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  Citation statistics : Table of Contents
   2011| July-September  | Volume 18 | Issue 3  
    Online since August 20, 2011

 
 
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ORIGINAL ARTICLES
Antibiotic susceptibility patterns of pseudomonas corneal ulcers in contact lens wearers
Mehrdad Mohammadpour, Zahra Mohajernezhadfard, Alireza Khodabande, Payman Vahedi
July-September 2011, 18(3):228-231
DOI:10.4103/0974-9233.84053  PMID:21887079
Purpose : To evaluate the resistance or susceptibility of Pseudomonas aeruginosa, the most common pathogen in contact lens keratitis and corneal ulcer, to different antibiotic regimens. Materials and Methods : This cross-sectional study included all patients with recently diagnosed contact lens corneal ulcer whose culture results were positive for P. aeruginosa, from March 2009 to March 2010. The empirical antibiotic therapy was changed to appropriate antibiotics according to the culture results, provided that satisfactory clinical improvement was not achieved with the initial antibiotic regimen. The overall sensitivity or resistance of P. aeruginosa to the most commonly used antibiotics was assessed based on the results of the antibiograms. Results : Fifty-two patients (43 females and 9 males) were included. Forty-five patients (86%) were wearing cosmetic contact lenses, while 7 patients (14%) were using therapeutic contact lenses. Thirty-nine patients (75%) were hospitalized and13 patients (25%) were followed up through an outpatient clinic. Thirty patients (58%) had central ulcers, whereas 22 patients (42%) had peripheral ulcers. Twelve patients (23%) had hypopyon in their first exam. The mean time to diagnose the ulcer after the last time wearing was 2 days (range: 12 hours to 5 days). AMT was required for 10 patients (19%). Based on the antibiograms, PA was shown to be sensitive in 100% of cases to ceftazidime and ciprofloxacin. Amikacin, imipenem, and gentamicin were the second most effective antibiotics. Conclusion : P. aeruginosa was highly sensitive to ceftazidime, ciprofloxacin, and amikacin. All cases were resistant to cefazolin. Resistance to multiple antibiotics might be a significant concern in patients with corneal ulcers. In referral centers dealing with corneal ulcers, the initial antibiotic regimens should be changed from time to time to prevent this phenomenon.
  7 3,702 258
CASE REPORTS
Response of diabetic papillopathy to intravitreal bevacizumab
Hassan Al-Dhibi, Arif O Khan
July-September 2011, 18(3):243-245
DOI:10.4103/0974-9233.84056  PMID:21887082
Diabetic papillopathy is an uncommon hyperemic optic disc swelling that occurs in patients with long-standing diabetes, is typically self-resolving with minimal effect on vision, and is likely ischemic in origin. The purpose of the current report is to document the response of diabetic papillopathy to intravitreal injection of bevacizumab (Avastin, Genentech Inc, San Francisco, California, USA), a humanized monoclonal antibody to vascular endothelial growth factor.
  5 4,376 170
Radial keratoneuritis as a presenting sign in Acanthamoeba keratitis
Abdullah Alfawaz
July-September 2011, 18(3):252-255
DOI:10.4103/0974-9233.84062  PMID:21887085
The visual outcomes of Acanthamoeba keratitis, a rare cause of corneal infection, can be devastating. This paper reports two contact lens wearers with severe pain and photophobia who presented to the emergency room. Biomicroscopy revealed radial keratoneuritis in both individuals. Tissue culture on a nonnutrient agar plate with Escherichia coli overlay resulted in a heavy growth of Acanthamoeba. The inpatient treatment included 0.02% polyhexamethylene biguanide, chlorhexidine, neomycin/polymyxin B/bacitracin (Neosporin), and oral fluconazole, which successfully controlled the corneal infection and improvement in the best corrected visual acuity in both patients. Infection did not recur during the 12-month follow-up period. Acanthamoeba keratitis can present as radial keratoneuritis, mimicking other common corneal infections resulting in diagnostic and treatment delays. Early diagnosis and prudent treatment of Acanthamoeba keratitis are the keys to restoring vision and avoiding the subsequent need for penetrating keratoplasty.
  4 2,942 148
ORIGINAL ARTICLES
Retinal detachment after laser In Situ keratomileusis
Saba Al-Rashaed, Ali M Al-Halafi
July-September 2011, 18(3):224-227
DOI:10.4103/0974-9233.84052  PMID:21887078
Purpose : To report characteristics and outcome of rhegmatogenous retinal detachment (RRD) after laser in situ keratomileusis (LASIK) for myopia. Materials and Methods : A retrospective chart review of patients who presented with RRD after myopic LASIK over a 10-year period. Results : Fourteen eyes were identified with RRD. Of these, two of 6112 LASIK procedures were from our center. The mean age of patients with RRD was 35.43 years. The mean interval of RRD after LASIK was 37.71 months (range, 4 months to 10 years). The macula was involved in eight eyes and spared in six eyes. Retinal breaks included a macular hole in two eyes, and giant tear in two eyes. Multiple breaks (>2 breaks) occurred in 6 cases. Pars plana vitrectomy (PPV) was performed in 3 (21.4%) eyes, a scleral buckle (SB) was performed in 4 (28.5%) eyes and 7 (50%) eyes underwent combined PPV and SB. Mean follow-up was 15.18 months (range, 1 month to 7 years). The retina was successfully attached in all cases. The final visual acuity was 20/40 or better in 7 (50%) eyes, 20/40 to 20/60 in 4 (28.5%) eyes, and 20/200 or less in 3 (21.4%) eyes. Poor visual outcome was secondary to proliferative vitreoretinopathy, epiretinal membrane, macular scar and amblyopia. Conclusion : The prevalence of RRD after LASIK was low at our institute. Anatomical and visual outcomes were acceptable in eyes that were managed promptly. Although there is no cause-effect relationship between LASIK and RRD, a dilated fundus examination is highly recommended before and after LASIK for myopia.
  4 2,416 150
Adopting western retinopathy of prematurity screening programs in eastern countries, are we screening properly?
Almutez Gharaibeh, Mohammed Khassawneh, Wadah Khriesat, Shadi Alkhatib, Yazan Migdadi
July-September 2011, 18(3):209-213
DOI:10.4103/0974-9233.84047  PMID:21887075
Purpose : To describe retinopathy of prematurity (ROP) among Jordanian preterm infants and evaluate the efficacy of applying current Western screening guidelines for Jordanian preterms. Materials and Methods : In this retrospective, descriptive hospital-based study, we collected data on preterm infants who were referred by their neonatologist for ROP screening at King Abdullah University Hospital between July 2006 and June 2007. Guidelines suggested by the American Academy of Pediatrics were followed. Additionally, older preterms considered at risk for ROP by the neonatal intensive care unit were screened. Any neonate with stage 1 ROP or higher in either eye was considered a positive case of ROP. Results : Ninety-one preterms were included in the study. The median birth weight was 1390 gm (range,730-1980 gms) and the gestational age ranged from 26 to 35 weeks with 64.8% of preterms ≤ 32 weeks. ROP occurred in 28.6% of all patients, in 20% of infants with birth weight greater than 1500 gms and in 9.4% of preterms with gestational age ≥ 32 weeks. Six patients (6.6%) required laser treatment, two with low birth weight greater than 1250 gm and one was 33 weeks of age. Consanguinity was identified in 19.2% of infants with ROP while consanguinity in infants who did not develop ROP was 1.9%. This difference was statistically significant (P<0.05). Conclusion : ROP occurs in premature infants in Jordan with gestational age above 32 weeks and birth weight above 1250 gm. Future guidelines for screening should incorporate the current study outcomes. A prospective, population-based is required to set national guidelines for ROP screening in the Jordanian population and similarly for different populations worldwide. Consanguinity may play a role in ROP development and further genetic studies may aid in elucidating the pathogenesis of ROP.
  4 2,598 222
CASE REPORTS
Acute papillitis in young female with toxoplasmosis
Rakhshandeh Alipanahi, Sima Sayyahmelli
July-September 2011, 18(3):249-251
DOI:10.4103/0974-9233.84060  PMID:21887084
Papillitis and complicating acute toxoplasma retinochoroiditis, are unusual and atypical features of toxoplasmosis. This report presents a female with unusual acute papillitis. This patient had an active toxoplasmic chorioretinitis lesion that appeared to involve the optic nerve head and a major blood vessel as well as central nervous systems (CNS). Papillitis may be secondary to juxtapapillary retinitis (Jensen choroiditis). Very rarely, the optic nerve head may be the primary site of involvement. This case report illustrates a rare presentation of acute papillitis in a young immunocompetent female.
  2 2,975 181
Superior and inferior ophthalmic veins thrombosis with cavernous sinus meningioma
Sameer Vyas, Palash Jyoti Das, Sunil Kumar Gupta, Nandita Kakkar, Niranjan Khandelwal
July-September 2011, 18(3):256-258
DOI:10.4103/0974-9233.84066  PMID:21887086
Ophthalmic vein thrombosis is an extremely rare entity. We present a case of middle-aged female who presented with proptosis. Contrast-enhanced computed tomography and magnetic resonance imaging showed cavernous sinus meningioma with ipsilateral superior and inferior vein thrombosis. A brief review of the vascular involvement of the meningioma and ophthalmic vein thrombosis is presented along with the case.
  2 3,612 117
Temporary exudative retinal detachment following photodynamic therapy in a patient with retinal capillary hemangioblastoma
Ozlem Barut Selver, Aylin Yaman, Ali Osman Saatci
July-September 2011, 18(3):246-248
DOI:10.4103/0974-9233.84058  PMID:21887083
A 21-year-old male with von Hippel-Lindau syndrome was treated for a retinal hemangioblastoma with photodynamic therapy (PDT). We employed the standard PDT protocol with doubled treatment duration. Seven days after the procedure, there were some perilesional intra- and subretinal hemorrhages and significant exudative retinal detachment extending inferiorly. Four weeks later, the hemorrhages had mostly cleared, and diminished subretinal fluid and partial regression of the hemangioblastoma were noted. PDT might induce temporary subretinal fluid accumulation in eyes with retinal hemangiomas.
  1 3,603 119
ORIGINAL ARTICLES
Outcomes of retreatment after aborted laser In Situ keratomileusis due to flap complications
Hani S Al-Mezaine, Saleh A Al-Amro, Abdulaziz Al-Fadda, Saleh Al-Obeidan
July-September 2011, 18(3):232-237
DOI:10.4103/0974-9233.84054  PMID:21887080
Purpose : To determine the refractive outcomes and complications of retreatment after aborted primary laser in situ keratomileusis (LASIK) due to flap complications. Materials and Methods : This retrospective study evaluated 50 retreated eyes that had flap complications during primary LASIK at the Eye Consultants Center in Riyadh, Saudi Arabia. Data were analyzed for patients with at least 3 months follow-up post retreatment. Results : Thirty-three eyes of 31 consecutive patients with 3 months follow-up or later post retreatment were included. The primary LASIK was aborted due to incomplete flaps in 22 eyes (66.7%), buttonhole flaps in 7 eyes (21.2%), free partial flaps in 3 eyes (9.1%), and a free complete flap in 1 eye (3.0%). Twenty-two eyes (66.7%) were retreated with LASIK, and 11 eyes (33.3%) were retreated with surface ablation. The mean spherical equivalent (SE) was −0.23 ± 0.72 D, the mean astigmatism was −0.65 ± 0.89 D, and the mean loss of the best corrected visual acuity (BCVA) was 0.78 lines at the final postoperative visit. At the last postoperative visit, 20/30 or better BCVA was achieved in 90.1% of eyes that underwent retreatment with LASIK and in 91% of eyes that were retreated with surface ablation. There was no statistical difference in postoperative SE between eyes retreated with LASIK and eyes retreated with surface ablation (P = 0.610). There was no statistical difference in postoperative BCVA between eyes retreated with LASIK and those retreated with surface ablation (P = 0.756). There were no intraoperative complications and no eyes required a second retreatment. Conclusion : Creation of a flap after a previous intraoperative flap complication was not associated with any complications. The refractive outcomes of retreatment with LASIK or surface ablation were comparable and reasonably favorable.
  1 2,183 112
Visual outcomes of conductive keratoplasty to treat hyperopia and astigmatism after laser in situ keratomileusis and photorefractive keratectomy
Alireza Habibollahi, Hassan Hashemi, Shiva Mehravaran, Mehdi Khabazkhoob
July-September 2011, 18(3):238-242
DOI:10.4103/0974-9233.84055  PMID:21887081
Aim : To determine the effect of conductive keratoplasty (CK) for the treatment of induced hyperopia and astigmatism after complicated myopic laser in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK). Materials and Methods : In this interventional case series, 11 eyes of seven subjects with a history of previous LASIK or PRK with inadequate stromal bed or flaps complications were enrolled. Inclusion criteria included residual spherical hyperopia of 1.00 to 3.00 diopters (D) and cylinder of -0.75 to -3.00 D. The modified Refractec nomogram and the LightTouch technique of CK were performed on all eyes. To treat cylinder, a pair of spots per -0.75 D of cylinder were delivered to the flat meridian. Uncorrected visual acuity at near and far (UCVAN and UCVAF respectively, logMAR), best corrected VA at near and far (BCVAN and BCVAF respectively, logMAR) were measured. Refractive outcome, contrast sensitivity, wave front aberrations were measured preoperatively and postoperatively. Statistical analysis was performed with the Wilcoxon signed rank test and the repeated measures analysis of variance with P<0.05 indicating statistically significant change from preoperatively to 1 year postoperatively. Results : The mean preoperative sphere (MS) was 2.57 ± 1.19 D and cylinder (MC) was -1.5 ± 0.49 D. Postoperatively, there was a significant decrease in MS to 0.36±0.98 D (P=0.003) and MC to -1.25 ± 0.76 D at 1 year (P<0.05, both cases). Spherical equivalent (SE) significantly decreased from +2.13 ± 1.09 D to -0.47 ± 1.29 D (P<0.001). The mean UCVAN significantly improved from 0.56 ± 0.32 preoperatively to 0.17 ±0.16 postoperatively (P=0.003). The mean UCVAF was 0.29 preoperatively and 0.22 postoperatively (P=0.353). Mean BCVAN was 0.18 and 0.02 after surgery, and mean BCVAF for far was 0.07 (P>0.05, both cases). Conclusions : CK is a predictable and reliable method to correct hyperopia after LASIK and PRK, however cylinder correction may induce irregular and unpredictable outcomes and a modified nomogram is required for further studies.
  1 2,606 122
Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion
Kakarla V Chalam, Selina Lin, Ravi K Murthy, Vikram S Brar, Shailesh K Gupta, Ravi Radhakrishnan
July-September 2011, 18(3):214-219
DOI:10.4103/0974-9233.84048  PMID:21887076
Purpose : The purpose was to determine if birth weight (BW) alone can be the sole criterion for screening infants at risk for retinopathy of prematurity (ROP). Materials and Methods : In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Guidelines (1997). Variables examined included gestational age (GA), birth weight (BW), and a composite variable BWGA Index [(grams Χ weeks)/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW ≤1250 g, and Group 2, BW >1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic (ROC) curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. Results : Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve (AUC) of 0.797 (standard error [SE] = 0.0329, P < 0.0001); for GA, AUC was 0.801 (SE = 0.0340, P < 0.0001) and for the BWGA Index, the AUC was 0.808 (SE = 0.0324, P < 0.0001). Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. Conclusion : Data from our neonatal intensive care unit suggest that birth weight ≤ 1250 g alone is an adequate parameter to identify premature infants at risk for ROP.
  1 2,380 178
Intravitreal bevacizumab as a primary treatment for idiopathic choroidal neovascularization
Rizwan A Cheema, Javed Mushtaq, Maheera A Cheema
July-September 2011, 18(3):220-223
DOI:10.4103/0974-9233.84051  PMID:21887077
Purpose : To report long-term outcomes of the use of intravitreal bevacizumab in subjects with idiopathic choroidal neovascularization (ICNV). Materials and Methods : Six consecutive subjects with ICNV were included in this prospective study. All subjects received 1.25 mg intravitreal bevacizumab at diagnosis. A decrease in best corrected visual acuity (BCVA), presence of increased retinal edema or hemorrhage, increased retinal thickness on optical coherence tomography (OCT) or increased leakage documented by fluorescein angiography prompted further injections of bevacizumab. Results : The study cohort was comprised of 3 males and 3 females with a mean age of 31.17 years. Mean follow-up was 13.8 months (range, 8 months to 20 months). Following intravitreal bevacizumab injection, vision improved in 3 subjects, remained stable in 3 subjects and no patient lost visual acuity. The mean BCVA improved to logMAR 0.20 at final follow-up from baseline at 0.950 logMAR (P=0.031). The mean central macular thickness and central foveal thickness at the last postoperative visits were reduced from pre-treatment levels of 374.33 ± 146.52 and 347.16 ± 213.97 to 251.20±35.36 and 215.33 ± 43.94 μm, respectively. (P = 0.99 and P = 0.16, respectively). Four subjects required repeat treatments. The total number of repeat treatments was 4. Two subjects required no repeat injections, 3 subjects had 1 retreatment and one subject required 2 additional treatments. The injections were well tolerated by all the subjects, with no ocular or systemic adverse events. Conclusion : Intravitreal injection of 1.25 mg bevacizumab in patients with ICNV is effective in improving and stabilizing vision. Additional studies, particularly determination of optimal protocol for timing of re-injection are required to assess long-term effects.
  1 2,367 131
Blindness in Iraq: Leading causes, target patients, and barriers to treatment
Faiz I Al-Shakarchi
July-September 2011, 18(3):199-203
DOI:10.4103/0974-9233.84044  PMID:21887073
Purpose : To define the main causes of blindness, demographic characteristics and barriers to care of blind patients attending a teaching eye hospital in Iraq. Material and Method : Successive new patients, 6 years of age and older, who attended three outpatients clinics at Ibn Al-Haetham Teaching Eye Hospital (IAHTEH), Baghdad, Iraq, from September 1 to November 30, 2007, were included in this study. Inclusion criterion was fulfillment of the World Health Organization's definition of blindness. The cause of blindness was identified and subjects were interviewed for collection of data on demographic characteristics and barriers to treatment. Results : Of 18612 consecutive patients who attended the outpatient clinics, 497 (2.7%) patients were blind. Cataract (76.1%), diabetic retinopathy (12.9%), and glaucoma (5%) were the leading causes of blindness. The majority of blind patients had low socioeconomic status and poor educational level. In cases of cataract, the most important barrier to treatment was the waiting list at the hospital (53.7%). A lack of awareness was the most important barrier to treatment for patients with diabetic retinopathy (54.7%) and glaucoma (56%). Conclusions : The preliminary data from our study will aid in the development of blindness prevention programs in Iraq. Priorities include decreasing waiting lists for cataract surgeries at governmental hospitals. Active health promotion programs for early detection and treatment of diabetic retinopathy and glaucoma are also warranted.
  - 4,500 171
Knowledge of primary prevention of diabetic retinopathy among general ophthalmologists, mid level eye care personnel and general physicians in Oman
Rajiv Khandekar, Rajesh Deshmukh, Urmi Vora, Saleh Al Harby
July-September 2011, 18(3):204-208
DOI:10.4103/0974-9233.84045  PMID:21887074
Objective : We present the outcomes of knowledge of diabetes and associated ocular complications among personnel comprising the eye care team in Oman. Materials and Methods : A closed ended questionnaire was administered during November 2008 and November 2009 to eye care team members in six regions of Oman, where trainings were held. All participants of these trainings were included in our study. The questionnaire comprised 15 questions that tested the knowledge of the diagnosis and treatment of diabetes and its ocular complications. They circled the most suitable reply for a list of choices. The replies were compared with the gold standard (answers from a medical retina specialist, a diabetologist's and general ophthalmologists answers). The participants were divided into two groups; acceptable (more than 50% score compared to gold standard) and less than desired (less than 50% score compared to gold standard.) We estimated the areas of acceptable level of knowledge in different subgroups. Results : All 87 (100%) of eye care team members participated. Of the 42 general ophthalmologists, 30 (71.4%) had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complication of diabetes. The acceptable level of knowledge among mid level eye care providers and general physicians was found in 15 (54.5%) and 4 (33.3%) respondents respectively. Conclusion : Less than the desired number of participants of the eye care team had an acceptable level of knowledge about primary prevention, ideal blood sugar and blood pressure levels and complications of diabetes. The training of eye care personnel need to enhance knowledge in the weak areas is identified in this study.
  - 3,402 230
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