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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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   2017| July-September  | Volume 24 | Issue 3  
    Online since November 9, 2017

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Evaluation of topical lignocaine jelly 2% for recurrent pterygium surgery with glue-free autologous conjunctival graft
Rajesh Subhash Joshi
July-September 2017, 24(3):126-130
DOI:10.4103/meajo.MEAJO_68_17  PMID:29279652
Aim: This study aims to evaluate the efficacy of lignocaine 2% jelly as a topical anesthesia in recurrent pterygium surgery with glue-free conjunctival limbal autograft. Materials and Methods: A prospective, nonrandomized, observational study, comprising of 51 patients (51 eyes) having recurrent pterygium, was conducted at a tertiary eye care center in central India. Pterygium excision with glue-free autologous conjunctival grafting was done under 2% lignocaine jelly. The visual analog scale was utilized to record the intra- and post-operative pain score. Patient comfort, intraoperative painful sensations perceived by the patient, supplemental anesthesia, complications, and surgeon discomfort were noted. Anesthetist also noted vital parameters and any intravenous drugs required. Results: No difference in intra- and post-operative pain score (P = 0.24) was observed in the patients. Zero score, i.e. no pain was noticed in 30 patients (58.8%) patients. The average surgical time was 29.20 min (+1.11). The average surgeon discomfort score was 0.18 + 0.51. Inadvertent eye movement was seen in 3 patients (5.9%). Lid squeeze was noted in 45 patients (88.2%) during placement of lid speculum. Forty-eight patients (94.1%) gave preference to the topical anesthesia of 2% lignocaine jelly compared to the previous mode of anesthesia. Conclusion: Pterygium surgery with glue-free autogenous conjunctival grafting can be performed successfully by preoperative local application of 2% lignocaine jelly. The ease of application, lack of toxicity and sufficient effect to complete the surgery make it an efficient alternative to injectable anesthetics.
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Prevalence and major causes of visual impairment in Iranian adults: A systematic review
Seyed-Farzad Mohammadi, Ghasem Saeedi-Anari, Elham Ashrafi, Seyed-Mehrdad Mohammadi, Farshad Farzadfar, Alireza Lashay, Hassan Hashemi
July-September 2017, 24(3):148-155
DOI:10.4103/meajo.MEAJO_168_16  PMID:29279656
Purpose: The purpose of this study is to provide a pooled estimate of moderate-to-severe visual impairment (MSVI) and blindness in Iran for people 50 years and over and to identify the major causes through systematic review. Materials and Methods: International (PubMed, ISI Web of Science, and Scopus) and national databases (Scientific Information Database, Barakat Knowledge Network System, Iran Databank of Ophthalmology Research, and Magiran) databases were searched. Following relevance assessment and critical appraisal, eight studies were included. A funnel plot was drawn to explore the stability for estimation. Single-variable meta-regression analysis was applied for heterogeneity assessment, and a random effect model was used (but no significant source for the observed heterogeneity was found). Results: Age-standardized pooled estimate of MSVI was 4.24% (95% confidence interval [CI]: 2.92–5.56); 3.98% (95% CI: 2.37–5.59) for men, and 4.08% (95% CI: 2.95–5.21) for women. Blindness (visual acuity <3/60) prevalence was 1.31% (95% CI: 1.23–1.39); 0.96% (95% CI: 0.89–1.03) for men, and 1.13% (95% CI: 1.06–1.20) for women. Causes of visual impairment (VI) were cataract (40.23%), amblyopia (12.03%), corneal opacity (9.63%), age-related macular degeneration (9.31%), diabetic retinopathy (4.94%), and glaucoma (3.67%). Conclusion: VI prevalence in the 50 years and older population in Iran seems significantly better than the corresponding global estimates. A rough 60% rate of treatable VI was estimated, mostly attributable to unoperated cataract.
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Occult optic disc pit maculopathy in a glaucomatous disc
Chokkahalli Krishnappa Nagesha, Pratyusha Ganne
July-September 2017, 24(3):165-166
DOI:10.4103/meajo.MEAJO_79_17  PMID:29279660
Optic pits are congenital defects of the optic disc. Diagnosis of optic pit maculopathy is quite challenging in the absence of a clinically visible or optical coherence tomography (OCT) proven pit. One such scenario is when there is advanced glaucomatous cupping. We present a case in which OCT helped detect optic disc pit maculopathy in a 60-year-old female.
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Outcomes of pneumatic retinopexy for the management of rhegmatogenous retinal detachment at a tertiary care center
Mohammad A Hazzazi, Saba Al Rashaed
July-September 2017, 24(3):143-147
DOI:10.4103/meajo.MEAJO_137_15  PMID:29279655
Purpose: The purpose of the study was to report the outcomes of pneumatic retinopexy (PR) for rhegmatogenous retinal detachment (RRD). Methods: A retrospective chart review of all patients with RRD who were managed with PR at the King Khaled Eye Specialist Hospital between 2000 and 2014. Data were collected on preoperative ocular history, characteristics of the RRD, postoperative anatomical and visual outcomes, and secondary surgeries. Results: Sixty-five eyes comprised the study sample with mean a follow-up of 42 months. Eighteen (27%) eyes had a history of ocular surgery and 5 (7.6%) had previous ocular trauma. Thirty-nine (60%) eyes had macula on RRD. Retinal detachment (RD) was caused by a single break in fifty (76.9%) eyes. Superior breaks were found in 56 (86.1%) eyes. Twelve (18%) eyes had posterior vitreous detachment. Fifty-one (78.5%) eyes underwent PR under local anesthesia and 9 (13.8%) underwent conjunctival peritomy. Octafluoropropane gas was used in 49 (75.4%) eyes and sulfur hexafluoride in 16 (24.6%) eyes. Cryotherapy was performed in 48 (73.8%) eyes and only laser photocoagulation in 8 (12.3%) eyes. Nine (13.8%) eyes underwent both cryotherapy and laser photocoagulation. Primary anatomical healing was achieved in 45 (69.2%) eyes, of which 20 (30.8%) required a second intervention. The final anatomical outcome was achieved in 100% of the eyes. At final visit, vision improved in 72% of eyes, was maintained in14.5%, and decreased in 9.7% (6). Conclusion: PR is a safe procedure for RRD repair. The final anatomical outcome was excellent in all cases including the recurrent RD after primary failure.
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Intravitreal bevacizumab for choroidal neovascularization associated with angioid streaks: Long-term results
T Lekha, Hari Narayan Prasad, Renuka Nikit Sarwate, Manasi Patel, S Karthikeyan
July-September 2017, 24(3):136-142
DOI:10.4103/meajo.MEAJO_17_17  PMID:29279654
Purpose: The purpose of the study was to evaluate the long-term efficacy and safety of intravitreal bevacizumab (IVB) in the treatment of choroidal neovascularization (CNV) secondary to angioid streaks (AS). Materials and Methods: Noncomparative, interventional retrospective case series involving ten patients (15 eyes) with a minimum follow-up of 25 months following IVB for AS-associated CNV. Demographic and clinical details at baseline and during follow-up were collected from patient records. Detailed clinical examination was followed by fundus fluorescein angiography and optical coherence tomography to confirm CNV. Both primary and recurrent CNVs were treated with monthly injections of IVB till the lesion stabilized. Primary outcome measures were the percentage of patients with stable or improved visual acuity (VA) and with stable or decreased central retinal thickness (CRT) at the last visit. Secondary outcome measure was the incidence of ocular and systemic complications. Results: Recurrence was observed in 11 eyes (73.33%) over a mean follow-up of 57.33 months (range: 25–100). A mean number of injections administered was 5.60. VA improved or stabilized in 73.33% and deteriorated in 26.67% of eyes at the final visit. Mean CRT improved from 324.40 μm at baseline to 265.53 μm at final visit, which was statistically significant. Complications observed were ocular hypertension in one patient and thromboembolic event in another patient. Conclusions: IVB appears to be a safe and effective option to treat CNV and to preserve vision over a prolonged period. It cannot eliminate the risk of recurrent CNV indicating the need for more effective treatments to arrest this visually debilitating condition.
  1,852 111 -
Superior oblique myokymia: Some novel observations
Sanitha Sathyan, Rosemary C Antony
July-September 2017, 24(3):162-164
DOI:10.4103/meajo.MEAJO_78_17  PMID:29279659
Superior oblique myokymia is a rare condition, characterized by spontaneous rhythmic contractions of the superior oblique muscle and was first described by Duane in 1906. However, the pathophysiology of this condition remains poorly understood even today. A number of medical and surgical treatment modalities have been tried, with variable results. We report a case of superior oblique myokymia in a pregnant female, which could be triggered with flashlight stimulation, and the result of treatment with timolol maleate 0.5% ophthalmic solution.
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Clinical profile and outcomes of optic neuritis in an HIV prevalent urban community in South Africa
Hamzah Mustak, Colin Cook
July-September 2017, 24(3):131-135
DOI:10.4103/meajo.MEAJO_133_17  PMID:29279653
Purpose: To determine the clinical profile, causes and response to corticosteroid therapy in patients admitted and treated for optic neuritis at a tertiary hospital in Cape Town, South Africa. Methods: A retrospective case review of 117 patients with optic neuritis between January 2002 and December 2012. Demographic information, clinical presentation, course of illness, investigations performed and visual outcomes at discharge and at three month follow up were collected for analysis. Results: 60 of 117 patients (51%) had an identifiable secondary cause for optic neuritis. Of the 57 patients with idiopathic optic neuritis, 14 had features associated with demyelinating disease. HIV and syphilis accounted for 62% of secondary causes of optic neuritis. Presenting visual acuity of hand movements (HM) or worse and absence of pain with extra ocular movement were associated with poorer final visual outcomes in the idiopathic optic neuritis group. Conclusion: Optic neuritis in our patients, as elsewhere in Africa, tends to be atypical in presentation. A high proportion of patients have an identifiable secondary cause. These patients thus require more extensive investigation in order to identify causes which may influence management. Secondary optic neuritis and idiopathic atypical optic neuritis carry a poorer prognosis than typical demyelinating optic neuritis.
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Mesopic quality of vision after accelerated 18 mW/cm2 corneal cross-linking: Mid-term results
Hassan Hashemi, Mohammad Miraftab, Soheila Asgari
July-September 2017, 24(3):121-125
DOI:10.4103/meajo.MEAJO_244_16  PMID:29279651
Purpose: The purpose of the study was to determine 2-year changes in mesopic higher-order aberrations (HOAs) and contrast sensitivity (CS) after accelerated corneal cross-linking (CXL) in keratoconus patients. Materials and Methods: In this before-after interventional case series, patients with progressive keratoconus were subjected to accelerated CXL (18 mW/cm2, 5 min). Patients were examined with the OPD-Scan III and CVS-1000 grating charts under mesopic conditions at baseline and at 12 and 24 months after CXL. Results: At 24 months after CXL, compared to baseline, mesopic CS in spatial frequencies of 3, 6, 12, and 18 cycle per degree reduced respectively to 0.09 ± 0.27, 0.09 ± 0.32, 0.11 ± 0.19, and 0.02 ± 0.10; these changes were not statistically significant (all P > 0.05). The reduction in ocular HOAs was 0.11 ± 0.43; ocular coma, trefoil, and spherical aberration (SA) decreased by 0.09 ± 0.36, 0.05 ± 0.35, and 0.00 ± 0.13 microns, respectively (all P > 0.05). Reductions in corneal HOAs (0.89 ± 7.08) including coma (0.99 ± 3.55), SA (1.14 ± 3.92), and trefoil (1.28 ± 5.53) were not statistically significant (all P > 0.05). Coma had the highest share of corneal HOAs before and 24 months after CXL and the largest 24-month decrease was seen in corneal SA. Conclusion: At 2 years after accelerated CXL, despite reduced keratometry and corneal flattening, mesopic CS as well as ocular and corneal HOA remained unchanged, and the procedure did not cause a reduction in patients' vision quality.
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Real-time optical coherence tomography incorporated in the operating microscope during cataract surgery
Mohammed A Almutlak, Turki Aloniazan, William May
July-September 2017, 24(3):156-158
DOI:10.4103/meajo.MEAJO_132_16  PMID:29279657
A 55-year-old male presented with reduced vision due to senile cataract. The patient consented to undergo real-time intraoperative anterior segment-optical coherence tomography (AS-OCT) during phacoemulsification with intraocular lens (IOL) implantation. Images were captured at various points during the surgery. The use of AS-OCT incorporated into the surgical microscope was evaluated as an adjunct to cataract surgery. We were able to successfully evaluate, in real-time, wound architecture, the attachment of Descemet's membrane, the posterior capsule, and IOL position. Real-time AS-OCT can be used to proactively address potential complications and verify IOL placement intraoperatively.
  1,700 74 -
Macular hole secondary to polypoidal choroidal vasculopathy
Prabu Baskaran, Utsab Pan
July-September 2017, 24(3):159-161
DOI:10.4103/meajo.MEAJO_30_16  PMID:29279658
We report a case of polypoidal choroidal vasculopathy (PCV) presented with massive submacular hemorrhage (SMH) and macular hole (MH). Spectral domain optical coherence tomography confirmed the presence of MH along with SMH and also revealed an extrafoveal-notched pigment epithelium detachment (PED) suggestive of PCV. Urgent pneumatic displacement with perfluoropropane (C3F8) was done. Indocyanine green angiography done 3 weeks later showed polyps in the superonasal macula corresponding to PED. Extrafoveal polyps were treated with laser photocoagulation. Inverted flap MH surgery was planned but the patient was lost to follow-up.
  1,653 77 -
The value of an appreciation of clinical profiles in communities as Aide-mémoire when faced with difficult ophthalmic diagnoses
David Meyer
July-September 2017, 24(3):119-120
DOI:10.4103/meajo.MEAJO_262_17  PMID:29279650
  1,545 60 -