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CASE REPORTS
Neodymium: Yttrium-aluminum-garnet laser anterior hyaloidotomy to treat trapped triamcinolone acetonide behind the crystalline lens after intravitreal injection
Francisco J Ascaso, Erika Ruiz de Gopegui, José M Cascante
January-March 2012, 19(1):163-165
DOI
:10.4103/0974-9233.92135
A 65-year-old male underwent intravitreal triamcinolone acetonide (IVTA) injection for treating a clinically significant macular edema (CSME) due to background diabetic retinopathy in his left eye. On the first postoperative day, visual acuity dropped from 20/80 to hand movements. Slit-lamp examination showed the drug between the posterior capsule of the lens and the anterior hyaloid face. Two weeks later, visual acuity and the milky fluid seemed unchanged. Neodymium:yttrium-aluminum-garnet (Nd:YAG) laser anterior hyaloidotomy was performed. One week later, slit-lamp examination of the retrolental space revealed the complete disappearance of triamcinolone and intraocular pressure remained stable. After a follow-up period of 2 months, visual acuity increased to 20/50 with the lens remaining clear. Nd:YAG laser anterior hyaloidotomy is an effective, simple, useful and minimally invasive outpatient procedure in patients with persistent entrapment of triamcinolone behind the crystalline lens, allowing the drug to clear without trauma to the lens.
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REVIEW ARTICLE
Orbital pseudotumor: Distinct diagnostic features and management
Imtiaz A Chaudhry, Farrukh A Shamsi, Yonca O Arat, Fenwick C Riley
January-March 2008, 15(1):17-27
DOI
:10.4103/0974-9233.53370
PMID
:20379424
Purpose:
To provide an overview of the spectrum of diseases known as 'idiopathic orbital inflammatory syndrome' also known as orbital pseudotumor, with emphasis on specific diagnostic challenges in the evaluation and management of patients with this disorder.
Methods:
Review of the relevant literature and summarize recent findings regarding the epidemiology, diagnosis, pathophysiology and treatment of orbital pseudotumor.
Results
: Orbital pseudotumor is a benign intraorbital process confined to the orbit but extra orbital involvement can occur. It is among the 3
rd
most common orbital diseases along with thyroid orbitopathy and lymphoproliferative disorder and accounts for 5-10% of orbital processes. Clinically, orbital pseudotumor has been categorized as myositis, dacryoadenitis, anterior, apical and diffuse process. Patients may present with diplopia, conjunctival chemosis, proptosis or abnormal computed tomography scan (CT-scan) findings. Patients may also have associated optic neuropathy. Diagnosis is based on careful history, ultrasonography (U/S), CT-scan and magnetic resonance imaging (MRI) studies which may also provide prognostic information. Treatment consists of systemic corticosteroids in the form of oral or intravenous administration. Confirmation is made by orbital biopsy. In addition to radiation, cytotoxic agents, immunosuppressant, IV immunoglobulin, biological therapy, TNF-alpha inhibitor monoclonal antibody and Mycophenolate Moftil have been found to be useful in the management of refractory orbital pseudotumor.
Conclusion:
Understanding of the clinical features of patients with orbital pseudotumor, differentiating it from other orbital processes by use of imaging techniques and timely implementation of available treatment strategies may help prevent visual loss and associated morbidity from this condition.
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Idiopathic juxtafoveolar retinal telangiectasis: A current review
Sawsan R Nowilaty, Hanan N Al-Shamsi, Wajeeha Al-Khars
July-September 2010, 17(3):224-241
DOI
:10.4103/0974-9233.65501
PMID
:20844678
Idiopathic juxtafoveolar retinal telangiectasis (IJFT), also known as parafoveal telangiectasis or idiopathic macular telangiectasia, refers to a heterogeneous group of well-recognized clinical entities characterized by telangiectatic alterations of the juxtafoveolar capillary network of one or both eyes, but which differ in appearance, presumed pathogenesis, and management strategies. Classically, three groups of IJFT are identified. Group I is unilateral easily visible telangiectasis occurring predominantly in males, and causing visual loss as a result of macular edema. Group II, the most common, is bilateral occurring in both middle-aged men and women, and presenting with telangiectasis that is more difficult to detect on biomicroscopy, but with characteristic and diagnostic angiographic and optical coherence tomography features. Vision loss is due to retinal atrophy, not exudation, and subretinal neovascularization is common. Group III is very rare characterized predominantly by progressive obliteration of the perifoveal capillary network, occurring usually in association with a medical or neurologic disease. This paper presents a current review of juxtafoveolar retinal telangiectasis, reviewing the classification of these entities and focusing primarily on the two most common types encountered in clinical practice, i.e., groups I and II, describing their clinical features, histopathology, natural history, complications, latest results from imaging modalities and functional studies, differential diagnosis, and treatment modalities.
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SYMPOSIUM - UVEITIS UPDATE
Appraisal, work-up and diagnosis of anterior uveitis: A practical approach
Carl P Herbort
October-December 2009, 16(4):159-167
DOI
:10.4103/0974-9233.58416
PMID
:20404984
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.
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CASE REPORTS
Median facial cleft in amniotic band syndrome
Debabrata Das, Gobinda Das, Sibnath Gayen, Arpita Konar
April-June 2011, 18(2):192-194
DOI
:10.4103/0974-9233.80713
PMID
:21731335
Amniotic band syndrome manifests at birth with a variety of malformations ranging from constriction ring to defects incompatible to life, in various parts of the body. Although some theories have been proposed for the development of this syndrome, the exact cause remains unknown. The median facial cleft is an extremely rare manifestation of amniotic band syndrome with a relative paucity of reports available in the literature. Here, we report one such case.
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SYMPOSIUM - UVEITIS UPDATE
Differential diagnosis of retinal vasculitis
Ahmed M Abu El-Asrar, Carl P Herbort, Khalid F Tabbara
October-December 2009, 16(4):202-218
DOI
:10.4103/0974-9233.58423
PMID
:20404987
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.
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4,694
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REVIEW ARTICLES
Adalimumab (Humira
TM
) in ophthalmology: A review of the literature
Piergiorgio Neri, Marta Lettieri, Cinzia Fortuna, Manuela Zucchi, Mara Manoni, Silvia Celani, Alfonso Giovannini
October-December 2010, 17(4):290-296
DOI
:10.4103/0974-9233.71588
PMID
:21180427
Tumor Necrosis Factor alpha (TNF-α) is a pleiotropic cytokine which plays a primary role in the induction of inflammation in autoimmune diseases. The newest anti-TNF-α agent is adalimumab (Humira, Abbott Pharmaceutical Inc.), a human-derived antibody. This review summarizes the characteristics of adalimumab, highlighting its clinical use in systemic and ocular inflammatory disorders, and the possible therapeutic strategies. Adalimumab has been successfully used for the treatment of rheumatoid arthritis, ankylosing spondylitis, and psoriasis arthritis. More recently, adalimumab has shown promising qualities in controlling intraocular inflammations, even though this has been used prevalently as a rescue therapy for unresponsive cases. This biologic agent was also used in pediatric cases, showing a good safety and efficacy profile. Albeit no direct comparison with other biologics has been done, and adalimumab seems to be equivalent to the other anti-TNF-α, the switching to adalimumab can offer a better uveitic control. Adalimumab is a promising drug for the treatment of uveitis, even though further studies are needed on its application as a primary therapy in uveitis.
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EYE PATHOLOGY UPDATES
Update in pathological diagnosis of orbital infections and inflammations
Vincent B Lam Choi, Hunter K.L Yuen, Jyotirmay Biswas, Myron Yanoff
October-December 2011, 18(4):268-276
DOI
:10.4103/0974-9233.90127
Orbital infections and inflammations include a broad spectrum of orbital diseases that can be idiopathic, infectious, from primary or secondary inflammatory processes. Being able to properly diagnose and manage these orbital diseases in a timely manner can avoid permanent vision loss and possibly save a patient's life. When clinicians are faced with such patients, quite often the exact diagnosis cannot be made just based on clinical examination, various laboratory tests and imaging are needed. Moreover, orbital biopsies with histopathological analyses are often required, especially for the atypical cases. Thus, it is important for the clinicians to be familiar with the pathological features and characteristics of these orbital diseases. This review provides a comprehensive update on the clinical and pathological diagnosis of these orbital infections and inflammations.
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CORNEA/REFRACTIVE UPDATE
Deep anterior lamellar keratoplasty: Indications, surgical techniques and complications
Farid Karimian, Sepehr Feizi
January-March 2010, 17(1):28-37
DOI
:10.4103/0974-9233.61214
PMID
:20543934
The concept of lamellar keratoplasty (LK) is not new. However, it had been abandoned and largely replaced by the time-honored technique of penetrating keratoplasty (PK) because LK is technically demanding, time consuming and gives suboptimal visual outcomes due to interface irregularity arising from manual lamellar dissection. Recent improvements in surgical instruments and introduction of new techniques of maximum depth of corneal dissection as well as inherent advantages such as preservation of globe integrity and elimination of endothelial graft rejection have resulted in a re-introduction of LK as an acceptable alternative to con ventional PK. This review article describes the indications, different techniques, clinical outcomes and complications o f deep anterior LK.
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REVIEW ARTICLE
Carotid cavernous fistula: Ophthalmological implications
Imtiaz A Chaudhry, Sahar M Elkhamry, Waleed Al-Rashed, Thomas M Bosley
April-June 2009, 16(2):57-63
DOI
:10.4103/0974-9233.53862
PMID
:20142962
Carotid cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF can be due to a direct connection between the cavernous segment of the internal carotid artery and the cavernous sinus, or a communication between the cavernous sinus, and one or more meningeal branches of the internal carotid artery, external carotid artery or both. These fistulas may be divided into spontaneous or traumatic in relation to cause and direct or dural in relation to angiographic findings. The dural fistulas usually have low rates of arterial blood flow and may be difficult to diagnose without angiography. Patients with CCF may initially present to an ophthalmologist with decreased vision, conjunctival chemosis, external ophthalmoplegia and proptosis. Patients with CCF may have predisposing causes, which need to be elicited. Radiological features may be helpful in confirming the diagnosis and determining possible intervention. Patients with any associated visual impairment or ocular conditions, such as glaucoma, need to be identified and treated. Based on patient's signs and symptoms, timely intervention is mandatory to prevent morbidity or mortality. The conventional treatments include carotid ligation and embolization, with minimal significant morbidity or mortality. Ophthalmologist may be the first physician to encounter a patient with clinical manifestations of CCF, and this review article should help in understanding the clinical features of CCF, current diagnostic approach, usefulness of the available imaging modalities, possible modes of treatment and expected outcome.
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CASE REPORTS
Progressive posterior lenticonus in a patient with alport syndrome
Ammar M Al-Mahmood, Samar A Al-Swailem, Abdulrahman Al-Khalaf, Ghada Y Al-Binali
October-December 2010, 17(4):379-381
DOI
:10.4103/0974-9233.71591
PMID
:21180444
We report a rare case of Alport syndrome with progressive posterior lenticonus. A 24-year-old male presented to our tertiary eye care center with history of poor vision. At initial presentation, the patient had bilateral anterior lenticonus, posterior subcapsular cataract, and renal failure. The patient was diagnosed with Alport syndrome based on a positive family history of the disease and clinical findings. Further examination revealed progressive posterior lenticonus that was not present initially. The presence of such finding is important because it influences the surgical approach to avoid complications during cataract surgery.
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ORIGINAL ARTICLES
Prevalence of uncorrected refractive error and other eye problems among urban and rural school children
Amruta S Padhye, Rajiv Khandekar, Sheetal Dharmadhikari, Kuldeep Dole, Parikshit Gogate, Madan Deshpande
April-June 2009, 16(2):69-74
DOI
:10.4103/0974-9233.53864
PMID
:20142964
Background:
Uncorrected refractive error is an avoidable cause of visual impairment.
Aim:
To compare the magnitude and determinants of uncorrected refractive error, such as age, sex, family history of refractive error and use of spectacles among school children 6-15 years old in urban and rural Maharashtra, India.
Study Design:
This was a review of school-based vision screening conducted in 2004-2005.
Materials and Methods:
Optometrists assessed visual acuity, amblyopia and strabismus in rural children. Teachers assessed visual acuity and then optometrists confirmed their findings in urban schools. Ophthalmologists screened for ocular pathology. Data of uncorrected refractive error, amblyopia, strabismus and blinding eye diseases was analyzed to compare the prevalence and risk factors among children of rural and urban areas.
Results:
We examined 5,021 children of 8 urban clusters and 7,401 children of 28 rural clusters. The cluster-weighted prevalence of uncorrected refractive error in urban and rural children was 5.46% (95% CI, 5.44-5.48) and 2.63% (95% CI, 2.62-2.64), respectively. The prevalence of myopia, hypermetropia and astigmatism in urban children was 3.16%, 1.06% and 0.16%, respectively. In rural children, the prevalence of myopia, hypermetropia and astigmatism was 1.45%, 0.39% and 0.21%, respectively. The prevalence of amblyopia was 0.8% in urban and 0.2% in rural children. Thirteen to 15 years old children attending urban schools were most likely to have uncorrected myopia.
Conclusion:
The prevalence of uncorrected refractive error, especially myopia, was higher in urban children. Causes of higher prevalence and barriers to refractive error correction services should be identified and addressed. Eye screening of school children is recommended. However, the approach used may be different for urban and rural school children.
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REVIEW ARTICLES
The SCHWIND AMARIS total-tech laser as an all-rounder in refractive surgery
Maria Clara Arbelaez, Samuel Arba Mosquera
January-March 2009, 16(1):46-53
DOI
:10.4103/0974-9233.48868
PMID
:20142960
Purpose:
To describe and argument an overview of the main features and unique technical points of AMARIS Total-Tech Laser, coupled with patient outcomes supporting the decision to perform LASIK treatments with maximised outcomes.
Settings:
Dr. M.C. Arbelaez, Muscat Eye Laser Center, Muscat, Sultanate of Oman.
Methods:
The findings collected during 18-month experience using SCHWIND AMARIS Total-Tech Laser have been reviewed to provide arguments for supporting the decision to perform LASIK treatments with maximised outcomes. For updated clinical outcomes, the last 100 myopic astigmatism treatments, the last 100 hyperopic astigmatism treatments, the last 30 ocular-wavefront-guided treatments, and the last 30 corneal-wavefront-guided treatments, all with 6-month follow-up, were included. For all those, LDV femtosecond system was used to prepare the flaps, and AMARIS flying spot system was used to perform ablations. Clinical outcomes were evaluated in terms of predictability, refractive outcome, safety, wavefront aberration, and contrast sensitivity.
Results:
6-month postoperatively, mean defocus was -0.14±0.31D and astigmatism 0.25±0.37D. 70% eyes were within ±0.25D of emmetropia. 43% eyes gained lines of best spectacle-corrected visual acuity. For Aberration-Free treatments, none of the aberration metrics changed from pre- to postoperative values in a clinically relevant amount. For ocular-wavefront-guided treatments, the surgery did not change coma or spherical aberration, and reduced trefoil (p<0.005). For corneal-wavefront-guided treatments, the trefoil, coma, and spherical aberrations, as well as the total root-mean-square values of higher order aberration, were significantly reduced (p<.05) when the pre-existing aberrations were greater than the repeatability and the biological noise.
Conclusions:
Although this review does not allow for evidence-based conclusions, following our strategy, LASIK results were excellent. LASIK surgery with AMARIS system yield excellent outcomes. Refractions were reduced to subclinical values with no induction of High-Order-Aberrations. Neither adverse events nor complications were observed.
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CORNEA/REFRACTIVE UPDATE
Keratoconus: Overview and update on treatment
Ladan Espandar, Jay Meyer
January-March 2010, 17(1):15-20
DOI
:10.4103/0974-9233.61212
PMID
:20543932
Keratoconus is a non-inflammatory, progressive thinning process of the cornea. It is a relatively common disorder of unknown etiology that can involve each layer of the cornea and often leads to high myopia and astigmatism. Computer-assisted corneal topography devices are valuable diagnostic tools for the diagnosis of subclinical keratoconus and for tracking the progression of the disease. The traditional conservative management of keratoconus begins with spectacle correction and contact lenses. Several newer, more invasive, treatments are currently available, especially for contact lens-intolerant patients. Intrastromal corneal ring segments can be used to reshape the abnormal cornea to improve the topographic abnormalities and visual acuity. Phakic intraocular lenses such as iris-fixated, angle-supported, posterior chamber implantable collamer and toric lenses are additional valuable options for the correction of refractive error. Corneal cross-linking is a relatively new method of stiffening the cornea to halt the progression of the disease. The future management of keratoconus will most likely incorporate multiple treatment modalities, both simultaneous and sequential, for the prevention and treatment of this disease.
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Intraocular lens power calculation after corneal refractive surgery
Vahid Feiz
January-March 2010, 17(1):63-68
DOI
:10.4103/0974-9233.61219
PMID
:20543939
Cataract surgery after corneal refractive surgery can be challenging for the ocular surgeon due to the difficulty with accurate intraocular lens (IOL) power determination and unexpected refractive surprises. As clinicians have done more work, a number of error sources have been determined. Furthermore, an increasing number of methods to avoid these refractive surprises have been proposed. The combination of this work has resulted in recommendations for the modification of standard IOL power calculations to improve outcomes. The following article includes a brief on, and by no means, inclusive, error sources and ways to compensate for them.
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SYMPOSIUM - ONCOLOGY UPDATE
Vascular tumors of the retina and choroid: Diagnosis and treatment
Mary E Turell, Arun D Singh
July-September 2010, 17(3):191-200
DOI
:10.4103/0974-9233.65486
PMID
:20844673
The vascular tumors of the retina and choroid comprise a diverse group of congenital and acquired lesions. The major vascular tumors of the retina include retinal capillary hemangioma, cavernous hemangioma of the retina, retinal vasoproliferative tumor, and racemose hemangiomatosis of the retina or Wyburn-Mason syndrome. Choroidal vascular tumors include circumscribed choroidal hemangioma and diffuse choroidal hemangioma. While classified as benign, visual symptoms secondary to exudative retinal detachment and a variety of other mechanisms are common and are a major source of long-term visual disability. While many therapeutic modalities exist, treatment of symptomatic cases can be challenging. Of particular importance, many of the vascular tumors of the retina and choroid have significant associations with systemic disease. As ocular symptoms are often the most common presenting disease manifestation, the ophthalmologist plays an important role in accurate and early diagnosis. The ability to initiate prompt screening and treatment in appropriate cases is critical. In the following article, the key clinical and diagnostic features of the major retinal and choroidal vascular tumors, their systemic associations, and the literature pertaining to the most currently available treatment strategies are reviewed.
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SYMPOSIUM - GLAUCOMA
The ex-press mini glaucoma shunt: Technique and experience
Steven R Sarkisian
July-September 2009, 16(3):134-137
DOI
:10.4103/0974-9233.56226
PMID
:20142979
The Ex-Press Mini Glaucoma Shunt has been available internationally for almost a decade with almost 35,000 implantations world wide. The device shunts aqueous from the anterior chamber to a subconjunctival reservoir in a similar fashion as trabeculectomy, without removal of any sclera or iris tissue. Developments in ophthalmic surgery have been focused on smaller incisions to improve patient outcomes and visual recovery. The Ex-Press is an example of these developments. This article will review the surgical technique for implanting the Ex-Press Mini Glaucoma Shunt and will highlight the clinical experience with the device.
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CORNEA/REFRACTIVE UPDATE
Corneal collagen cross-linking
Mirko R Jankov II, Vesna Jovanovic, Ljubisa Nikolic, Jonathan C Lake, Georgos Kymionis, Efekan Coskunseven
January-March 2010, 17(1):21-27
DOI
:10.4103/0974-9233.61213
PMID
:20543933
Corneal collagen cross-linking (CXL) with riboflavin and ultraviolet-A (UVA) is a new technique of corneal tissue strengthening by using riboflavin as a photosensitizer and UVA to increase the formation of intra- and interfibrillar covalent bonds by photosensitized oxidation. Keratocyte apoptosis in the anterior segment of the corneal stroma all the way down to a depth of about 300 microns has been described and a demarcation line between the treated and untreated cornea has been clearly shown. It is important to ensure that the cytotoxic threshold for the endothelium has not been exceeded by strictly respecting the minimal corneal thickness. Confocal microscopy studies show that repopulation of keratocytes is already visible 1 month after the treatment, reaching its pre-operative quantity and quality in terms of functional morphology within 6 months after the treatment. The major indication for the use of CXL is to inhibit the progression of corneal ectasias, such as keratoconus and pellucid marginal degeneration. CXL may also be effective in the treatment and prophylaxis of iatrogenic keratectasia, resulting from excessively aggressive photoablation. This treatment has also been used to treat infectious corneal ulcers with apparent favorable results. Combination with other treatments, such as intracorneal ring segment implantation, limited topography-guided photoablation and conductive keratoplasty have been used with different levels of success.
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SYMPOSIUM - GLAUCOMA
Cataract surgery to lower intraocular pressure
John P Berdahl
July-September 2009, 16(3):119-122
DOI
:10.4103/0974-9233.56222
PMID
:20142975
Cataract and glaucoma are common co morbidities. Cataract surgery is frequently performed in patients with glaucoma. In this study, a review of literature with search terms of cataract, glaucoma and intraocular pressure is followed by evaluation and synthesis of data to determine the effect of cataract surgery on intraocular pressure. Cataract surgery seems to lower intraocular pressure on a sustained basis, especially in patients with higher preoperative intraocular pressure. The mechanism of action of these finds remains speculative.
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3,330
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ORIGINAL ARTICLES
Cataract surgical outcomes in diabetic patients: Case control study
Oluwatoyin H Onakpoya, Charles O Bekibele, Stella A Adegbehingbe
April-June 2009, 16(2):88-91
DOI
:10.4103/0974-9233.53868
PMID
:20142968
Purpose:
To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria.
Design:
A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria.
Subjects:
Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005.
Main outcome:
Mean post operative visual acuity and surgical complications.
Results:
Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 ± 7.2 years. The mean post operative visual acuity in diabetics was 0.11±0.38, 0.33±0.57 and 0.38±0.49 at one week, two months and six months compared with 0.23±0.19, 0.46±0.37 and 0.48±0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively). Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications.
Conclusion:
Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome.
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SYMPOSIUM - UVEITIS UPDATE
Inflammatory choroidal neovascularization
Piergiorgio Neri, Marta Lettieri, Cinzia Fortuna, Mara Manoni, Alfonso Giovannini
October-December 2009, 16(4):245-251
DOI
:10.4103/0974-9233.58422
PMID
:20404991
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.
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REVIEW ARTICLES
Update on sympathetic Ophthalmia
J Fernando Arevalo, Reinaldo A Garcia, Hassan A Al-Dhibi, Juan G Sanchez, Luis Suarez-Tata
January-March 2012, 19(1):13-21
DOI
:10.4103/0974-9233.92111
Sympathetic ophthalmia (SO) is a bilateral diffuse granulomatous intraocular inflammation that occurs in most cases within days or months after surgery or penetrating trauma to one eye. The incidence of SO ranges from 0.2 to 0.5% after penetrating ocular injuries and 0.01% after intraocular surgery. Vitreoretinal surgery and cyclodestructive procedures are considered risk factors. The time from ocular injury to onset of SO varies greatly, ranging from a few days to decades, with 80% of the cases occurring within 3 months after injury to the exciting eye and 90% within 1 year. The diagnosis is based on clinical findings rather than on serological testing or pathological studies. It presents as a bilateral diffuse uveitis. Patients report an insidious onset of blurry vision, pain, epiphora, and photophobia in the sympathizing, non-injured eye. Classically this is accompanied by conjunctival injection and a granulomatous anterior chamber reaction with mutton-fat keratic precipitates (KPs) on the corneal endothelium. In the posterior segment, the extent of inflammation can vary. Systemic corticosteroids are the first line therapy for SO. If patients are non-responsive to steroid therapy or have clinically significant side effects, cyclosporine, azathioprine or other immunosuppressive agents can be used for long-term immunomodulatory therapy.
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ORIGINAL ARTICLES
Assessment and management of children with visual impairment
Taha A Labib, Mohamed A El Sada, Boshra Mohamed, Neveen M Sabra, Hanan M Abdel Aleem
April-June 2009, 16(2):64-68
DOI
:10.4103/0974-9233.53863
PMID
:20142963
Purpose:
The aim of this work was to evaluate the role of low vision aids in improving visual performance and response in children with low vision.
Study Design:
Prospective clinical case series.
Materials and Methods:
This study was conducted on 50 patients that met the international criteria for a diagnosis of low vision. Their ages ranged from 5 to 15 years. Assessment of low vision included distance and near visual acuity assessment, color vision and contrast sensitivity function. Low vision aids were prescribed based on initial evaluation and the patient's visual needs. Patients were followed up for 1 year using the tests done at the initial examination and a visual function assessment questionnaire.
Results:
The duration of visual impairment ranged from 1 to 10 years, with mean duration ± SD being 4.6± 2.3299. The near visual acuities ranged from A10 to A20, with mean near acuity ± SD being A13.632 ± 3.17171. Far visual acuities ranged from 6/60 (0.06) to 6/24 (0.25), with mean far visual acuity ± SD being 0.122 ± 0.1191. All patients had impaired contrast sensitivity function as tested using the vision contrast testing system (VCTS) chart for all spatial frequencies. Distance and near vision aids were prescribed according to the visual acuity and the visual needs of every patient. All patients in the age group 5-7 years could be integrated in mainstream schools. The remaining patients that were already integrated in schools demonstrated greater independency regarding reading books and copying from blackboards.
Conclusion:
Our study confirmed that low vision aids could play an effective role in minimizing the impact of low vision and improving the visual performance of children with low vision, leading to maximizing their social and educational integration.
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CASE REPORTS
Traditional medicine in Oman: Its role in ophthalmology
Radha Shenoy, Alexander Bialasiewicz, Rajiv Khandekar, Badar Al Barwani, Habiba Al Belushi
April-June 2009, 16(2):92-96
DOI
:10.4103/0974-9233.53869
PMID
:20142969
Aim:
To present three patients with ocular disease who developed a range of complications following use of traditional medications.
Settings and Design:
Case series
Methods:
Three patients who were examined in the Ophthalmic department of a tertiary care teaching hospital in the Sultanate of Oman between 2003 and 2004, seeking care following use of traditional medicines and or healing practices for various ophthalmic problems described below.
Results:
The first patient was a computer professional with a chalazion; the patient used a plant extract from 'Calotropis procera' as a part of the treatment. He developed corneal edema with decrease in vision in his left eye following application of the plant extract. Treatment with topical steroids and antibiotics resulted in a complete clinical and visual recovery. The second patient developed a fungal corneal ulcer (dermatophyte - Trichophyton mentagrophyte) after sustaining injury with an animal tail to the right eye and used honey for pain relief prior to presentation. She responded poorly to anti-fungal treatment, underwent a penetrating keratoplasty with recurrence of infection in the graft that resulted in a vascularized corneal scar. The third patient was a five-year-old child who was treated with 'wasam' on the occiput for intraocular inflammation following bilateral uncomplicated cataract extraction. Following this treatment the topical steroid was discontinued. The "Wasam" treatment indirectly resulted in exacerbation of the intraocular inflammation and secondary glaucoma and poor vision as well as 'Wasam ulcers' on the occiput. Despite treatment of the intraocular inflammation, the visual outcome was poor.
Conclusion:
Traditional medicine in Oman is sought by many for variable reasons. Lack of evidence-based scientific data on its safety or efficacy does not deter the Omanis from flocking the traditional healers. However, when applied in the treatment of ocular diseases, traditional medicine and healing practices seem to cause more harm than benefit for the patient.
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CORNEA/REFRACTIVE UPDATE
Day to day clinically relevant corneal elevation, thickness, and curvature parameters using the orbscan II scanning slit topographer and the pentacam scheimpflug imaging device
Hassan Hashemi, Shiva Mehravaran
January-March 2010, 17(1):44-55
DOI
:10.4103/0974-9233.61216
PMID
:20543936
The introduction of different techniques and computerized devices into clinical ophthalmology has significantly improved our knowledge of the eyes, optics, and eye conditions. Today, corneal topography is performed with a wide range of devices that implement a variety of techniques. Advance computerized analysis systems provide us with simple and quick evaluation procedures, yet the sophisticated data and clinical information that is generated can only be interpreted with adequate knowledge of the system itself as well as the accepted normal ranges of various properties assessed with these systems. Two computerized topography systems that are in common use are the Orbscan (Bausch and Lomb Inc., Rochester, NY, USA) and the Pentacam (Oculus GmBH, Wetzlar, Germany). The Orbscan is a slit-scanning device and the Pentacam is Scheimpflug imaging device. In this review, we present a brief description of both technologies, the techniques implemented in each device and the acquisition process with each. This will be followed by a list of corneal parameters that need to be assessed in screening patients for refractive surgery. We will discuss how these parameters are displayed, how each parameter may serve as clinic criteria, and how data should be interpreted. We will also try to provide evidence regarding the accuracy of different measurements, and the comparability of the two devices.
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© Middle East African Journal of Ophthalmology | Published by
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Online since 10
th
March, 2009