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  Citation statistics : Table of Contents
   2010| October-December  | Volume 17 | Issue 4  
    Online since October 13, 2010

 
 
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ORIGINAL ARTICLES
Corneal crosslinking for keratoconus in Iranian patients: Outcomes at 1 year following treatment
Ladan Saffarian, Hamid Khakshoor, Mehran Zarei-Ghanavati, Habibollah Esmaily
October-December 2010, 17(4):365-368
DOI:10.4103/0974-9233.71600  PMID:21180440
Aim and Design: A retrospective, nonrandomized, single-center clinical study was designed to evaluate the outcomes of corneal collagen crosslinking (CXL) for progressive keratoconus in Iranian patients 12 months after CXL. Settings: This study was carried out at Navid Didegan Eye Center, a private clinic, Mashhad, Iran. Materials and Methods: Ninety-two eyes of 53 subjects with progressive keratoconus were evaluated in this study. All eyes completed 1-year follow-up. The outcome measures were uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), sphere and cylinder refraction, keratometry, and corneal thickness. Comparison of baseline and 1-year postoperative data is reported in this study. The Wilcoxon signed-ranked and Student's t-tests were used for statistical analyses. P < 0.05 was statistically significant. Results: The mean age was 21.5 ± 3.4 years (range, 16 -30 years). Thirty-one (58.5%) of the subjects were men and 22 (41.5%) were women. Mean baseline UCVA and BSCVA were 0.61 ± 0.31 and 0.06 ± 0.12 logarithm of minimal angle of resolution (logMAR), respectively. One year postoperatively UCVA was 0.31 ± 0.25 logMAR and BSCVA was 0.0 ± 0.01 logMAR. UCVA and BSCVA were statistically higher postoperatively (P < 0.001, both parameters). The mean astigmatism decreased by 0.78 ± 1.49 diopter (D) with significant variation during the follow-up period (P < 0.001). Mean baseline simulated keratometry (SIM K) was 46.94 ± 2.37 D and decreased to 46.0 ± 2.33 D on year postoperatively (P < 0.001). Conclusion: Corneal CXL seems to be efficient in stabilization of progressive keratoconus progression in Iranian patients at 1 year of followup.
  10 5,810 219
Tracing children with blindness and visual impairment using the key informant survey in a district of north-western Nigeria
Nasiru Muhammad, Nuhu M Maishanu, Aliyu M Jabo, Mansur M Rabiu
October-December 2010, 17(4):330-334
DOI:10.4103/0974-9233.71601  PMID:21180434
Purpose: To identify children with irreversible blindness in a district of northern Nigeria for enrolment into an inclusive education pilot project. Materials and Methods: Using key informants (KIs) working and residing within the communities, children with blindness and visual impairment in Gwadabawa local government area (LGA) were identified and then examined by a team of ophthalmologists/optometrists. Data analysis was performed manually using simple percentages and proportions. Results: Sixty children were reported with visual problems by parents/guardians of whom 58 (97%) were examined. Twenty children (35%) were blind, 17 (29%) were irreversibly blind, and 9 (16%) had low vision (<6/18 to 3/60) with presenting vision. The major causes of childhood blindness were corneal opacity/phthisis bulbi (75%), and cataract (15%). The cause of irreversible blindness in these children was largely preventable (80%) as it was due to childhood-related illnesses, such as vitamin A deficiency and measles. Conclusions: The major causes of childhood blindness in the study area were avoidable and the use of KI survey in this study provided an opportunity for service delivery.
  7 5,496 189
Reasons for not performing keratorefractive surgery in patients seeking refractive surgery in a hospital-based cohort in "Yemen"
Mahfouth A Bamashmus, Mahmoud F Saleh, Mohamed A Awadalla
October-December 2010, 17(4):349-353
DOI:10.4103/0974-9233.71605  PMID:21180437
Background: To determine and analyze the reasons why keratorefractive surgery, laser in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) were not performed in patients who presented for refractive surgery consultation. Materials and Methods: A retrospective observational study was performed between January 2006 and December 2007 in the Yemen Magrabi Hospital. The case records of 2,091 consecutive new patients who presented for refractive surgery were reviewed. Information from the pre-operative ophthalmic examination, such as refractive error, corneal topography and visual acuity, were analyzed. The reasons for not performing LASIK and PRK in the cases that were rejected were recorded and analyzed. Results: In this cohort, 1,660 (79.4%) patients were advised to have LASIK or PRK from the 2,091 patients examined. LASIK and PRK were not advised in 431 (21%) patients. The most common reasons for not performing the surgery were high myopia >-11.00 Diopters (19%), keratoconus (18%), suboptimal central corneal thickness (15%), cataract (12%) and keratoconus suspect (forme fruste keratoconus) (10%). Conclusion: Patients who requested keratorefractive surgery have a variety of problems and warrant comprehensive attention to selection criteria on the part of the surgeon. Corneal topographies and pachymetry of refractive surgery candidates need to be read cautiously. High-refractive error, keratoconus and insufficient corneal thickness were found to be the leading reasons for not performing keratorefractive surgery in this study.
  3 4,691 188
Ophthalmic manifestations of leukemia in a tertiary hospital population of adult Nigerian Africans
Boniface I Eze, Godswill O Ibegbulam, Sunday Ocheni
October-December 2010, 17(4):325-329
DOI:10.4103/0974-9233.71599  PMID:21180433
Purpose: To determine the prevalence and pattern of leukemic ophthalmopathy among adults at the University of Nigeria Teaching Hospital (UNTH), Enugu, south-eastern, Nigeria. Materials and Methods: This prospective, observational case series surveyed adult leukemia patients presenting at UNTH's departments of Hematology/Immunology and Ophthalmology from July 2003 to August 2008. The demographic profile, clinical data from for each individual in the cohort were statistically collated and analyzed. A P <0.05 was considered as statistically significant. Results: There were 72 participants (45 males and 27 females), aged 32.7 ± 9.8 years (range, 18 years to 72 years). Leukemic ophthalmopathy was present in 77.8% of subjects. The leading ophthalmic manifestations of leukemia were retinal vascular abnormalities in 50.0% of subjects, conjunctival pallor in 27.8% of subjects, sub-conjunctival hemorrhage in 19.4% of subjects, and retinal hemorrhage in 16.7% of subjects. Ocular co-morbidity was present in 47.2% of subjects. Vision loss occurred in 37.5% of subjects, of which 32.1% was leukemia related, and the remaining due to ocular co-morbidity. Leukemic ophthalmopathy was more prevalent in chronic leukemia (P <0.05), frequently affected the ocular posterior segment (P < 0.05), and often resulted from secondary hematologic complications (P <0.05). There was no gender difference in the prevalence of leukemia (P = 0.0822) or leukemic ophthalmopathy (P = 0.6624). Conclusion: The prevalence of leukemic ophthalmopathy in Enugu is high. It is often associated with significant ocular co-morbidity and vision loss. These have implications for clinicians involved in leukemia management. Early diagnosis and regular ophthalmic examinations are recommended to optimize treatment outcomes.
  3 4,571 149
CASE REPORTS
Acute ocular complications from self-administered topical Kermes
Huda A Al-Ghadeer
October-December 2010, 17(4):382-384
DOI:10.4103/0974-9233.71589  PMID:21180445
To report severe ocular complications and their management after self-administered topical kermes dye eye drops. A case report of a 55-year-old man who suffered severe ocular surface damage after application of topical kermes eye drops to his left eye. Active compounds of the kermes eye drops were studied for their composition. Patient reported decreased vision in the affected eye and the external eye examination revealed complete corneal abrasion, cicatrization of the conjunctiva, and symblepharon formation. The patient required immediate cleansing of the ocular surface along with irrigation. He was treated with topical corticosteroids and frequent lubrication. Gas chromatography/mass spectrometry analysis of the retrieved topical material revealed the presence of acid. The patient's visual acuity improved from 20/200 before treatment to 20/25 after treatment.Topically administered kermes eye drops may cause severe ocular injuries. Public education, early recognition of such injuries, and timely intervention may prevent permanent damage to the ocular adnexae.
  2 5,088 108
ORIGINAL ARTICLES
Case-control studies and risk factors for cataract in two population studies in Nigeria
SI Echebiri, P. G. C. Odeigah, SN Myers
October-December 2010, 17(4):303-309
DOI:10.4103/0974-9233.71592  PMID:21180429
Purpose: The aim of this study was to determine and investigate the risks associated with cataract in South Western and North Central Nigeria. Materials and Methods: A hospital-based, case-control study was conducted in Lagos (Lagos group), South Western Nigeria, and Kano (Kano group), North Central Nigeria. In this study, 530 subjects with visually impairing cataracts (study group) and 530 age- and sex-matched controls (control group) were recruited from patients aged 40 to 89 years attending the ophthalmology clinics at the same hospital. All subjects were examined for the presence/absence of cataract and interviewed about their educational achievements, diarrhea/dehydration crises, urban/rural residence, and ophthalmological conditions. A standardized questionnaire was administered to all subjects. Logistic regression analysis with age adjustment, literacy, outdoor work, body mass index, crowding, regular vegetable intake, heavy alcohol, and cigarette intake was performed. P < 0.05 was considered statistically significant. Results: Using multivariate regression analysis, after adjustment for age and other demographics factors, low education and no education [adjusted odds ratios (OR) = 2.42 for the Lagos group and 4.10 for Kano group] and a positive history of diarrhea or dehydration crises (adjusted OR = 1.31 for the Lagos group and 2.12 for Kano group) were associated with an increased risk for cataract. Senile cataracts were more common among the Fulani ethnic group (adjusted OR = 2.21) of North Central Nigeria. However, rural or urban residence did not reveal any positive risk for cataract. Conclusion: The risk of cataract in North Central Nigeria is similar to that in South Western Nigeria. Cataracts were strongly associated with increasing age,with peak age of 55 years and were more common in those with lower education, severe diarrhea and among the members of Fulani in North Central Nigeria.
  2 5,047 224
Perception and attitude of people toward onchocerciasis (river blindness) in south western Nigeria
AO Adeoye, AO Ashaye, OH Onakpoya
October-December 2010, 17(4):310-314
DOI:10.4103/0974-9233.71594  PMID:21180430
Background: Onchocerciasis (river blindness) is a major cause of bilateral blindness with devastating socioeconomic consequences. Since Nigeria is the most heavily onchocerciasis endemic country in the world, the information on people's knowledge about this disease is significant. This could influence their response to current preventive measures of the African Programme for Onchocerciasis Control. Aim: This study was designed to estimate the level of knowledge and attitudes of rural/semi-urban communities in Ife North Local Government Area of Osun State toward onchocerciasis. Materials and Methods: Cluster random sampling was used to select 500 adults for the study. Semi-structured questionnaires were administered to subjects. Data on knowledge of the local name, cause, mode of transmission, manifestation, severity, treatment, and prevention of onchocerciasis were collected and analysed. Statistical analysis included frequency distribution of the responses and a Chi-square test for comparison of variables with the P value for statistical significance set at 0.05. Results: Onchocerciasis was well known by its local name among 458 (91.6%) of the respondents. Only seven (1.4%) knew that it affects both the eyes and skin. The cause was commonly attributed to impure blood by 114 (22.8%), whereas transmission was thought to be through fomites by 161 (32.2%). Only 12 (2.4%) respondents attributed the disease to blackfly bites. The level of education and the association of onchocerciasis with a river were significantly associated (P = 0.001). Subcutaneous nodules were felt to contain water (85.4%), baby worms (3.2%), and fat (0.6%). There was a negative attitude toward sufferers of the disease. Conclusion: Adequate information transfer in simple local dialect by trained personnel to the communities at risk of onchocerciasis is essential for better uptake of all aspects of the onchocerciasis control programme.
  2 4,853 188
The effects of blunt trauma and cataract surgery on corneal endothelial cell density
Baris Yeniad, Isik Corum, Cahit Ozgun
October-December 2010, 17(4):354-358
DOI:10.4103/0974-9233.71604  PMID:21180438
Purpose: This study was designed to investigate the effects of trauma and cataract surgery on corneal endothelial cell density (ECD) in patients with a traumatic cataract due to blunt trauma without globe laceration. Materials and Methods: In this prospective study, 31 subjects with traumatic cataract (traumatic cataract group) and 30 subjects with a senile cataract (control group) were enrolled. The subjects with traumatic cataract were subdivided into two groups: uncomplicated surgery subgroup (n = 19) in which subjects underwent standard phacoemulsification with intraocular lens implantation and complicated surgery subgroup (n = 12) in which subjects underwent cataract surgery other than standard phacoemulsification. The ECD of the traumatic cataract group and the control group was compared preoperatively and at 3 months or later postoperatively. A P value less than 0.05 was considered statistically significant. Results: The ECD in the eyes with traumatic cataract was 13.1% lower than that for healthy eyes preoperatively (P = 0.043). Postsurgical ECD decreased by 16.7% in complicated surgery subgroup and 11.9% in uncomplicated surgery subgroup (P = 0.049) after 3 months postoperatively. The ECD decreased by 10.8% in the control group (P = 0.489). Conclusions: Patients with cataracts due to blunt trauma had a decreased endothelial cell count, which was significantly aggravated by cataract surgery. The loss of corneal endothelium cells due to surgery depends on the surgical approach.
  2 5,192 243
CASE REPORTS
Conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection
LM van Zyl, JJ Hill
October-December 2010, 17(4):385-386
DOI:10.4103/0974-9233.71587  PMID:21180446
We report a case of conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection after phacoemulsification surgery. This case report highlights a serious complication of the inadvertent use of methylprednisolone as a subconjunctival agent. To report a case of conjunctival necrosis due to subconjunctival methylprednisolone (Depo-Medrol™) acetate injection after phacoemulsification. Case report a single case presenting to a tertiary ophthalmic unit. An 82-year-old patient underwent uncomplicated phacoemulsification in the right eye. Postoperatively, she was given a subconjunctival injection of methylprednisolone. Two weeks later, she presented with a painful ulcerated lesion of the conjunctiva proximal to the injection site. The ulcerated lesion was surgically excised and she made a complete recovery.In this reported case, methylprednisolone was used in error with significant resultant morbidity. This preparation is not registered for the off label use in ophthalmology, and this case report highlights the danger of its inadvertent use as a subconjuctival agent.
  1 4,157 105
Intravitreal avastin for choroidal neovascularization associated with stargardt-like retinal abnormalities in pseudoxanthoma elasticum
Giuseppe Querques, Anna V Bux, Francesco Prascina, Nicola Delle Noci
October-December 2010, 17(4):387-389
DOI:10.4103/0974-9233.71586  PMID:21180447
The aim of the study was to describe a patient with pseudoxanthoma elasticum (PXE), showing Stargardt-like retinal abnormalities, who underwent treatment with intravitreal bevacizumab for subfoveal choroidal neovascularization (CNV) of the right eye (RE). A 57-year-old woman with diagnosis of angioid streaks, retinal flecks, and chorioretinal Stargardt-like atrophy due to PXE was referred to our department for sudden decreased vision in her RE (20/160). Upon a complete ophthalmologic examination, including fluorescein angiography (FA), and optical coherence tomography (OCT), the patient was diagnosed with subfoveal CNV of the RE. Owing to the subfoveal localization of the CNV, the patient was submitted to intravitreal bevacizumab injection. At the 1-month follow-up, visual acuity (VA) improved (20/40), and FA and OCT revealed the CNV closure. Twelve months after the treatment, the patient's VA remained stable with no recurrence of active CNV. On the basis of our findings, a single intravitreal bevacizumab injection seems to induce total regression of CNV complicating PXE, in a patient showing Stargardt-like retinal abnormalities. Further investigations are required to confirm our results.
  1 4,064 103
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.
  1 13,892 199
ORIGINAL ARTICLES
Combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery in cases with cataract and posterior segment diseases
Ahmet Taylan Yazici, Necip Kara, Ercument Bozkurt, Mehmet Cakir, Hasan Goker, Ahmet Demirok, Omer Faruk Yilmaz
October-December 2010, 17(4):359-364
DOI:10.4103/0974-9233.71602  PMID:21180439
Background: Combined cataract surgery and transconjunctival sutureless vitrectomy are a good option in patients with cataract and vitreoretinal diseases. Aim: To evaluate the effectiveness, outcomes, and complications of combined 23-gauge transconjunctival sutureless vitrectomy and cataract surgery. Settings and Design: A retrospective case series was conducted at the Beyoglu Eye Education and Research Hospital. Materials and Methods: In this study, 28 eyes of 28 patients underwent combined 23-gauge transconjunctival sutureless vitrectomy and phacoemulsification and IOL implantation for cataract and various posterior segment diseases. The outcome measures included, visual acuity, intraocular pressure changes, and anatomical success were evaluated. Results: The mean follow-up was 4.8 months (range, 3-15 months). Mean overall preoperative visual acuity was 20/333, and final acuity was 20/95 (P < 0.001). Mean intraocular pressure (IOP) on the preoperative and first postoperative day was 15.6 ± 7.5 and 13.8 ± 3.3 mmHg, respectively (P > 0.05). Three eyes (10.7%) had postoperative hypotony (<6 mmHg)that all recovered spontaneously within the first postoperative week. Three eyes (10.7%) required laser treatment for iatrogenic retinal tears. Anatomical success was obtained in all cases. No serious complications such as endophthalmitis were observed during the follow-up period. Conclusion: Combined transconjunctival sutureless vitrectomy and phacoemulsification was effective and safe in patients with significant lens opacities and vitreoretinal pathology. Although the anatomic and visual outcomes were satisfactory, the outcomes depended mainly on underlying vitreoretinal pathology.
  1 4,445 130
Psychosocial characteristics of totally blind people in a Nigerian city
Dupe S Ademola-Popoola, Mosunmola F Tunde-Ayinmode, Tanimola M Akande
October-December 2010, 17(4):335-342
DOI:10.4103/0974-9233.71603  PMID:21180435
Purpose: To characterize the demographic and psychosocial problems of a group of blind people as a way of attracting more attention to and providing data that can improve the psychosocial care of the visually impaired. Materials and Method: A cross-sectional descriptive study of a population of totally blind people in Ilorin, Nigeria using a self-report questionnaire (SRQ). The questionnaire was verbally administered by the study personnel in the local language. Simple frequency tables were obtained and the Chi-square test was performed to determine significant differences between variables. P-value <0.05 was considered statistically significant. Results: Sixty one blind patients consented to participate. Most participants were engaged in street begging for their livelihood. Most subjects desired a job change, signifying dissatisfaction with the present occupation. Up to 80% of the cohort was married and had spouses who were also blind in at least one eye. Approximately two-thirds had five or more children and majority lived with family members who were responsible for taking care of their personal hygiene, cooking and mobility. The majority developed blindness in childhood and 16% had a family history of blindness and 77% had never used conventional eye care, with corneal disease being the most frequent cause of blindness. Many feared that their children may also become blind. Thirty-one (51%) scored ≥5 on SRQ and were classified as probable cases of psychological disorder. Conclusion: Blindness in a majority of cases that started in childhood was probably preventable. Inaccessibility to or failure of the formal rehabilitation and social welfare systems may have caused this psychosocial dilemma. The high level of social and family interaction provides opportunity for organized preventive ophthalmology, community health care services and psychosocial care.
  1 5,607 171
Incidence and complications of traditional eye medications in Nigeria in a teaching hospital
Catherine U Ukponmwan, Nanaiashat Momoh
October-December 2010, 17(4):315-319
DOI:10.4103/0974-9233.71596  PMID:21180431
Purpose: The aim of this study was to determine the types and nature of traditional eye medications (TEMs), their sources, and the ocular complications that may arise from use in a teaching hospital in Nigeria. Materials and Methods: A prospective study of consecutive subjects who used TEM before presentation to the Eye Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria between July 1, 2004 and June 30, 2008. P < 0.05 was considered statistically significant. Results: A total of 113 subjects were evaluated of which 64 were males (56.6%), females (43.4%) were females. There was no significant difference in the number of males and females (P > 0.05). Rural dwellers were more likely to use TEM than urban dwellers (P < 0.0001). The mean age of the subjects was 47.9 ΁ 22.3 years (range, 4-90 years). The most common traditional medication was derived from plant extracts (54.9%) followed by concoctions (21.2%). Complications occurred in 54.8% of the subjects. Ocular complications included corneal opacities in 13.35% of subjects, staphyloma in 9%, and corneal ulcers in 8%. Other complications were panophthalmitis, endophthalmitis, uveitis, cataract, and bullous keratopathy. Eleven subjects underwent evisceration or enucleation of the affected eye. There was no significant difference in the type of medication used and ocular complications (P = 0.956). Sources of TEM were self-medication in 38.9% of subjects, relatives in 27.4%, and traditional healers in 17.7%. Conclusion: The use of TEM is a common practice that could be harmful and lead to blindness. Proper health education of the public and traditional healers can reduce the prevalence of preventable blindness.
  1 4,699 215
REVIEW ARTICLES
Ab interno trabeculectomy
Mina B Pantcheva, Malik Y Kahook
October-December 2010, 17(4):287-289
DOI:10.4103/0974-9233.71585  PMID:21180426
Anterior chamber drainage angle surgery, namely trabeculotomy and goniotomy, has been commonly utilized in children for many years. Its' reported success has ranged between 68% and 100% in infants and young children with congenital glaucoma. However, the long-term success of these procedures has been limited in adults presumably due to the formation of anterior synechiae (AS) in the postoperative phase. Recently, ab interno trabeculectomy with the Trabectome™ has emerged as a novel surgical approach to effectively and selectively remove and ablate the trabecular meshwork and the inner wall of the Schlemm's canal in an attempt to avoid AS formation or other forms of wound healing with resultant closure of the cleft. This procedure seems to have an appealing safety profile with respect to early hypotony or infection if compared to trabeculectomy or glaucoma drainage device implantation. This might be advantageous in some of the impoverish regions of the Middle East and Africa where patients experience difficulties keeping up with their postoperative visits. It is important to note that no randomized trial comparing the Trabectome to other glaucoma procedures appears to have been published to date. Trabectome surgery is not a panacea, however, and it is associated with early postoperative intraocular pressure spikes that may require additional glaucoma surgery as well as a high incidence of hyphema. Reported results show that postoperative intraocular pressure (IOP) remains, at best, in the mid-teen range making it undesirable in patients with low-target IOP goals. A major advantage of Trabectome surgery is that it does not preclude further glaucoma surgery involving the conjunctiva, such as a trabeculectomy or drainage device implantation. As prospective randomized long-term clinical data become available, we will be better positioned to elucidate the exact role of this technique in the glaucoma surgical armamentarium.
  1 4,409 210
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.
  1 11,693 437
CASE REPORTS
Malignant nodular hidradenoma of the eyelid: A rare sweat gland tumor
Abdulla Al Baghli, Suresh S Reddy, Maragaret A Reddy
October-December 2010, 17(4):374-376
DOI:10.4103/0974-9233.71595  PMID:21180442
We report a case of malignant nodular hidradenoma in a middle-aged man, who presented with a nodular swelling in the eyelid. The tumor was similar to its benign counterpart but had additional features such as surface ulceration, numerous mitiotic figures, and an infiltrative growth pattern. Malignant forms of hidradenomas are unusual and the possibility this variant should be considered in the differential diagnosis of eyelid tumors.
  - 10,008 192
Transcorneal tube erosion of an Ahmed valve implant in an adult
Sami Al-Shahwan
October-December 2010, 17(4):377-378
DOI:10.4103/0974-9233.71593  PMID:21180443
Ahmed valve implants are currently used to manage high-risk complicated adults and pediatric glaucoma when standard filtration surgery is unsuccessful. Despite its success, the Ahmed valve shunt has significant complications particularly in the anterior segment. We report an unusual case of transcorneal tube erosion of an Ahmed valve implant in an adult that resulted from long-standing tube-corneal touch. Periodic observation of tube position is recommended.
  - 5,423 101
EDITORIAL COMMENTARY
Childhood visual impairment and other challenges in the Middle East and African region
Deepak P Edward
October-December 2010, 17(4):285-286
DOI:10.4103/0974-9233.71583  PMID:21180425
  - 3,130 163
LETTERS TO EDITOR
Ophthalmic disorders in adult lymphoma patients
Mohammad Javed Ali, Santosh Honavar
October-December 2010, 17(4):390-390
DOI:10.4103/0974-9233.71582  PMID:21180448
  - 2,818 107
Authors' reply
Afekhide E Omoti, Caroline E Omoti, Rita O Momoh
October-December 2010, 17(4):390-391
PMID:21180449
  - 2,442 63
ORIGINAL ARTICLES
Refractive error and visual functions in children with special needs compared with the first grade school students in Oman
Urmi Vora, Rajiv Khandekar, Sarvanan Natrajan, Khalfan Al-Hadrami
October-December 2010, 17(4):297-302
DOI:10.4103/0974-9233.71590  PMID:21180428
Background: We evaluated the refractive status and visual function of children with special needs (other handicap) in 2010 and compared them with healthy 1 st grade school students in Oman. Materials and Methods: This was a cohort study. Optometrists recorded vision using a logarithm of minimum angle of resolution (LogMAR) chart. Preferential looking method was used for testing 31 children. Cycloplegic refraction was performed on all children. Contrast sensitivity was tested using 2.5%, 10%, and 100% contrast charts. Ocular movement, alignment, and anterior segment were also assessed. A pediatrician reviewed the health records of all the children at the time of their enrollment in this study to determine if the child had been diagnosed with a systemic condition or syndromes. The visual functions were assessed by study investigators. We estimated the rates and the risk of different visual function defects in children with special needs. Result: The prevalence of refractive error in 70 children (4.7 ± 0.8 years) with special needs (group 1) and 175 normal healthy first grade students (group 2) were 58.5% and 2.9%, respectively. The risk of refractive error was significantly higher in children with special needs [relative risk, 48.1 (95% confidence interval, 17.54-131.8)]. Hyperopia (>1.00 D), myopia (≥ 1.00D) and astigmatism (≥ ±1.00 D) were found in 18.6%, 24.3%, and 27.1%, respectively, in group 1. Six children in this group had defective near vision. Sixteen (80%) children with Down syndrome had refractive error. Seven (50%) children with developmental disorder showed decreased contrast sensitivity. Conclusion: Prevalence of uncorrected refractive error was much higher in children with special needs. Prevalence of strabismus, nystagmus, and reduced contrast sensitivity was also higher in children with special needs. Early vision screening, visual function assessment, correction of refractive error, and frequent follow-up are recommended.
  - 5,674 330
Computerized motion sensitivity screening tests in a multicountry rural onchocercal community survey in Africa
OE Babalola, RE Umeh, AO Mahmoud
October-December 2010, 17(4):320-324
DOI:10.4103/0974-9233.71597  PMID:21180432
Purpose: To determine whether the Wu-Jones Motion Sensitivity Screening Test (MSST) accurately reflects the burden of optic nerve disease in several onchoendemic communities in Africa. Materials and Methods: The MSST was used to evaluate subjects in the communities of Raja in Sudan, Bushenyi in Uganda, Morogoro in Tanzania, and Ikon, Olomboro, and Gembu in Nigeria. Motion sensitivity was expressed as a percentage of motion detected in the individual eye, and this was averaged for the community. A perfectly normal eye would detect all motion and score 100%. Results: In this study, 3858 eyes of 2072 subjects were tested. The test was completed in 76% of respondents. Acceptability was high. Average test time was 120.4 s. The overall mean motion sensitivity of all eyes tested was 88.49%, ±17.49. Using a cutoff level of 50%, 6.4% of all subjects tested were subnormal. The highest proportion of subnormals recorded was in Morogoro at 12.7%. Severe defects in a community best correlated with optic nerve disease prevalence, while the proportion of the defect from a higher cutoff level best correlated with overall ocular morbidity. A repeat examination in the next 5 years following ivermectin treatment will show the influence, if any, on community-wide MSST performance. Conclusion: A wide range in community scores reflected disease diversity. The MSST appears to be a useful test in community-wide screening and diagnosis as it reflects the general level of ocular pathology and specifically, optic nerve disease.
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Mitomycin-C needle bleb revision in congenital glaucoma
Thanaa Helmy Mohamed Elsayed, Tamer Mohamed El-Raggal
October-December 2010, 17(4):369-373
DOI:10.4103/0974-9233.71598  PMID:21180441
Purpose and Settings: This study was designed to evaluate the efficacy and safety of mitomycin-C (MMC) augmented needling procedure in the management of failed bleb after trabeculectomy in congenital glaucoma. This study was carried out at Ain Shams University Hospital. Patients and Methods: A retrospective study was carried on 30 eyes of 25 patients with congenital glaucoma with bleb failure after trabeculectomy. The mean age of the subjects was 7.3 ± 3.4 years (range, 1-12 years). Under general anesthesia, needling procedure was performed with adjunctive use of a mixture of 0.1 mL of MMC (0.04 mg/mL) and 0.2 mL of lidocaine 1% injected subconjunctivally. Needling was performed with a 30-gauge needle to dissect the areas of subconjunctival fibrosis and re-establish aqueous outflow. Results: Follow-up ranged from 6 to 20 months (mean, 9.23 ± 5.25 months). One needling revision was performed in 22 eyes (73.3%) and eight eyes (26.7%) received two needle revisions. The mean intraocular pressure (IOP) decreased from 26.9 ± 2.85 mmHg (range, 21-34 mmHg) before surgery to 15.63 ± 3.15 mmHg (range, 10-24 mmHg) at last follow-up. Complications included significant subconjunctival hemorrhage in six eyes, intraoperative bleb leak in two eyes, choroidal detachment in one eye, and minimal hyphema in one eye. Conclusion: MMC needle bleb revision appears to be an effective method to revive failed filtration surgery after trabeculectomy in patients with congenital glaucoma. This technique is effective in reducing IOP with preservation of the remaining conjunctiva for further surgery.
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A forecast of ophthalmology practice trends in Saudi Arabia: A survey of junior residents
Fahad Alwadani, Aziz Alrushood, Hisham Altokhy, Tariq Alasbali
October-December 2010, 17(4):343-348
DOI:10.4103/0974-9233.71606  PMID:21180436
Purpose: The aim of this study is to identify the trends in practice pattern among current ophthalmology residents in Saudi Arabia. Materials and Methods: Ophthalmology residents in Saudi Arabia responded anonymously to a written survey between November 2007 and February 2008. The survey contained questions on demographic information, medical education, residency training, career goals and factors influencing their career choice. The data were categorized by gender. The influence of gender on outcome was assessed in a univariate fashion using the Chi-square or Fisher exact test when appropriate. A P-value of 0.05 or less was considered statistically significant for all analyses. Results: A total of 68 out of 85 residents (80%) responded to the survey. Over one-half of the residents preferred to pursue a fellowship within Saudi Arabia (53%), while others (25%) planned to train in North America. The majority of respondents wished to practice in an urban setting (63%). Anterior segment was the most desired subspecialty, while general ophthalmology and glaucoma were not a popular choice. Most residents were interested in refractive surgery (77%) and research (75%). The main factor influencing the decision to pursue ophthalmology was the ability to combine medicine and surgery (97%), while a positive elective experience was also an important factor, particularly for female respondents (91% vs. 57%; P < 0.001). Conclusion: Concerted efforts are required to encourage adoption to ophthalmic practice in public institutions rather than in private practice. In addition training in underrepresented subspecilaties should be encouraged to ensure adequate ophthalmic care for all citizens of Saudi Arabia.
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