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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
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October-December 2017
Volume 24 | Issue 4
Page Nos. 167-222

Online since Friday, January 12, 2018

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ORIGINAL ARTICLES  

Outcomes of scleral-fixated intraocular-lens in children with idiopathic ectopia lentis p. 167
Abdulaziz I Al Somali, Faisal N Al-Dossari, Khalid E Emara, Ahmed Al Habash
DOI:10.4103/meajo.MEAJO_105_16  
PURPOSE: The purpose of the study was to review the safety and stability of scleral-fixated intraocular lens (IOL) 2 years after implantation in children with idiopathic ectopia lentis (EL). METHODS: This retrospective case series enrolled children with EL managed between 2011 and 2015 at a tertiary eye hospital in the eastern of Saudi Arabia. Data were collected on age, gender, vision, isolated or syndromic pathology, intraoperative and postoperative complications, spherical equivalent refraction, and final best-corrected visual acuity (BCVA). RESULTS: The series included 18 eyes of 11 children with EL (6 males and 5 females). There were 7 bilateral and 4 unilateral cases. The median age was 3.5 years (25% quartile 1 year; range: 1–8 years). Preoperatively, fixation was absent in 3 eyes, 8 eyes were fixating but vision could not be recorded. In the remaining seven eyes, median distant visual acuity was 0.1 (25% quartile: 0.08). The median postoperative follow-up was 24 months (25% quartile, 7 months). Complications included two eyes with iris capture and one eye with lens subluxation requiring re-implantation. Postoperative BCVA was better than 20/60 in 15 (83%) eyes. At last follow-up, 6 eyes required myopic correction, 1 eye was emmetropic, and 11 eyes were hypermetropic. One eye with glaucoma was managed medically. CONCLUSION: Scleral fixated IOL in eyes of young children with EL had good visual outcomes and high stability. However, there is a high incidence of residual refractive error.
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Keratoconus asymmetry between both eyes based on corneal tomography p. 171
Nathalie Bussières, Osama Hamid Ababneh, Mohammed Ali Abu Ameerh, Muawyah D Al Bdour
DOI:10.4103/meajo.MEAJO_311_16  
PURPOSE: To characterize the asymmetry between both eyes in patients with keratoconus based on corneal tomography. MATERIALS AND METHODS: All patients with keratoconus who presented to the eye clinic at Jordan University Hospital between January 2008 and November 2011 were included in the study. Using computerized corneal tomography, the keratometric values and indices of both eyes of participants with keratoconus and normal controls were compared. For both eyes to be considered symmetrical, the difference between the mean curvature power (Km), flat curvature power (K1), or steep curvature power (K2) in both eyes was equal to or <2.5 diopters, and the difference between the thinnest corneal points was equal to or <25.0 μm between both eyes. RESULTS: Ninety-eight patients with keratoconus and 49 normal participants were evaluated. The mean age of the participants was 26.3 ± 6.6 years. The results showed two populations of patients with keratoconus: one with asymmetrical corneas who were more affected by the disease and another with symmetrical corneas. As the disease severity increased, the differences between the two eyes increased for patients with the asymmetrical form, while both corneas of patients with the symmetrical form were similar. CONCLUSIONS: Corneal tomography identified two forms of keratoconus: symmetrical and asymmetrical. The latter tended to be more severe and occurred in a younger age group. Questions remain about whether the two keratoconic forms are specific to the Middle Eastern population and whether there are ethnic or demographic forms of the disease.
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Cataract and glaucoma surgery: Endoscopic cyclophotocoagulation versus trabeculectomy p. 177
Sheila Marco, Karim F Damji, Samir Nazarali, Chris J Rudnisky
DOI:10.4103/meajo.MEAJO_232_16  
PURPOSE: To compare the efficacy and safety of endoscopic cyclophotocoagulation (ECP) versus trabeculectomy with mitomycin C (trab) in combination with cataract surgery. MATERIALS AND METHODS: We evaluated the 6-month results of patients undergoing phacoemulsification (phaco) with either ECP or trab. The primary outcome was mean intraocular pressure (IOP) at 6 months; secondary outcomes were change in glaucoma medications, visual acuity, intraocular inflammation, and postoperative complications. Complete success was a target IOP of <21 mmHg and >6 mmHg without glaucoma medications. Qualified success was target IOP achieved through glaucoma medications. RESULTS: We evaluated 53 eyes of 53 patients; 24 (45.3%) eyes were treated with ECP-phaco and 29 (54.7%) with trab-phaco. At 6 months, there was no significant difference in mean IOP of the two groups (ECP-phaco 14.2 ± 3.6 mmHg; trab-phaco 13.0 ± 2.5 mmHg; P = 0.240). Six (25.0%) ECP-phaco eyes and 20 (69.0%) trab-phaco eyes achieved complete success (P = 0.002). Qualified success was achieved in 18 (75.0%) ECP-phaco eyes and 9 (31.0%) trab-phaco eyes (P = 0.002). The mean reduction of medication from baseline was significant (ECP-phaco 1.2 ± 1.1; trab-phaco 2.1 ± 1.5; P = 0.020). ECP-phaco resulted in more IOP spikes on the 1st postoperative day (P = 0.040) and more anterior cellular reaction at 1 week and 1 month compared to trab-phaco (P < 0.05). The rate of postoperative complications was not significantly different between groups. CONCLUSION: At 6 months, ECP-phaco demonstrated similar improvements in IOP and visual acuity compared to trab-phaco. However, ECP-phaco patients had higher incidences of immediate postoperative IOP spikes and anterior chamber inflammation as well as requiring additional medications postoperatively.
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Epidemiology and clinical features of thyroid-associated orbitopathy in Accra p. 183
Edith Mawunyo Ackuaku-Dogbe, Josephine Akpalu, Benjamin Abaidoo
DOI:10.4103/meajo.MEAJO_91_17  
PURPOSE: Thyroid-associated orbitopathy (TAO), a clinical manifestation of Graves' disease, is an autoimmune disorder of the orbital and periorbital tissue. Data on the epidemiology and clinical presentation of TAO in Africa are generally scarce and unavailable in Ghana. We investigated the epidemiology and clinical features of TAO among patients with thyroid disorders attending the Korle Bu Teaching Hospital, Accra. SUBJECTS AND METHODS: This was a descriptive cross-sectional study of patients diagnosed with thyroid disorders which was conducted at the endocrine and orbital clinics of the Korle Bu Teaching Hospital. Diagnosis was based on clinical features and confirmed by a thyroid function test. Data collected and analyzed included demography, systemic and ocular features of thyroid disorder, and thyroid function tests. RESULTS: Of the 194 patients with thyroid disorders recruited, 117 (60.30%) had TAO. The mean age was 45.22 years (standard deviation: 13.90). The male:female ratio was 1:4.45. The most common ocular symptoms were “bulging eyes” (76/65.00%) and “puffy eyelid” (62/53.00%), and the common signs were eyelid retraction (97/82.91%) and proptosis (80/68.38%). Mild TAO was diagnosed in 64.96% of patients with only 6.84% having the severe form. The outcomes of the thyroid function test, thyroid disorder, and severity of TAO did not record any statistically significant differences. CONCLUSIONS: The epidemiology is similar to those reported from other parts of the world, but the ocular presentation seems to be milder than in Caucasians.
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Investigating the visual status of preschool children in Riyadh, Saudi Arabia p. 190
Ali M Alsaqr, Ghayda'a Ibrahim, Ali Abu Sharha, Raied Fagehi
DOI:10.4103/meajo.MEAJO_123_17  
PURPOSE: The purpose of the study was to explore the vision status of preschool children aged 3–6 years in Al Riyadh and to identify children at risk of amblyopia. MATERIALS AND METHODS: This was a cross-sectional population-based study. Visual acuity (VA) was measured using 15-line Lea symbols, refractive error was assessed using the Mohindra near retinoscopy technique, and peak contrast sensitivity (CS) was measured with the aid of the numerical CS test. We recruited 335 children, with their parents' written consent, from 14 kindergartens. RESULTS: A total of 335 children were recruited; 42 children (13%) exhibited reduced VA (Median [interquartile ranges (IQRs)], 0.00 [0.01]); most were emmetropic (87.7%). Myopia (4.2%), hyperopia (8.1%), and astigmatism (20%) were also observed. Most children had normal CSs. About 14% of children were at risk of amblyopia. It has been observed that 26% of families have some kind of refractive error. CONCLUSIONS: It is important to perform vision screening of preschoolers. Early detection of abnormalities in refractive errors could help to minimize the effect of visual impairment.
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Comparative evaluation of corneal endothelium in diabetic patients undergoing phacoemulsification p. 195
Pramod Kumar Sahu, Gopal Krushna Das, Sumeet Agrawal, Sabitabh Kumar, Nitish Kumar
DOI:10.4103/meajo.MEAJO_212_16  
PURPOSE: To determine if phacoemulsification with intraocular lens implantation has a greater impact on the corneal endothelium of type 2 diabetic patients as compared to nondiabetics. MATERIALS AND METHODS: This study compared the endothelial status in 60 diabetics with good glycemic control and 60 nondiabetics before and after uneventful phacoemulsification. Central corneal endothelial cell density, percentage hexagonality and percentage coefficient of variation (%CV) were measured using a specular microscope. RESULTS: Data were age and sex matched. Diabetics showed significantly higher loss in endothelial cell count as compared to nondiabetics. At the end of 3 months, there was a decline of 157 endothelial cell (standard deviation [SD] 90) in the diabetic group and 121 (SD 50) in the control group. This was statistically significant (P = 0.008). Furthermore, the diabetics showed a slower recovery trend in the endothelial healing response as evidenced by lower change in the %CV. The change in %CV was 4.5 in the control group and 3.1 in diabetic group which was statistically significant (P = 0.016). Significant correlation was found between energy used and change in endothelial count as well as %CV in nondiabetics only. CONCLUSION: In spite of good glycemic control, diabetics have significantly more endothelial damage in comparison to nondiabetics with similar nuclear grading and phaco energy used. This warrants a more careful use of phaco energy in diabetics.
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Comparison of the efficacy of carboxymethylcellulose 0.5%, hydroxypropyl-guar containing polyethylene glycol 400/propylene glycol, and hydroxypropyl methyl cellulose 0.3% tear substitutes in improving ocular surface disease index in cases of dry eye p. 202
Prafulla K Maharana, Sapna Raghuwanshi, Ashish K Chauhan, Vaishali G Rai, Rajesh Pattebahadur
DOI:10.4103/meajo.MEAJO_165_15  
PURPOSE: To compare the efficacy of carboxymethylcellulose 0.5% (CMC), hydroxypropyl-guar containing polyethylene glycol 400/propylene glycol (PEG/PG), and hydroxypropyl methylcellulose 0.3% (HPMC) as tear substitutes in patients with dry eye. METHODS: A retrospective evaluation of cases presenting with symptoms of dry eye from July 2014 to June 2015 was done. Patients with Ocular Surface Disease Index (OSDI) scoring >12 were included in the study. Parameters such as age, gender, Schirmer test (ST), and tear film breakup time (TBUT) were recorded on day 0, week 1, and week 4. For analysis, cases were divided into three groups; Group 1 – CMC, Group 2 – PEG/PG, and Group 3 – HPMC. RESULTS: Overall, 120 patients were included in the study. Demographic data and baseline characteristics were comparable among the groups. Group 2 had significant improvement in percentage change in OSDI (weeks 0–1, 0–4, and 1–4, P = 0.00), TBUT (weeks 0–1, P = 0.01; 0–4, P = 0.006; and 1–4, P = 0.007), and in ST (weeks 0–1, P = 0.02; 0–4, P = 0.002; and 1–4, P = 0.008) compared to Group 1 at all follow-ups. Group 3 had improvements similar to Group 2, but it was not at all follow-ups (improvement in percentage change OSDI [weeks 0–1, 0–4, and 1–4, P = 0.00], TBUT [weeks 0–1, P = 0.10; 0–4, P = 0.03; and 1–4, P = 0.04], and in ST [weeks 0–1, P = 0.007; 0–4, P = 0.03; and 1–4, P = 0.12]). No significant difference was found between Groups 2 and 3. CONCLUSIONS: Hydroxypropyl-guar containing PEG/PG and HPMC as tear substitutes are better than CMC. While HPMC was comparable to PEG/PG in subjective improvement, the objective improvement was not consistent.
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Assessment of annual diabetic eye examination using telemedicine technology among underserved patients in primary care setting p. 207
Elham Hatef, Miriam Alexander, Bruce G Vanderver, Peter Fagan, Michael Albert
DOI:10.4103/meajo.MEAJO_19_16  
CONTEXT: Digital retinal imaging with the application of telemedicine technology shows promising results for screening of diabetic retinopathy in the primary care setting without requiring an ophthalmologist on site. AIMS: We assessed whether the establishment of telemedicine technology was an effective and efficient way to increase completion of annual eye examinations among underserved, low-income (Medicaid) diabetic patients. SETTINGS AND DESIGN: A cross-sectional study in a primary care setting. SUBJECTS AND METHODS: Health care claims data were collected before the establishment of telemedicine technology in 2010 and after its implementation in 2012 for Medicaid patients at East Baltimore Medical Center (EBMC), an urban health center that is part of Johns Hopkins Health System. STATISTICAL ANALYSIS USED: The primary outcome measure was the compliance rate of patients with diabetic eye examinations; calculated as the number of diabetic patients with a completed telemedicine eye examination, divided by the total number of diabetic patients. RESULTS: In 2010, EBMC treated 213 Medicaid diabetic patients and in 2012 treated 228 Medicaid patients. In 2010, 47.89% of patients completed their annual diabetic eye examination while in 2012 it was 78.07% (P < 0.001). After adjustment for age, gender, HgBA1C, disease severity, using resource utilization band score as a proxy, and medication possession ratio; telemedicine technology significantly increased the compliance (odds ratio: 4.98, P < 0.001). CONCLUSIONS: Adherence to annual eye examinations is low in the studied Medicaid diabetic population. Telemedicine technology in a primary care setting can increase compliance with annual eye examinations.
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CASE REPORTS Top

Aeromonas Salmonicida as a causative agent for postoperative endophthalmitis p. 213
Abhishek Varshney, Manmath Das, Priyanka Chaudhary, Rashmi Kumari, Kusha Yadav
DOI:10.4103/meajo.MEAJO_238_17  
We report a case of a 55-year-old female who presented with pain, redness, and profound visual loss in her right eye 2 weeks after cataract surgery. An ophthalmic examination showed light perception vision, corneal edema with severe anterior chamber reaction and hypopyon, exudative membranes on the anterior lens surface, and dense vitreous exudates. Under the impression of acute postoperative exogenous endophthalmitis, immediate pars plana vitrectomy with culture of vitreous aspirate and intravitreal antibiotic injections were performed. Bacterial growth was observed on culture plates and broths which were identified as Aeromonas salmonicida by VITEK 2 compact system. So far, no report has been published regarding endophthalmitis due to A. salmonicida. Here, we present the first report of A. salmonicida isolated from the ocular specimen.
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Localized trichiasis causing focal full-thickness corneal edema, endothelial cell loss, and corneal scarring requiring penetrating keratoplasty p. 216
Tiffany Sara Liu, Seth Meskin
DOI:10.4103/meajo.MEAJO_304_16  
The purpose of the study was to report a case of focal trichiasis causing full-thickness corneal edema, scarring, and endothelial cell loss requiring penetrating keratoplasty (PK). A 66-year-old male was referred for trichiasis of the right upper eyelid corresponding to an area of full-thickness corneal edema. No keratic precipitates or guttata was noted. Specular microscopy showed diffuse endothelial cell loss. He was treated with topical steroids and acyclovir with epilation of lashes. Anterior chamber paracentesis was negative for varicella-zoster virus, cytomegalovirus, and herpes simplex virus. The patient developed diffuse stromal scarring with a decrease in vision and ultimately underwent PK with preceding eyelid repair. To the best of our knowledge, we present the first reported case of chronic trichiasis causing full-thickness corneal edema, scarring, and endothelial cell loss requiring PK.
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Cytomegalovirus retinitis as a presenting feature of multisystem disorder: Dyskeratosis congenita p. 219
Swapnil Parchand, Adarsh Barwad
DOI:10.4103/meajo.MEAJO_230_15  
Cytomegalovirus (CMV) retinitis is an opportunistic infection commonly seen in disorders that affect the immune system of the body such as acquired immunodeficiency syndrome and hematological malignancies such as leukemia/lymphoma or organ transplantation. The occurrence of CMV retinitis in the absence of such condition should be thoroughly investigated, as it is a strong indicator of poor immune competence. We here report an interesting case of CMV retinitis as a presenting feature of rare multisystem disorder “Dyskeratosis congenita.”
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LETTER TO THE EDITOR Top

Demographic and clinical features of pediatric uveitis at a tertiary referral center in Iran p. 222
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/meajo.MEAJO_261_16  
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