http://www.meajo.org/currentissue.asp Table of Contents:Middle East Afr J Ophthalmol 2009 - 16(4) Herbort Carl P Editorial Middle East African Journal of Ophthalmology 2009 16(4):157-1580974-9233 Herbort Carl P

Middle East African Journal of Ophthalmology 2009 16(4):157-158

]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=157;epage=158;aulast=Herbort Herbort Carl P Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):159-1670974-9233 Herbort Carl P

Middle East African Journal of Ophthalmology 2009 16(4):159-167

This article presents a comprehensive approach of the diagnosis of anterior uveitis and appropriate investigational tests based on clinical signs. Uveitis has classically been presented by uveitis specialists as an obscure and complicated field in ophthalmology that was supposed to be restricted to the happy few who had the knowledge, which in some countries was even prevented from being diffused. The effect was that ophthalmologists turned away from uveitis or were not correctly armed when they chose to take care of uveitis patients. The consequences of this situation often fell upon the patients. Since more than 15 years our group has been represented by the Society for Ophthalmo-Immunoinfectiology in Europe (SOIE), which has been working to alter this image of uveitis and ensure that the knowledge of the basics of uveitis reaches the practicing ophthalmologist. Our firm believe is that up to 70% of uveitis cases, especially anterior uveitis, can be taken care of by the practicing ophthalmologist following a structured approach in the appraisal of the uveitis case. Judging from the attendance obtained, the response to our approach in every country (where we organise courses) has been inversely proportional to the previous disinterest since we started publicizing it.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=159;epage=167;aulast=Herbort Herbort Carl P Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):168-1870974-9233 Herbort Carl P

Middle East African Journal of Ophthalmology 2009 16(4):168-187

In recent years enormous progress has been achieved in investigational procedures for uveitis. Imaging is one such example with the advent of new methods such as indocyanine green angiography, ultrasound biomicroscopy and optical coherence tomography to cite only the most important. This tremendous increase in precision and accuracy in the assessment of the level and degree of inflammation and its monitoring comes in parallel with the development of extremely potent and efficacious therapies. In view of these developments, our whole attitude in the appraisal and investigation of the uveitis patient has to be adapted and correctly reoriented integrating the recent developments and this is no different for ocular angiography.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=168;epage=187;aulast=Herbort Abu El-Asrar Ahmed M, Abouammoh Marwan, Al-Mezaine Hani S Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):188-2010974-9233 Abu El-Asrar Ahmed M, Abouammoh Marwan, Al-Mezaine Hani S

Middle East African Journal of Ophthalmology 2009 16(4):188-201

In recent years, ocular involvement due to TB has re-emerged. Tuberculous uveitis is a readily treatable disease and the consequences of delay in either ocular or systemic diagnosis can be very serious for the patient. It is important to have a high index of suspicion of the diagnosis in patients with unexplained chronic uveitis and this will be influenced by the socio-economic circumstances, family history, ethnic origin, and previous medical history of the patient. Treatment with antituberculous therapy combined with systemic corticosteroids resolves inflammation without recurrences after medical therapy.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=188;epage=201;aulast=Abu Abu El-Asrar Ahmed M, Herbort Carl P, Tabbara Khalid F Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):202-2180974-9233 Abu El-Asrar Ahmed M, Herbort Carl P, Tabbara Khalid F

Middle East African Journal of Ophthalmology 2009 16(4):202-218

Retinal vaculitis is a sight-threatening inflammatory eye condition that involves the retinal vessels. Detection of retinal vasculitis is made clinically, and confirmed with the help of fundus fluorescein angiography. Active vascular disease is characterized by exudates around retinal vessels resulting in white sheathing or cuffing of the affected vessels. In this review, a practical approach to the diagnosis of retinal vasculitis is discussed based on ophthalmoscopic and fundus fluorescein angiographic findings.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=202;epage=218;aulast=Abu Tugal-Tutkun Ilknur Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):219-2240974-9233 Tugal-Tutkun Ilknur

Middle East African Journal of Ophthalmology 2009 16(4):219-224

Behcet's disease is a multisystem inflammatory disorder that is most common in countries along the ancient "Silk Road". The eye is the most commonly involved vital organ in Behηet's patients and the typical form of involvement is a relapsing remitting panuveitis and retinal vasculitis. Uveitis is the initial manifestation of the disease in 10-15% of the patients. Anterior uveitis is always nongranulomatous. Diffuse vitritis, retinal infiltrates, sheathing of predominantly retinal veins, and occlusive vasculitis are the typical signs of posterior segment inflammation. Spontaneous resolution of acute inflammatory signs is a diagnostic feature. Fundus fluorescein angiography is the gold standard in monitoring inflammatory activity. Laser flare photometry is a useful noninvasive tool since flare readings correlate with fluorescein angiographic leakage. The most common complications are cataract, maculopathy, and optic atrophy. Male patients have a more severe disease course and worse visual prognosis. Immunomodulatory therapy is indicated in all patients with posterior segment involvement. Corticosteroids combined with azathioprine and/or cyclosporine is used initially. Biologic agents, including interferon alfa and infliximab, are used in resistant cases. Visual prognosis has improved in recent years with an earlier and more aggressive use of immunomodulatory therapy and the use of biologic agents in resistant cases.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=219;epage=224;aulast=Tugal-Tutkun Khairallah Moncef, Jelliti Bechir, Jenzeri Salah Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):225-2380974-9233 Khairallah Moncef, Jelliti Bechir, Jenzeri Salah

Middle East African Journal of Ophthalmology 2009 16(4):225-238

Infectious causes should always be considered in all patients with uveitis and it should be ruled out first. The differential diagnosis includes multiple well-known diseases including herpes, syphilis, toxoplasmosis, tuberculosis, bartonellosis, Lyme disease, and others. However, clinicians should be aware of emerging infectious agents as potential causes of systemic illness and also intraocular inflammation. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. This review recapitulates the systemic and ocular mainfestations of several emergent infectious diseases relevant to the ophthalmologist including Rickettsioses, West Nile virus infection, Rift valley fever, dengue fever, and chikungunya. Retinitis, chorioretinitis, retinal vasculitis, and optic nerve involvement have been associated with these emergent infectious diseases. The diagnosis of any of these infections is usually based on pattern of uveitis, systemic symptoms and signs, and specific epidemiological data and confirmed by detection of specific antibody in serum. A systematic ocular examination, showing fairly typical fundus findings, may help in establishing an early clinical diagnosis, which allows prompt, appropriate management.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=225;epage=238;aulast=Khairallah Bouchenaki Nadia, Herbort Carl P Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):239-2440974-9233 Bouchenaki Nadia, Herbort Carl P

Middle East African Journal of Ophthalmology 2009 16(4):239-244

Purpose: Fuchs' uveitis is often diagnosed with substantial delay at the origin of deleterious consequences such as unnecessary treatment. The aim of the study was to analyse the type and frequency of posterior inflammatory and fluorescein angiographic signs in Fuchs' uveitis in conjunction with the other clinical signs and evaluate their respective importance in the diagnosis of the disease. In particular, diagnostic delay and erroneous diagnoses were investigated. Patients and Methods: Patients seen in our centers between 1995 and 2008 with the diagnosis of Fuchs' uveitis were analysed. The data collected included age, initial and final visual acuities, clinical findings at presentation, mean diagnostic delay, erroneous diagnoses, laser flare photometry values, fundus and fluorescein angiography manifestations and ocular complications. Results: One hundred and five patients were included. The mean age at diagnosis was 34 years. Twelve patients (11.4%) had bilateral involvement. The mean diagnostic delay was 3.04 ± 4.30 years. The most frequent clinical signs were vitreous infiltration (97.40%), typical Fuchs' keratic precipitates (94.90%), crystalline lens opacities or cataract (47%), heterochromia (42.60%), ocular hypertension or glaucoma (12.80%). The mean laser flare photometry value at presentation was 9.85 ± 6.28 ph/ms. Thirty-nine patients (37.14%) had undergone fluorescein angiography showing disc hyperfluorescence in 97.7% and peripheral retinal vascular leakage in 13.6%. Conclusions: Fuchs' uveitis is significantly underdiagnosed likely because vitreous involvement was previously described but not commonly recognized as an association with Fuchs' uveitis in the clinician's mind and therefore has often been given a different diagnostic label. Moreover, the very frequent inflammatory signs on fluorescein angiography such as disc hyperfluorescence and more rarely peripheral retinal vascular leakage, which has not been typically associated with Fuchs' uveitis, appear to represent an additional factor leading to misdiagnosis. Such clinical findings need to be publicised in order to reduce misdiagnosis, and diagnostic delay.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=239;epage=244;aulast=Bouchenaki Neri Piergiorgio, Lettieri Marta, Fortuna Cinzia, Manoni Mara, Giovannini Alfonso Symposium - Uveitis Update Middle East African Journal of Ophthalmology 2009 16(4):245-2510974-9233 Neri Piergiorgio, Lettieri Marta, Fortuna Cinzia, Manoni Mara, Giovannini Alfonso

Middle East African Journal of Ophthalmology 2009 16(4):245-251

Purpose and Methods: Choroidal neovascularization (CNV) can be a severe sight-threatening sequela, which can be secondary to both infectious and noninfectious uveitis. This review summarizes the different diseases associated with CNV, highlighting new treatment modalities and the possible strategies, which could be applied for the therapy of this occurrence. Results: Since CNV can often originate from posterior pole lesions and can be hard to identify, an accurate examination is mandatory in order to identify the correct diagnosis. In the majority of cases, fluorescein angiography (FA), indocyanine green angiography (ICGA) and optical coherence tomography (OCT) enable the determination of the clinical characteristics of the CNV. An infectious disease should be looked for to include a suitable therapy when available. The treatment strategy for CNV secondary to noninfectious uveal inflammations should be directed at controlling the inflammatory process. Systemic corticosteroids with or without immunosuppressive agents are indicated even when the CNV occurs with apparently inactive uveitis: Chronic subclinical inflammation can be the basis for the pathogenesis of CNV. Additional therapies aimed directly at the neovascular process, such as the intravitreal anti-Vascular Endothelial Growth Factor (VEGF) agents, are recommended particularly when the therapy shows an insufficient response. Conclusion: CNV secondary to uveitis is a severe sequela leading to significant visual impairment. ICGA is mandatory in order to obtain relevant information about the choroidal status. Several therapeutic options have been considered, but no guidelines are provided at the moment. Moreover, the current data are still only based on case reports or small series. For such reasons, further trials are mandatory to validate the preliminary available results.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=245;epage=251;aulast=Neri Omoti Afekhide E, Omoti Caroline E, Momoh Rita O Original Article Middle East African Journal of Ophthalmology 2009 16(4):252-2550974-9233 Omoti Afekhide E, Omoti Caroline E, Momoh Rita O

Middle East African Journal of Ophthalmology 2009 16(4):252-255

Context: Ocular manifestations of lymphoma are rare events. Most reports of ocular involvement in lymphoma are case reports or reports of a few patients. Aims: To determine the ophthalmic disorders in adult, African, lymphoma patients. Settings and Design: A prospective study of ocular disorders in adult patients with lymphoma was conducted at the University of Benin Teaching Hospital, Benin City, Nigeria, between July 2004 and June 2007. Materials and Methods: The patients were interviewed and examined by the authors and the ocular findings recorded. Statistical Analysis: Data was analyzed on computer with the aid of the Instat GraghPad^™ v2.05a statistical package software. The mean, standard deviation, Mann-Whitney U-statistic and P value were calculated. Results: A total of 111 patients with hematological malignancies were seen over a period of three years of which 62 (55.85%) had lymphomas. Of these, 51(82.3%) were non-Hodgkin's lymphoma and 11(17.7%) were Hodgkin's lymphoma. Ocular disorders occurred in 16 patients (31.4%) with non-Hodgkin's lymphoma and none of the patients with Hodgkin's lymphoma (Mann-Whitney U-statistic is equal to 7.500, U' is equal to161.50, P , 0.0001). The ocular disorders due to non-Hodgkin's lymphoma were seen as - proptosis in six patients (11.8%), retinopathies in three (5.9%), conjunctival infiltration in three (5.9%), optic atrophy in two (3.9%), keratoconjunctivitis in one (two per cent), desquamating nodular lid lesions in one (two per cent), papilloedema in one (two per cent), and upper lid mass in one (two per cent). Four patients (6.5%) had monocular blindness. Conclusions: Ophthalmic disorders are relatively common in non-Hodgkin's lymphoma. Ophthalmic evaluation is needed in these patients for early identification and treatment of potentially blinding conditions.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=252;epage=255;aulast=Omoti El-Raggal Tamer M Original Article Middle East African Journal of Ophthalmology 2009 16(4):256-2590974-9233 El-Raggal Tamer M

Middle East African Journal of Ophthalmology 2009 16(4):256-259

Purpose: To evaluate the safety, efficacy of riboflavin-ultraviolet A irradiation (UVA) corneal cross-linking and present refractive changes induced by the treatment in cases of keratoconus. Materials and Methods: The study includes 15 eyes of 9 patients with keratoconus with an average keratometric (K) reading less than 54 D and minimal corneal thickness greater than 420 microns. The corneal epithelium was removed manually within the central 8.5 mm diameter area and the cornea was soaked with riboflavin eye drops (0.1% in 20% dextran t-500) for 30 minutes followed by exposure to UVA radiation (365 nm, 3 mW/cm ² ) for 30 minutes. During the follow-up period, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, slit lamp examination and topographic changes were recorded at the first week, first month, 3 and 6 months. Results: There was statistically significant improvement of UCVA from a preoperative mean of 0.11 ± 0.07 (range 0.05-0.3) to a postoperative mean of 0.15 ± 0.06 (range 0.1-0.3) (P < 0.05). None of the eyes lost lines of preoperative UCVA but 1 eye lost 1 line of preoperative BSCVA. The preoperative mean K of 49.97 ± 2.81 D (range 47.20-51.75) changed to 48.34 ± 2.64 D (range 45.75-50.40). This decrease in K readings was statistically significant (P < 0.05). All eyes developed minimal faint stromal haze that cleared in 14 eyes within 1 month. In only 1 eye, this resulted in a very faint corneal scar. Other sight threatening complications were not encountered in this series. Progression of the original disease was not seen in any of the treated eyes within 6 months of follow-up. Conclusion: Riboflavin-UVA corneal cross-linking is a safe and promising method for keratoconus. Larger studies with longer follow up are recommended.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=256;epage=259;aulast=El-Raggal Abdalla Walid M Original Article Middle East African Journal of Ophthalmology 2009 16(4):260-2620974-9233 Abdalla Walid M

Middle East African Journal of Ophthalmology 2009 16(4):260-262

Purpose: To determine the efficacy of limbal-conjunctival autograft surgery with stem cells in the management of primary and recurrent pterygium and determine the best corrected visual acuity after surgery. Materials and Methods: Surgical excision of pterygium and limbal-conjunctival transplantation with stem cells was of 40 eyes (of 31 patients) with pterygium. Thirty one cases were primary and nine cases were recurrent pterygia. Graft margins were secured to the recipient site while stem cells aspect was sutured to the limbus. Results: After one year of follow-up, 37 of 40 (92.5%) eyes were free of recurrence. One of the three recurrent cases was aggressive (recurrence occurred two months after surgery) and the other two showed 2 mm corneal extension at 12 months follow-up. In 24 patients, out of 40 (60%), best corrected visual acuity improved more than two lines. Conclusion: Limbal-conjunctival autograft surgery, including stem cells, appears to be an effective surgical technique in preventing pterygium recurrence and it can also help in improving the best corrected visual acuity.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=260;epage=262;aulast=Abdalla Chaudhry Imtiaz A Case Report Middle East African Journal of Ophthalmology 2009 16(4):263-2650974-9233 Chaudhry Imtiaz A

Middle East African Journal of Ophthalmology 2009 16(4):263-265

A 28-year-old man who had acquired ptosis of his left upper eyelid after a traffic accident did not benefit from standard levator advancement surgery. Patient had significant ptosis with moderate levator function. A modified Fasanella-Servat procedure under local anesthesia resulted in the desired correction of his left upper eyelid ptosis. A review of the Fasanella-Servat procedure for ptosis surgery is presented, as well as its modifications, along with its limitations.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=263;epage=265;aulast=Chaudhry Fahed Daoud C, Fahed Charbel D Case Report Middle East African Journal of Ophthalmology 2009 16(4):266-2680974-9233 Fahed Daoud C, Fahed Charbel D

Middle East African Journal of Ophthalmology 2009 16(4):266-268

A 35-year-old female presented for laser in-situ keratomileusis (LASIK). Her preoperative eye exam was normal, with a preop refraction of OD -2.50 D Sph +1.25 D Cyl Χ175 and OS -2.75 D Sph +1.50 D Cyl Χ165 (cycloplegic and manifest), with 20/20 BCVA OU. The central pachymetry reading was 553 ΅m in the right eye. Preoperative topography was normal. At the start of the pendular microkeratome path, some resistance was felt, but the microkeratome continued along its path. Upon inspection of the flap, there was a central rectangle of intact epithelium with two mirror-image flaps on both sides. The flap was repositioned and LASIK was discontinued. The cornea healed with two faint thin linear vertical parallel scars at the edge of the pupil. Postoperative inspection of the blade revealed central blunting. One month postoperatively, the uncorrected visual acuity (UCVA) was 20/20. Manifest and cycloplegic refractions were plano. This is an interesting case of accidental flap complication resulting in the correction of mild myopic astigmatism.]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=266;epage=268;aulast=Fahed Jethani Jitendra Letter To Editor Middle East African Journal of Ophthalmology 2009 16(4):269-2690974-9233 Jethani Jitendra

Middle East African Journal of Ophthalmology 2009 16(4):269-269

]]> http://www.meajo.org/article.asp?issn=0974-9233;year=2009;volume=16;issue=4;spage=269;epage=269;aulast=Jethani