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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
Coverpage
July-September 2019
Volume 26 | Issue 3
Page Nos. 123-183

Online since Monday, September 30, 2019

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ORIGINAL ARTICLES  

Has spectral-domain optical coherence tomography retinal nerve fiber layer assessment become the method of choice for glaucoma evaluation in clinical practice? p. 123
Vivekanand Undrakonda, Sarita Gonsalves, Shailaja S Bhat
DOI:10.4103/meajo.MEAJO_62_18  
AIM: The aim of the study was to assess the role of spectral-domain optical coherence tomography (SD-OCT) as a method of choice for early glaucoma diagnosis in glaucoma suspects. DESIGN: This was a retrospective cross-sectional study. MATERIALS AND METHODS: After a comprehensive ophthalmic examination and visual field analysis, 20 patients were included in each of the three groups: Normal group, possible glaucoma, definitive glaucoma, respectively. The optic nerve head (ONH) and peripapillary retinal nerve fiber layer parameters of participants were analyzed using SD-OCT optic disc cube protocol scans. Data was analyzed using one-way analysis of variance test. RESULTS: ONH RNFL defects in possible glaucoma patients were frequently found in superior, inferior, and temporal quadrants. CONCLUSION: Diagnostic capability of SD-OCT parameters for detection of structural changes in the ONH and retinal nerve fiber layer differed in three groups significantly. Hence, using SD-OCT has become an imperative and quick way of timely diagnosis of glaucoma in private practice.
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Impact of visual impairment and blindness on quality of life of patients in Owerri, Imo State, Nigeria p. 127
Ifeoma Ejiakor, Eberechukwu Achigbu, Onyinye Onyia, Omolabake Edema, U Nkwogu Florence
DOI:10.4103/meajo.MEAJO_256_18  
PURPOSE: This study sought to determine the quality of life (QOL) of patients with visual impairment in Federal Medical Centre, Owerri, Imo State, with a view to making recommendations for comprehensive management of patients. MATERIALS AND METHODS: This was a hospital-based, cross-sectional study carried out at the Eye Clinic of Federal Medical Centre, Owerri, Imo State, Southeast Nigeria. New patients aged 18 years and older were consecutively recruited. Data were obtained using a semi-structured questionnaire and a World Health Organization's QOL Scale-Short Form (WHO-QOL-BREF). Participants had comprehensive eye examinations, and data were analyzed using the Statistical Package for the Social Sciences version 22. RESULTS: One hundred and eight (53.7%) females and 93 (46.3%) males with a mean age of 55.92 ± 16.94 years participated in the study. The major causes of visual impairment were uncorrected refractive error, glaucoma, and cataract. Glaucoma (6.5%) was the leading cause of blindness. The overall QOL score was 61.10 ± 19.75, with the lowest mean score in the environmental domain. With increasing visual impairment, there was a 19.1% reduction in QOL. QOL was also affected by age, duration of visual impairment, and history of poor near vision. CONCLUSION: The leading causes of visual impairment and blindness in this study are avoidable and treatable. Health education, appropriate intervention, and support groups should be encouraged. This may serve to reduce the burden of visual impairment and improve the QOL of patients.
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Prevalence and determinants of color vision defects among preparatory university students at Makkah, Saudi Arabia p. 133
Osama Abdulqadir Khairoalsindi, Bayan Mutlaq Almasoudi, Ashjan Yousef Bamahfouz, Abdullah Atiah Alghamdi, Muhammad Irfanullah Siddiqui
DOI:10.4103/meajo.MEAJO_29_19  
PURPOSE: To estimate the magnitude and determinants of color vision defects (CVD) among preparatory health science students. METHODS: A cross-sectional survey was conducted in 2017. Participants were assessed using 24-plate Ishihara's Test of Color Vision chart. If ≤9 plates were read correctly, the color vision was regarded as deficient. The CVD prevalence and its 95% confidence interval (CI) were calculated. CVD was associated with gender, family history of CVD, and other vision problems. RESULTS: We evaluated 1126 students (552, 49% males; mean age: 18.7 ± 0.7 years). The prevalence of CVD was 1.77% (95% CI: 1.0, 2.6). Among male students, it was 3.5% (95% CI: 1.9, 5.0). Only one female student had CVD. The Duran CVD was found in 18 (1.6%) students. However, only two students had Tritan CVD. Three among twenty CVD students knew that they suffer from CVD. CVD was positively associated to a family history of CVD (odds ratio [OR] = 3.8; 95% CI: 1.4, 10.1;P = 0.02) and male gender (OR = 20.4 [95% CI: 2.7, 153]). CVD was not significantly associated to other vision problems (OR = 0.8 [95% CI: 0.3, 2.0]). CONCLUSION: Eighteen in thousand health sciences students suffered from CVD. Ten percent of them had Tritan CVD. Duran CVD seems to be a male sex-related and/or a familial condition. Most of the CVD students seem to have adopted to this defect and were not aware of suffering from it. Screening for CVD is therefore debatable.
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Periocular lobular capillary hemangioma in adults: A clinicopathological study p. 138
Kavya Madhuri Bejjanki, Dilip Kumar Mishra, Swathi Kaliki
DOI:10.4103/meajo.MEAJO_42_19  
PURPOSE: To describe a case series of periocular lobular capillary hemangiomas in adults, outlining characteristic clinical and histopathological patterns. MATERIALS AND METHODS: This was a retrospective case series of 16 patients with review of clinical and histopathological features. RESULTS: Eleven male and five female patients were diagnosed with periocular lobular capillary hemangioma at a median age of 38 years (mean, 41 years; range, 21–71 years). The median tumor basal diameter was 6 mm (mean, 7 mm; range, 3–14 mm) and all were well circumscribed. They arose over the course of weeks to months and developed most commonly in the eyelid region (n = 10), followed by the conjunctiva (n = 6). Excisional biopsy of the lesion was done in all cases. On histopathology, the tumors were composed of repeating units of capillary-sized lobules lined by plump endothelial cells. Lesion recurrence was noted in one case. CONCLUSION: Lobular capillary hemangiomas are common benign vascular tumors of periocular region in adults. Clinicohistopathological features and clinical presentation of these lesions are distinctive. Excisional biopsy was curative with recurrence noted rarely.
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One-year results of stab incision glaucoma surgery and radiofrequency-assisted stab incision in management of open-angle glaucoma p. 141
Marwa Metwally Salama, Rehab Mahmoud Abdel-Hamid, Mohamed Karam El-Basty, Omar Mohamed El-Zawahry
DOI:10.4103/meajo.MEAJO_153_18  
PURPOSE: The aim of the study is to evaluate the surgical outcome of stab incision glaucoma surgery (SIGS) and compare it with radiofrequency-assisted stab incision in the treatment of uncontrolled open-angle glaucoma. PATIENTS AND METHODS: A prospective, interventional study included 50 eyes who were assigned into two equal groups: Group A underwent stab incision procedure with preoperative subconjunctival (SC) mitomycin-C (MMC) and Group B underwent radiofrequency-assisted technique without MMC. Intraoperative and postoperative complications, visual acuity, intraocular pressure (IOP), and bleb status were evaluated up to 12 months. RESULTS: Mean preoperative IOP in Group A was 26.96 ± 2.42 reduced to 13.43 ± 2.31 while in Group B was 27.20 ± 3.57 reduced to 15.48 ± 3.68 mmHg (P < 0.001) with a mean reduction of 50.61% ± 8.42% and 43.56% ± 12.83%, 12 months postoperatively in Groups A and B, respectively. Non-basal peripheral iridectomy was the most encountered intraoperative complication in 8 eyes (32%) and 9 eyes (36%) and hypotony was the most reported postoperative complication in 5 eyes (20%) and 9 eyes (36%) in Groups A and B, respectively. Flat bleb area had been reported at the end of follow-up time in 3 eyes (13%) and 7 eyes (30%) in Groups A and B, respectively. Complete success rate was 52.2% and 28.6% while qualified success rate was 28.8% and 42.9% in Groups A and B, respectively. CONCLUSION: SIGS with SC MMC is an effective and safe procedure in IOP lowering, while radiofrequency-assisted stab incision had high incidence of subconjunctival scarring and ostium closure.
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Glaucoma patch graft surgery utilizing corneas augmented with collagen cross-linking p. 148
Donald U Stone, Earl Randy Craven, Sameer I Ahmad, Ali AlBeshri, Ohoud A Owaidhah
DOI:10.4103/meajo.MEAJO_78_18  
PURPOSE: Glaucoma drainage device surgery (GDDS) has gained popularity, with outcomes equivalent to trabeculectomy. Erosion of the tube through the overlying conjunctiva may occur in 5%–10% of eyes. Donor corneal tissue has been used as a patch graft for GDDS. MATERIALS AND METHODS: This was a prospective proof of concept study in 10 patients undergoing GDDS. From patients undergoing endothelial keratoplasty, the donor tissue (approximately 300 μ in thickness) was placed epithelial side down in a well and was allowed to soak in riboflavin solution (VibeX, Avedro, Waltham, MA, USA) for 15 min. This anterior corneal lenticule received 8 mW/cm2 ultraviolet (UV) irradiation applied for 15 min (total energy of 7.2 J/cm2). Each lenticule was then bisected and utilized for the two study participants. The tissue was sutured over the tube during the GDDS and then was covered with recipient conjunctiva as per the usual technique. Representative graft tissues were fixed and examined to determine the depth of cross-linking effect. The patients were followed for 1 year. RESULTS: Histology revealed no apparent demarcation line in the cross-linked grafts; this supported a full-thickness cross-linking treatment effect. There were no intra- or postoperative complications attributed to the graft tissue. No patient developed erosion or exposure of the tube during the 1-year follow-up. CONCLUSIONS: UV-riboflavin cross-linking of the corneal tissue patch graft material appears to be a safe modification when used in GDDS and warrants ongoing study. This method of patch graft can replace other costy methods used with GDD.
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To evaluate choroidal and retinal thicknesses in singleton versus twin pregnancies using optical coherence tomography p. 153
Sait Alim, Asker Zeki Ozsoy
DOI:10.4103/meajo.MEAJO_171_18  
PURPOSE: The purpose of the study was to evaluate the choroidal and retinal thicknesses in singleton versus twin pregnancies. MATERIALS AND METHODS: This study included 20 single and 20 twin pregnant women in their 3rd trimester with 20 age-matched healthy nonpregnant women as a control group. All participants underwent a detailed ocular examination. Cirrus enhanced depth imaging-optical coherence tomography was used for choroidal thickness (CT) with frame enhancement software. The study was divided into three groups: Group 1 – singleton pregnancy, Group 2 – twin pregnancy, and Group 3 – healthy nonpregnant controls. CT was measured from nasal, subfoveal, and temporal fields. RESULTS: Regarding CT, the twin pregnancy group had the thickest choroid followed by the singleton pregnancy group and control group. There was a statistically significant difference between Group 2 and Group 3 in terms of nasal, subfoveal, and temporal CTs (P = 0.002, P = 0.001, and P = 0.003, respectively). There was a statistically significant difference between Group 1 and Group 3 regarding just subfoveal CT (P = 0.028). Regarding retinal thickness, there was a statistically significant difference between Group 1 and Group 3 regarding the mean macular volume and ganglion cell-inner plexiform layer thicknesses (P < 0.05). Furthermore, regarding mean retinal nerve fiber layer thickness, there was a statistically significant difference between Group 1 and Group 2 and between Group 2 and Group 3 (P = 0.004, P = 0.003, respectively). CONCLUSION: Our study is the first one which evaluates choroidal and retinal thicknesses in twin pregnancies. We found that there was an increase in CT in the 3rd trimester of pregnancies and it was prominent in twin pregnancies.
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Visual outcome of preterm infants screened in a tertiary care hospital p. 158
Anuja Sathar, Shanavas Abbas, Zinia T Nujum, Jasmin L Benson, Girijadevi P Sreedevi, Sobha K Saraswathyamma
DOI:10.4103/meajo.MEAJO_64_17  
OBJECTIVE: The aim of this study is to assess the incidence of retinopathy of prematurity (ROP) in preterm infants and to compare the visual outcomes in babies with and without ROP. MATERIALS AND METHODS: A consecutive cohort of 812 preterm babies were recruited with gestational age ≤32 weeks and or birth weight ≤1500 g. The outcome was assessed at the end of 15 months by determining fixation behavior, cycloplegic refraction, and vision by Cardiff cards. Incidence of visual outcomes with 95% confidence limits and relative risks were estimated. Chi-squared test and t-test were used as tests of significance. RESULTS: The incidence of ROP was 25%. The incidence of myopia, hypermetropia, astigmatism, and strabismus were 15.8% (14.3–17.3), 6% (5.1–7.1), 55.6% (53.6–57.7), and 1.8% (1.4%–2.5%), respectively, in the cohort. The most common refractive error in terms of spherical equivalence was myopia (19.8% in ROP and 14.4% in non-ROP group). The mean visual acuity measured by Cardiff Acuity cards was 0.282 and 0.27 logarithm of the minimum angle of resolution units (right eye) and 0.293 and 0.277 (left eye) in patients with and without ROP, respectively. Strabismus was present in 5% of ROP group and 0.8% of non-ROP group babies. Babies with ROP had six times (risk ratio-6.02; 95% confidence interval 2.8–12.8) higher chance of developing strabismus than those without ROP. CONCLUSIONS: Ophthalmological morbidities in premature infants such as refractive errors and strabismus are high in addition to complications like ROP. The incidence of these conditions is more in infants with ROP when compared to non-ROP group.
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Efficacy and safety of a novel blunt cannula trans-sub-Tenon's retrobulbar block for vitreoretinal surgery p. 163
Tafadzwa Young-Zvasara, Johanna Winder, Sidath Wijetilleka, Laurie Wheeler, Roger Mcpherson
DOI:10.4103/meajo.MEAJO_151_18  
PURPOSE: To evaluate a novel trans-sub-Tenon's retrobulbar block (TSTRB) compared to sub-Tenon's block (STB) and peribulbar block (PBB) anesthesia for vitreoretinal surgery. METHODS: This study was a prospective evaluation of cases undergoing TSTRB, STB, or PBB. The Kallio scale and Brahma scales were used to score hemorrhage and extraocular motility, respectively. Pain was documented on a visual analog score graded (1–10) at induction, intraoperatively, and postoperatively, any confounding variables were noted. RESULTS: Seventy eyes have been used in this analysis, of which TSTRB was used in 37% (n = 26), PBB in 34% (n = 24), and STB in 29% (n = 20). Postoperative analgesia was required by 10% (n = 2) of STB and 8% (n = 2) of PBB; none of the TSTRB cases required analgesia (P = 0.003). The mean volume required with each technique was as follows: TSTRB, 4.8 ml; STB, 5.3 ml; and PBB, 10.4 ml (P = 0.030). The volume of anesthesia was correlated with the level of proptosis and even more important affected the ease of surgery most (P = 0.005). Akinesia was greatest with TSTRB > PBB > STB (P = 0.040). There were no complications such as brainstem anesthesia, globe perforation, or retrobulbar hemorrhage. CONCLUSION: Intentionally extending a STB into the retrobulbar space, via a TSTRB fenestration utilizes a familiar skill set. TSTRB produced the best levels of reduced kinesia during surgery and increased duration of postoperative analgesia. The technique uses a small-volume anesthesia.
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BRIEF COMMUNICATION Top

Use of fibrin glue in the management of Descemet membrane perforation during deep anterior lamellar keratoplasty p. 168
Saad S Alharbi, Ahmad Alameer
DOI:10.4103/meajo.MEAJO_97_19  
PURPOSE: To describe the use of fibrin glue to seal Descemet membrane (DM) microperforation and macroperforation during deep anterior lamellar keratoplasty (DALK). METHODS: A retrospective chart review was performed on patients who had DM perforation managed by fibrin glue during DALK at King Khaled Eye Specialist Hospital (KKESH) between June 2014 and February 2019. RESULTS: One thousand two hundred and eighty-eight DALK surgeries were performed at KKESH during the study period. Fibrin glue was used to seal DM perforations in four cases of DALK for keratoconus. CONCLUSION: Fibrin glue is an effective method to seal DM microperforations and macroperforations during DALK, which reduces the rate of conversion to penetrating keratoplasty (PK), preserving the advantage of DALK over PK.
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CASE REPORTS Top

Carunclar mass as the presenting sign of primary orbital liposarcoma p. 172
Reza Nabie, Monireh Halimi, Erfan Bahramani, Banafsheh Kharrazi Ghadim
DOI:10.4103/meajo.MEAJO_69_18  
This study aims to report a case of primary orbital liposarcoma which presented as caruncle mass. A 45-year-old woman presented to our hospital to evaluate the bumpiness of the caruncle in her left eye. A yellowish nodule , which was firmly attached to the sclera , was seen in the caruncle area and seemed to extend into the orbit. Incisional biopsy revealed myxoid liposarcoma She denied further evaluation and came back with enlarged mass after one year .She underwent lid-sparing exentration and was free of recurrence for 5 years.
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Delayed orbital emphysema mimicking orbital cellulitis: An uncommon complication of dental surgery p. 175
Jessica R Chang, Fatemeh Rajaii, Timothy J McCulley
DOI:10.4103/meajo.MEAJO_241_18  
A 79-year-old man presented to the ophthalmology clinic with acute-onset left orbital and periorbital swelling, 6 days following surgery to revise a zygomatic implant to anchor his dentures. On evaluation, there was left eye proptosis with ipsilateral facial crepitus. Emphysema was confirmed on computed tomography. With visual function and motility remaining intact, he was observed without intervention. Within 2 weeks, his evaluation returned to baseline. Periorbital emphysema is a rare complication of dental procedures. Awareness of this potential complication enables timely diagnosis and avoidance of unnecessary therapy.
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Multicolor imaging characteristics of Best's vitelliform macular dystrophy p. 178
Kumar Saurabh, Rupak Roy, Nicey Roy Thomas
DOI:10.4103/meajo.MEAJO_303_17  
A 40-year-old woman presented with vitellieruptive stage of Best's vitelliform macular dystrophy (BVMD) in the right eye and pseudohypopyon stage in the left eye. She underwent comprehensive ophthalmic examination and fundus imaging using multicolor (MC) imaging technology of Spectralis (Heidelberg Engineering, Heidelberg, Germany) spectral-domain-optical coherence tomography system. Composite MC imaging revealed larger area of retinal pigment epithelium atrophy in vitellierruptive stage of the disease in the right eye compared to color fundus photograph. Retinal elevation in the pseudohypopyon stage was better delineated on composite MC and blue reflectance images in the left eye. Subretinal lipofuscin was best seen in green reflectance and short-wave autofluorescence images. The present case reports the MC imaging features of BVMD.
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Unilateral malignant glaucoma postbilateral implantable collamer lens: Effect of miotics p. 181
Wassef A Chanbour, Carole G Cherfan, Elias F Jarade, Johnny M Khoury
DOI:10.4103/meajo.MEAJO_197_18  
An implantable collamer lens® (ICL) V4c model (STAAR Surgical, Monrovia, CA, USA) was placed in the eye of a 31-year-old male patient with high myopia followed by the development of malignant glaucoma. After failing medical treatment for 5 days, a noncomplicated pars plana vitrectomy and anterior hyaloidectomy succeeded in breaking the aqueous misdirection. Sixteen months later, intraoperative miotics were purposefully withheld from the ICL surgery in the fellow eye and malignant glaucoma did not develop. Even though the patient's visual acuity postoperatively was 20/20, OU, a single small atrophic iris patch in the affected eye resulted in slightly more halos and glare in mesopic conditions as compared to the fellow eye. Earlier surgical intervention may have prevented iris ischemia and iridocorneal touch with its subsequent iris atrophy and resulted in an even more favorable visual outcome. Withholding intraoperative miotics during ICL surgery appeared to be beneficial in this case.
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