distance 1 along with blunting of vision in that eye. Matched-pair analysis was performed to correlate variables. P < 0.05 was considered statistically significant. RESULTS: We included 39 children with UNCLDO. The mean axial length was 21.4 ± 1.3 mm for the eyes with UCNLDO and 21.6 ± 1.0 mm for the fellow eye (P = 0.4). Hyperopia >+2 D was present in 17 (44%) eyes with UCNLDO and none of the fellow eyes. None of the participants had strabismus. CONCLUSION: Axial length and risk factors of amblyopia such as anisometropia, hyperopia, and strabismus were not associated with UCNLDO. UCNLDO is likely an isolated defect.
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Retinal detachment after cyclophotocoagulation in a child with knobloch syndrome p. 161
Ali S Al-Beshri, Igor Kozak, Earl Randy Craven
Knobloch syndrome (KS) is typically characterized by high myopia, vitreoretinal degeneration, retinal detachment, and macular abnormalities. We report a case of glaucoma in KS, which represents the fourth reported case and the first description of the retinal events after the glaucoma procedure. Retinal detachment followed standard cyclophotocoagulation procedure for glaucoma in a 2-month-old boy. Ophthalmologists should be aware of the possibility of retinal detachment from any ocular intervention in patients with KS.
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Subretinal hypopyon in presumed tubercular uveitis: A report of two cases p. 163
Rohan Chawla, Koushik Tripathy, Seema Meena, Aswini Kumar Behera
Subretinal hypopyon is an uncommon entity which has been described in ocular infections and inflammations including endophthalmitis, acute retinal necrosis, and sympathetic ophthalmia. The authors report subretinal hypopyon in two cases of presumed tubercular uveitis which responded well to antitubercular therapy (ATT). The first case was a 47-year-old male with bilateral peripapillary chorioretinitis with a subretinal hypopyon. Tuberculosis was confirmed on biopsy of a cervical lymph node which revealed acid-fast bacilli. Case 2 was a 17-year-old male with unilateral involvement in the form of a choroidal granuloma with disc edema and retinitis. In addition, a subretinal hypopyon was evident. Both these cases showed dramatic anatomical improvement with ATT. A novel finding of subretinal hypopyon is described in these cases of presumed ocular tuberculosis. It may be prudent to start empirical ATT early on detection of a subretinal hypopyon along with other manifestations compatible with tubercular etiology.
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Inverted internal limiting membrane technique maintains macular hole closure in retinal detachment following macular hole repair p. 167
Ogugua N Okonkwo, Michael E Gyasi, Adekunle O Hassan, Olufemi Oderinlo
Recent advances in macular hole surgery have significantly improved the rates of anatomical success. One important advance is the dye-assisted peeling of the internal limiting membrane (ILM) around the hole. In large holes (<400 μ), sometimes, ILM peeling alone is not enough to achieve closure, and this may be improved by inverting part of the peeled membrane and using it to cover the macular hole or inverting and tucking the ILM flap into the hole. In this case report, a patient with large full-thickness macular hole underwent a hole repair with an inverted ILM flap technique. The eye developed a subsequent retinal detachment with large collection of subretinal fluid beneath the repaired hole, but the hole remained intact, suggesting that the adhesive forces binding an inverted flap to the edges of a repaired macular hole appear to be strong enough to maintain structural integrity of the closed hole even in the presence of a macula-involving retinal detachment with large subretinal fluid collection.
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Punctal plug as a treatment option for dry eye associated with congenital supernumary puncta p. 170
Alicia Galindo-Ferreiro, Laila AlGhafri, Patricia Akaishi, Alberto Galvez-Ruiz, Julio Galindo-Alonso, Silvana Schellini, Augusto Cruz
This study aims to describe a case of double lower lacrimal punctum-canaliculi in a dry eye patient treated with a punctal plug. A 60-year-old healthy female presented with complaints of tearing, itchy eyes, and foreign body sensation in the right eye for many years. There was no history of trauma or inflammation. Two patent independent supernumerary puncta and canaliculi were present on the right lower eyelid. The Schirmer Test II (with anesthesia) was zero, the tear breakup time was 2 s, and superficial punctate erosions were present in the right eye. A long-term nonabsorbable punctal plug was inserted into one of the lower puncta. At 9-month follow-up, the dry eye symptoms decreased markedly, the Schirmer Test II improved and superficial keratitis resolved.
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