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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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   2013| January-March  | Volume 20 | Issue 1  
    Online since January 23, 2013

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Nanotechnology approaches for ocular drug delivery
Qingguo Xu, Siva P Kambhampati, Rangaramanujam M Kannan
January-March 2013, 20(1):26-37
DOI:10.4103/0974-9233.106384  PMID:23580849
Blindness is a major health concern worldwide that has a powerful impact on afflicted individuals and their families, and is associated with enormous socio-economical consequences. The Middle East is heavily impacted by blindness, and the problem there is augmented by an increasing incidence of diabetes in the population. An appropriate drug/gene delivery system that can sustain and deliver therapeutics to the target tissues and cells is a key need for ocular therapies. The application of nanotechnology in medicine is undergoing rapid progress, and the recent developments in nanomedicine-based therapeutic approaches may bring significant benefits to address the leading causes of blindness associated with cataract, glaucoma, diabetic retinopathy and retinal degeneration. In this brief review, we highlight some promising nanomedicine-based therapeutic approaches for drug and gene delivery to the anterior and posterior segments.
  19,716 942 19
Presentation, diagnosis and management of limbal stem cell deficiency
Kunjal Sejpal, Pejman Bakhtiari, Sophie X Deng
January-March 2013, 20(1):5-10
DOI:10.4103/0974-9233.106381  PMID:23580847
The human corneal surface epithelium is continuously repopulated by the limbal stem cells (LSCs). Limbal Stem Cell Deficiency (LSCD) can lead to corneal opacity and vascularization, with consequent visual impairment or blindness. Many acquired and congenital diseases can lead to LCSD by direct injury to the LSCs, destruction of LSC niche, or both. Based on the severity of the disease, LSCD can present with various symptoms and signs. Although LSCD can be detected clinically, laboratory tests are necessary to confirm the diagnosis and monitor the disease progression. This article concisely reviews the clinical presentation, techniques for diagnosis and management of LSCD.
  14,002 622 19
Future perspectives for regenerative medicine in ophthalmology
Jennifer Elisseeff, Marcos G Madrid, Qiaozhi Lu, J Jeremy Chae, Qiongyu Guo
January-March 2013, 20(1):38-45
DOI:10.4103/0974-9233.106385  PMID:23580850
Repair and reconstruction of the cornea has historically relied on synthetic materials or tissue transplantation. However, the future holds promise for treatments using smart biomaterials and stem cells that direct tissue repair and regeneration to ultimately create new ocular structures that are indistinguishable from the original native tissue. The cornea is a remarkable engineering structure. By understanding the physical structure of the tissue and the resulting impact of the structure on biological function, we can design novel materials for a number of ophthalmic clinical applications. Furthermore, by extending this structure-function approach to characterizing corneal disease processes, new therapies can be engineered.
  6,540 328 1
Strategies for local gene therapy of corneal allograft rejection
Pho Nguyen, Samuel C Yiu
January-March 2013, 20(1):11-25
DOI:10.4103/0974-9233.106382  PMID:23580848
Penetrating keratoplasty is the most common type of tissue transplant in humans. Irreversible immune rejection leads to loss of vision and graft failure. This complex immune response further predisposes future corneal transplants to rejection and failure. A diverse armamentarium of surgical and pharmacologic tools is available to improve graft survival. In this review, we will discuss the various gene therapeutic strategies aimed at potentiating the anterior chamber-associated immune deviation to extend graft survival.
  6,470 228 3
Bilateral total optic atrophy due to transdermal methanol intoxication
Yalçin Iscan, Çigdem Coskun, Veysi Öner, Fatih Mehmet Türkçü, Mehmet Tas, Mehmet Fuat Alakus
January-March 2013, 20(1):92-94
DOI:10.4103/0974-9233.106406  PMID:23580862
In this case report, we document a 54-year-old woman with total bilateral optic nerve atrophy after local application of methanol containing spirit. Almost all the reported cases of methanol intoxication in the literature are caused by oral ingestion. In this rare case, we present transdermal absorption of methanol that may cause irreversible blindness in addition to intracerebral lesions.
  5,544 207 2
Surgical technique for excisional bleb revision using a rotational conjunctival flap for a large conjunctival defect
Kara L Schultz, Thasarat S Vajaranant, Kristin Suhr, Jacob T Wilensky, Elmer Y Tu
January-March 2013, 20(1):98-101
DOI:10.4103/0974-9233.106409  PMID:23580864
Bleb dysesthesia is a common but under recognized late complication of trabeculectomy, sometimes requiring surgical revision if conservative measures fail. We describe in detail a surgical technique for closure of a large conjunctival defect following bleb excision for refractory dysesthesia. Two subconjunctival 5-fluorouracil injections were given to improve bleb function. Eight months post-operatively, the intraocular pressure is well controlled on two agents, and the patient has had resolution of dysesthesia.
  5,198 141 -
Improving diabetic retinopathy screening in Africa: Patient satisfaction with teleophthalmology versus ophthalmologist-based screening
Khaliq Kurji, Dan Kiage, Christopher J Rudnisky, Karim F Damji
January-March 2013, 20(1):56-60
DOI:10.4103/0974-9233.106388  PMID:23580853
Purpose: To assess patient preference for diabetic retinopathy (DR) screening with teleophthalmology or face-to-face ophthalmologist evaluation in Nairobi, Kenya. Materials and Methods: Fifty seven diabetic patients from a one-stop multidisciplinary diabetic clinic (consisting of a diabetologist, nurse educator, foot specialist, nutritionist, ophthalmologist, and neurologist) in Nairobi, Kenya were included if they had undergone both a teleophthalmology (stereoscopic digital retinal photographs graded by an ophthalmologist remotely) and a traditional clinical screening exam (face to face examination). A structured questionnaire with a 5-point Likert scale was developed in both English and Swahili. The questionnaire was administered over the telephone. Ten questions were used to compare patient experience and preferences between teleophthalmology and a traditional clinical examination for DR. A mean score >3.25 on the Likert scale was considered favourable. Results: Successfully telephone contact was possible for 26 (58% male, 42% females) of the 57 patients. The mean ages of the male and female patients were 52.4 and 46.5 years respectively. Patients were satisfied with their teleophthalmology examination (mean 4.15 ± 0.97). Patients preferred the teleophthalmology option for future screenings (mean 3.42 ± 1.52). This preference was driven primarily by convenience, reduced examination time, and being able to visualize their own retina. Conclusion: In this study, diabetic patients preferred a teleophthalmology based screening over a traditional ophthalmologist-based screening. The use of teleophthalmology in Africa warrants further study and has the potential to become the screening model of choice. Cost effectiveness in comparison to an ophthalmologist-based screening also requires evaluation.
  4,842 246 3
Efficacy and safety of intacs SK in moderate to severe keratoconus
Ahmed M El-Moatassem Kotb, Mohamed Hantera
January-March 2013, 20(1):46-50
DOI:10.4103/0974-9233.106386  PMID:23580851
Purpose: To examine the safety and efficacy of Intacs SK for moderate to severe keratoconus (KC) using femtosecond technology. Materials and Methods: This prospective, non-comparative study included 37 contact lens intolerant keratoconic eyes (stage II-III) of 24 patients who underwent femtosecond-assisted Intacs SK implantation. Inclusion criteria were mean K readings <56.00 D, corneal thickness >400 μm at the incision site, mesopic pupil <6.50 mm. Evaluation included manifest refraction, slitlamp examination, corneal topography, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA). P < 0.05 was statistically significant. Results: Thirty-one (83.8%) eyes were classified as Amsler-Krumeich's stage II and 6 (16.2%) were stage III. Mean central pachymetry was 490.3 ± 37.4 μm. UDVA at 6 months post-operatively was significantly better than pre-operatively (0.90 log MAR ± 0.52 standard deviation [SD] versus 0.32 ± 0.27 logMAR; respectively, P < 0.0001), as was the spherical equivalent (SEq) (-3.64 ± 2.52 D vs. -1.84 ± 2.2 D; P < 0.0001). The mean CDVA and manifest cylinder improved compared with pre-operatively (P = 0.319 and P = 0.078, respectively). Average keratometry decreased significantly from 48.50 ± 3.08 D to 44.40 ± 3.03 D (P < 0.0001). Conclusion: Implantation of Intacs SK using femtosecond laser in moderate to severe KC is safe and effective.
  4,622 206 3
Delayed onset chloroquine retinopathy presenting 10 years after long-term usage of chloroquine
Mohmmad Salman Kazi, Kumar Saurabh, Pukhraj Rishi, Ekta Rishi
January-March 2013, 20(1):89-91
DOI:10.4103/0974-9233.106404  PMID:23580861
Chloroquine retinopathy is a known complication of long-term use of chloroquine. This retinopathy can appear even after usage of chloroquine has stopped. The present case report describes the history and clinical features of chloroquine retinopathy developing a decade after discontinuing the drug.
  4,544 164 6
Early vitreous hemorrhage after vitrectomy with preoperative intravitreal bevacizumab for proliferative diabetic retinopathy
Tatsuhiko Sato, Shin-ichi Morita, Hajime Bando, Shigeru Sato, Toshihide Ikeda, Kazuyuki Emi
January-March 2013, 20(1):51-55
DOI:10.4103/0974-9233.106387  PMID:23580852
Purpose: To evaluate the effect of preoperative intravitreal bevacizumab (IVB) on surgical procedures, visual prognosis, and postoperative complications, especially postoperative vitreous hemorrhage, in cases with proliferative diabetic retinopathy (PDR). Materials and Methods: Seventy-one eyes of 54 consecutive patients (23 eyes of 18 women, 48 eyes of 36 men) were investigated in this study. Twenty-five eyes received IVB one to 30 days before the vitrectomy (Bevacizumab Group) and the other 46 eyes had the vitrectomy alone (Control Group). The surgical procedures, best-corrected visual acuities at baseline, 1, 3, and 6 months after the vitrectomy, and postoperative complications in the Bevacizumab Group were compared to the Control Group. Results: The patients were significantly younger in the Bevacizumab Group compared to the Control Group (P = 0.008). The incidence of preoperative vitreous hemorrhage, tractional retinal detachment, and iris neovascularization was significantly higher in the Bevacizumab Group than in the Control Group (P = 0.017, 0.041, and 0.018, respectively). The surgical procedures performed and the visual acuity at all time points was not significantly different between groups (P > 0.05, all comparisons). The incidence of early (≤4 weeks) postoperative vitreous hemorrhage was significantly higher in the Bevacizumab Group (27%) than in the Control Group (7%; P = 0.027) although the rate of late (>4 weeks) postoperative vitreous hemorrhage was not significantly different between groups (P > 0.05). Conclusion: Vitrectomy with preoperative IVB may have no detrimental effect on surgical procedures and achieves the surgical outcomes for repair of PDR equal to vitrectomy alone despite the obvious selection bias of the patients in this study. However, special monitoring is highly recommended for early postoperative vitreous hemorrhage because bevacizumab in the vitreous may be washed out during vitrectomy.
  4,420 250 4
Prevalence of second-eye cataract surgery and time interval after first-eye surgery in Iran: A clinic-based study
Marzieh Katibeh, Hamid-Reza Moein, Mehdi Yaseri, Mojtaba Sehat, Armen Eskandari, Hossein Ziaei
January-March 2013, 20(1):72-76
DOI:10.4103/0974-9233.106395  PMID:23580856
Purpose: To determine the prevalence of second-eye senile cataract surgery (SECS) as a proportion of all senile cataract surgeries and the trend in the interval between first and second cataract operations in a main referral and academic eye hospital. Materials and Methods: In this cross-sectional study, a list of patients who underwent senile cataract surgery over four consecutive years (2006-2009) was retrieved from hospital computer-based records as the sampling frame. With a systematic random method, 15% of records were selected (1,585 out of 10,517 records). Results: First- and second-eye operations were performed in 1,139 (71.9%; 95% confidence interval [CI], 69.5-74.1) and 446 eyes (28.1%; 95% CI, 25.9-30.35), respectively. The proportion of SECS procedures increased from 24.3% in 2006 to 33.4% in 2009 (P = 0.017). The median (interquartile range) interval between the two operations was 9 (4-24) months, which remained stable during the study period. The SECS rate was 10.4% higher (P = 0.01) and the time interval was 13 months shorter (P = 0.007) in patients who underwent phacoemulsification than extracapsular cataract extraction. Conclusion: The number of cataract operations in this tertiary eye care setting increased 1.5 fold over the study period. The proportion of second-eye operations also rose from 1/4 to 1/3 during the same time.
  4,469 167 1
Ocular involvement of brucellosis
Nooshin Bazzazi, Alireza Yavarikia, Fariba Keramat
January-March 2013, 20(1):95-97
DOI:10.4103/0974-9233.106407  PMID:23580863
A 29-year-old male diagnosed with brucellosis a week earlier was referred to the ophthalmology clinic with visual complaints. On examination, visual acuity was 20/25, he had conjunctival injection on slit lamp examination. There was also bilateral optic disk swelling plus retinal hyperemia (optic disc hyperemia and vascular tortuosity) and intraretinal hemorrhage on funduscopy. The patient was admitted and treated with cotrimoxazole, rifampin, doxycycline and prednisolone for 2 months. Ocular manifestations subsided gradually within 6 months after treatment. Brucellosis can affect the eye and lead to serious ocular complications. Early diagnosis and prompt treatment should be considered in endemic areas.
  4,036 192 -
Type I retinopathy of prematurity in infants with birth weight less than 1251 g: Incidence and risk factors for its development in a nursery in Kuwait
Vivek B Wani, Anil K Uboweja, Muzaffar Gani, Jamal Al-Kandari, Mahmood Kazem, Niran Al-Naqeeb, Cherian Thomas, Murad Al-Serafi, Mumtaz M Shukkur
January-March 2013, 20(1):66-71
DOI:10.4103/0974-9233.106393  PMID:23580855
Purpose: To report the rate of acute retinopathy of prematurity (ROP) and Type I ROP among infants with birth weight (BW) <1251 g and identify the risk factors for the development of Type I ROP. Materials and Methods: A retrospective review of ROP records of infants with BW <1251 g was performed to identify infants with acute ROP and Type I ROP. Infants with Type I ROP were compared with those without Type I ROP to assess the risk factors for the development of Type I ROP. P < 0.05 was statistically significant. Multivariate analysis was performed and odds ratio (OR) and 95% confidence intervals (CI) were calculated. Results: Among the 207 infants with BW <1251 g, acute ROP occurred in 154 infants (74.4%) and Type I ROP in 95 eyes of 50 infants (24.4%). The numbers of infants with BW <750 g and BW <1000 g were 19.3% and 58.4%, respectively, and the incidences of Type I ROP were 50% and 36.4%, respectively, among them. Forty-four (46.3%) eyes were treated at stage 2+ ROP in zone I or II. All the eyes treated for Type I ROP showed complete regression. Gestational age at birth (OR 0.657, 95% CI: 0.521-0.827; P < 0.0001) and number of ventilated days (OR 1.017, 95% CI: 1.005-1.029; P = 0.006) were identified as independent risk factors for the development of Type I ROP. Conclusions: The rate of Type I ROP in this study is higher than that in previous studies due to the higher number of infants with BW <1000 g in our cohort and the treatment of more eyes with stage 2+ ROP. However, all the treated eyes had a favorable outcome. Gestational age at birth and number of ventilated days were independent risk factors for the development of Type I ROP.
  4,015 151 3
Microsporidial spores can cross the intact descemet membrane in deep stromal infection
Somasheila I Murthy, Vishram A Sangit, Varsha M Rathi, Geeta K Vemuganti
January-March 2013, 20(1):80-82
DOI:10.4103/0974-9233.106399  PMID:23580858
We report a rare case of a deep stromal keratitis with a chronic indolent course, diagnosed as microsporidial keratitis from corneal scrapings. The patient's condition worsened despite medical therapy and penetrating keratoplasty was performed. The histopathology of the corneal tissue revealed multiple microsporidial spores in the posterior stroma and the endothelial exudates, whereas there was no clinical or histopathological breach in Descemet's membrane. This is the second report in the literature to report that micropsoridial spores can cross the intact Descemet's membrane.
  3,934 160 1
Transient increased exudation after photodynamic therapy of intraocular tumors
Arman Mashayekhi, Carol L Shields, Jerry A Shields
January-March 2013, 20(1):83-86
DOI:10.4103/0974-9233.106400  PMID:23580859
To report transient increased exudation after photodynamic therapy (PDT) of three different intraocular tumors (retinal hemangioblastoma, retinal astrocytoma, amelanotic choroidal melanoma). PDT with verteporfin (6 mg/m [2] body surface area) was delivered at a dose of 50 J/cm [2] and intensity of 600 mW/cm [2] over 83 s. All patients experienced decreased vision within a few days following PDT. Optical coherence tomography showed development of subfoveal fluid in all cases and noncystoid intraretinal edema in the eye with juxtapapillary retinal hemangioblastoma. There was complete absorption of retinal/subretinal fluid with improvement of visual acuity to 20/20 in all cases between 3 weeks to 4 months after PDT.
  3,938 129 2
Blindness and severe visual impairment in pupils at schools for the blind in Burundi
Patrick Ruhagaze, Kahaki Kimani Margaret Njuguna, Lévi Kandeke, Paul Courtright
January-March 2013, 20(1):61-65
DOI:10.4103/0974-9233.106390  PMID:23580854
Purpose: To determine the causes of childhood blindness and severe visual impairment in pupils attending schools for the blind in Burundi in order to assist planning for services in the country. Materials and Methods: All pupils attending three schools for the blind in Burundi were examined. A modified WHO/PBL eye examination record form for children with blindness and low vision was used to record the findings. Data was analyzed for those who became blind or severely visually impaired before the age of 16 years. Results: Overall, 117 pupils who became visually impaired before 16 years of age were examined. Of these, 109 (93.2%) were blind or severely visually impaired. The major anatomical cause of blindness or severe visual impairment was cornea pathology/phthisis (23.9%), followed by lens pathology (18.3%), uveal lesions (14.7%) and optic nerve lesions (11.9%). In the majority of pupils with blindness or severe visual impairment, the underlying etiology of visual loss was unknown (74.3%). More than half of the pupils with lens related blindness had not had surgery; among those who had surgery, outcomes were generally poor. Conclusion: The causes identified indicate the importance of continuing preventive public health strategies, as well as the development of specialist pediatric ophthalmic services in the management of childhood blindness in Burundi. The geographic distribution of pupils at the schools for the blind indicates a need for community-based programs to identify and refer children in need of services.
  3,786 221 1
Acute bilateral endophthalmitis following bilateral intravitreal bevacizumab (avastin) injection
Ali Tabatabaii, Aliasghar Ahmadraji, Alireza Khodabande, Mohammadreza Mansouri
January-March 2013, 20(1):87-88
DOI:10.4103/0974-9233.106402  PMID:23580860
The clinical presentation and management of two patients who presented with acute bilateral endophthalmitis following bilateral intravitreal bevacizumab injection. Both cases were diagnosed clinically and subsequent to a vitreous sample, intravitreal ceftazidime (2.25 mg/0.1ml) and vancomycin (1 mg/0.1ml) were injected. One patient had a significant improvement in signs and symptoms after intravitreal antibiotics. However, there were was no improvement in the other patient and pars plana vitrectomy was performed bilaterally. Vitreous cultures were positive in both cases for Staphylococcus epidermidis.
  3,565 150 4
Corneal ectasias: Study cohorts and epidemiology
Alexander Bialasiewicz, Deepak P Edward
January-March 2013, 20(1):3-4
  3,400 172 -
In vivo confocal microscopy in chloroquine-induced keratopathy
Iacopo Paladini, Ugo Menchini, Rita Mencucci
January-March 2013, 20(1):77-79
DOI:10.4103/0974-9233.106397  PMID:23580857
In vivo confocal microscopy is becoming a mandatory examination to study corneal abnormalities such as drug deposits in systemic disease. A female diagnosed with fibromyalgia on systemic chloroquine for 9 months presented for an ophthalmic examination. Confocal microscopy was performed using the Confoscan 4 (Nidek Co. Ltd., Gamagori, Japan) and multiple highly reflective deposits in the epithelial basal cells were found, that were consistent with choloquine. Deposits were also present in the wing cell layer. In the anterior stroma these deposits were rare. Atypically shaped and branched nerves were also present in the anterior stroma. Corneal deposits of chloroquine can be evaluated by confocal microscopy. Confocal microscopy provides information on corneal metabolism and physiology. Chloroquine keratopathy can affect the anterior stroma in addition to the epithelium.
  3,423 121 1
Ocular therapeutics of the future
Samuel C Yiu
January-March 2013, 20(1):1-2
DOI:10.4103/0974-9233.106378  PMID:23580845
  2,914 188 -