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Middle East African Journal of Ophthalmology Middle East African Journal of Ophthalmology
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   2018| January-March  | Volume 25 | Issue 1  
    Online since May 18, 2018

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Implantation of customized, preshaped implant for orbital fractures with the aid of three-dimensional printing
Sirous Nekooei, Mahsa Sardabi, Mohammad Etezad Razavi, Amirhossein Nekooei, Mohammad Yaser Kiarudi
January-March 2018, 25(1):56-58
DOI:10.4103/meajo.MEAJO_262_16  PMID:29899654
Orbital floor fractures alone or in conjunction with other facial skeletal fractures are the most commonly encountered midfacial fractures. The technological advances in 3-dimensional (3D) printing allow the physical prototyping of 3D models, so creates an accurate representation of the patient's specific anatomy. A 56-year-old Caucasian man with severe hypoglobus and enophthalmos with an extensive blowout fracture was scheduled for reconstruction. First, 3D physical models were created based on the computed tomography scan datasets from patient. Then, this model was used as templates for preoperative trimming the implant. Surgical reconstruction with the aid of pre-shaped, customized prosthesis based on 3D anatomical model resulted in significant esthetic and clinical improvement. It is possible to build anatomical models on the basis of computed tomography scan datasets. It is relatively inexpensive and can be used in the repair of complex orbital floor fractures.
  3,247 104 -
Comparison of goldmann applanation, noncontact air puff, and tono-pen XL tonometry in normal controls versus glaucoma patients at a university hospital in Riyadh, Saudi Arabia
Essam A Osman, Priscilla W Gikandi, Abdul-Rahman A Al-Jasser, Majeedah Alotaibi, Ahmed Mousa
January-March 2018, 25(1):8-13
DOI:10.4103/meajo.MEAJO_291_16  PMID:29899644
PURPOSE: The purpose of this study is to compare intraocular pressure (IOP) measured by the Goldmann applanation tonometer (GAT), the Tono-Pen XL (TPXL), and a noncontact airpuff tonometer (NCT) in glaucoma patients and normal controls. METHODOLOGY: In the current study, two groups of individuals were recruited; the first group included glaucoma patients (glaucoma group) while the second one was a glaucoma-free group. The IOP was measured through GAT, NCT, and TPXL for the same participants by three different physicians in both groups. Measurements through the three devices were compared statistically. Correlations between different methods of assessment were also assessed. RESULTS: In the glaucoma group, the mean IOP measured was 16.0 ± 5.5 mmHg (range, 6–40 mmHg) with GAT 20.5 ± 6.9 mmHg (range, 10–52 mmHg) with the TPXL, and 20.2 ± 6.5 mmHg (range, 8–50 mmHg) with the NCT. In the control group, the mean IOP was 14.0 ± 2.7 mmHg (range, 9–19 mmHg) with GAT, 17.3 ± 3.8 mmHg (range 6–30 mmHg) with the TPXL, and 17.9 ± 3.9 mHg (range 10–27 mmHg) with the NCT. CONCLUSION: IOP measurements were approved among the three devices with relatively higher readings using both NTC and TPXL. All three methods are required to address different situations that present in the daily clinical and surgical practice.
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Accommodation, convergence, and stereopsis in dyslexic schoolchildren
Monireh Feizabadi, Ebrahim Jafarzadehpur, Majid Akrami
January-March 2018, 25(1):14-18
DOI:10.4103/meajo.MEAJO_71_17  PMID:29899645
BACKGROUND: Previous studies have shown a correlation between reading problems and binocular function, but few studies have assessed visual skills in dyslexic students, particularly in Iranian Farsi-language students. This study is aimed to determine some of the binocular functions of dyslexic children and compare it with a group of age, sex, and social class-matched control children. MATERIALS AND METHODS: We conducted a case–control study on 27 dyslexic children and 40 age, sex, and social class-matched control children (all between 7 and 13 years old) in grades one to six. This study was performed at three elementary schools in Tehran, Iran. Monocular and binocular near point of accommodation (NPA) were measured using the subjective push-up method, near point of convergence (NPC) was determined using the standard push-up technique, and stereoacuity was tested with the Titmus stereotypes in all of the children. RESULTS: Mean NPA of the right eye was 6.90 cm in dyslexic group and 5.98 cm in the control group (P = 0. 003). Mean NPA of the left eye in dyslexic children was 7.32 cm and in the control group was 6.23 cm (P = 0. 003). Mean binocular NPA was 6.66 cm in dyslexic and 6 cm in the control group (P = 0. 049). However, mean NPC (P = 0.33) and mean stereoacuity (P = 0.785) did not differ significantly between the dyslexic and control groups. CONCLUSION: Our findings showed a reduced monocular and binocular NPA in dyslexic children so that this function should be assessed by an optometric clinician in children with dyslexia.
  2,234 113 -
Intravitreal bevacizumab with or without triamcinolone for wet age-related macular degeneration: Twelve-month results of a prospective, randomized investigation
Qader Motarjemizadeh, Naser Samadi Aidenloo, Mohammad Abbaszadeh, Vahid Sadrinia
January-March 2018, 25(1):1-7
DOI:10.4103/meajo.MEAJO_292_16  PMID:29899643
PURPOSE: The purpose of this study is to compare the long-term outcomes of intravitreal bevacizumab (IVB) with a combination therapy including IVB/intravitreal triamcinolone acetonide (IVB/IVTA) in neovascular age-related macular degeneration (AMD). MATERIALS AND METHODS: This prospective, randomized clinical trial was conducted on 136 eyes of 136 patients with neovascular AMD. Eyes were randomly assigned to receive IVB alone (71 eyes) or in combination with IVTA (65 eyes). In the IVB group, three consecutive injections of 1.25 mg/0.05 ml of bevacizumab were administered 1 month apart, whereas in the IVB/IVTA group, 4 mg/0.05 mL of triamcinolone acetonide was added to bevacizumab in the first injection. Additional IVB injections were administered in eyes demonstrating active choroidal neovascularization. Best-corrected visual acuity (BCVA) and optical coherence tomography were performed at baseline as well as at all follow-up visits. RESULTS: No differences were seen between the patients receiving IVB and those receiving IVB/IVTA in terms of baseline BCVA (P = 0.97) and baseline central macular thickness (CMT) (P = 0.77). BCVA improved, and CMT reduced significantly in both study arms at almost all follow-up intervals. IVB/IVTA intervention, compared with IVB, was statistically more effective in improving BCVA (P = 0.01) and in reducing CMT (P = 0.02) after 12 months. The average number of reinjections was 1.25 ± 0.92 in the IVB group and 1.06 ± 1.01 in the IVB/IVTA group (P = 0.44). CONCLUSION: Our results suggest that the synergistic effect of intravitreal triamcinolone and IVB for treatment of neovascular AMD shows itself most apparently after 8 months of follow-up.
  1,972 114 -
Frequency of cataract in Iran: A meta-analysis and systematic review
Hosien Shahdadi, Mohammad Naim Aminifard, Abbas Balouchi, Hosein Rafiemanesh, Jasem Allahyari
January-March 2018, 25(1):40-46
DOI:10.4103/meajo.MEAJO_300_17  PMID:29899650
PURPOSE: Cataract is the leading cause of blindness and the second cause of low vision in the world. In the world, Asia has the highest number of blind population. The aim of the present systematic review and meta-analysis was to assess the frequency of clinical cataracts in Iran. MATERIALS AND METHODS: The frequency of clinical cataract was defined based on the international criteria and the measured outcome of the disease. Study selection, data extraction, and quality assessment were performed by two independent reviewers. We explored PubMed, Google Scholar, ISI Web of Science, and national databases (scientific information database, Magiran) to evaluate the clinical cataract of cataract in the Iranian populations from 1995 to July 2017. Statistical analysis was performed using STATA 14.0 software. RESULTS: Of 283 studies, 27 studies utilized meta-analysis. In 2017, the pooled overall frequency of clinical cataract in 59668 people was 9.27% (95% confidence interval [CI]: 8.09, 10.45, I2 = 98.82%). Based on subgroup analysis, in the random effect method, the frequency of clinical cataract in males and females were 8.03% (CI: 6.78, 9.28) and 8.32% (CI: 7.08, 9.55), respectively. CONCLUSION: Regarding the high frequency of clinical cataract in Iran, it seems that paying attention to the results of the current study and the application of international policy plans may contribute to better cataract control in Iran.
  1,855 101 -
Causes of permanent severe visual impairment and blindness among Jordanian population
Basel Turki Baarah, Raed Ali Shatnawi, Ahmed Essa Khatatbeh
January-March 2018, 25(1):25-29
DOI:10.4103/meajo.MEAJO_202_16  PMID:29899647
PURPOSE: To report the causes of permanent severe visual impairment and blindness among Jordanian blind people. MATERIALS AND METHODS: This study was conducted on 1422 legally blind or worse vision people of all ages who attended the ophthalmic division of a medical committee for evaluation of disabled persons from July 2013 through November 2014. They were divided into two age groups: adult group (998 cases) and childhood group (<16 years, 424 cases). Patients presented reports from their ophthalmologists detailing their eye examination including best-corrected visual acuity, slit-lamp examinations, and if applicable, intraocular pressure, dilated ophthalmoscopy, and visual field and the primary cause of visual impairment. Blind defined as best-corrected visual acuity < 6/60 (20/200) and/or visual field of 20° or less. RESULTS: Retinitis pigmentosa was the most common cause of blindness among adult group (29.7%) followed by diabetic retinopathy (19.9%) and glaucoma (15.8%). Congenital whole-globe malformations were the most common cause of blindness among childhood cases (16.7%) followed by retinopathy of prematurity (ROP) (15.8%) and retinal dystrophies (13.9%). Overall, blindness related to genetic diseases, illnesses, and trauma was present at 56.5% (803), 41.7% (593), and 1.8% (26) of cases, respectively. CONCLUSIONS: Genetic diseases such as retinitis pigmentosa, diabetic retinopathy, and glaucoma were the dominant causes of blindness among adults, while whole-globe malformation, ROP, and retinal dystrophies were the dominant causes of childhood blindness. These major causes of blindness should be considered in future public health and nongovernmental organizations strategies for blindness prevention in Jordan.
  1,753 105 -
Choroidal haller's and sattler's layers thickness in normal Indian eyes
Rupak Roy, Kumar Saurabh, Chinmayi Vyas, Kaustubh Deshmukh, Preeti Sharma, Dhileesh P Chandrasekharan, Aditya Bansal
January-March 2018, 25(1):19-24
DOI:10.4103/meajo.MEAJO_77_17  PMID:29899646
AIM: This study aims to study normative choroidal thickness (CT) and Haller's and Sattler's layers thickness in normal Indian eyes. MATERIALS AND METHODS: The choroidal imaging of 73 eyes of 43 healthy Indian individuals was done using enhanced depth imaging feature of spectralis optical coherence tomography. Rraster scan protocol centered at fovea was used for imaging separately by two observers. CT was defined as the length of the perpendicular line drown from the outer border of hypereflective RPE-Bruch's complex to inner margin of choroidoscleral junction. Choroidal vessel layer thickness was measured after defining a largest choroidal vessel lumen within 750 μ on either side of the subfoveal CT vector. A perpendicular line was drawn to the innermost border of this lumen, and the distance between the perpendicular line and innermost border of choroidoscleral junction gave large choroidal vessel layer thickness (LCVLT, Haller's layer). Medium choroidal vessel layer thickness (MCVLT, Sattler's layer) was measured as the distance between same perpendicular line and outer border of hypereflective RPE-Bruch's complex. RESULTS: The mean age of individuals was 28.23 ± 15.29 years (range 14–59 years). Overall, the mean subfoveal CT was 331.6 ± 63.9 μ. Mean LCVLT was 227.08 ± 51.24 μ and the mean MCVLT was 95.65 ± 23.62 μ. CT was maximum subfoveally with gradual reduction in the thickness as the distance from the fovea increased. CONCLUSION: This is the first study describing the choroidal sublayer thickness, i.e., Haller's and Sattler's layer thickness along with CT in healthy Indian population.
  1,740 79 -
Autologous scleral flap technique to repair exposed sutures after transscleral suture fixation of an intraocular lens
Aliyah Hadi Alameri, Donald Ural Stone
January-March 2018, 25(1):47-48
DOI:10.4103/meajo.MEAJO_196_16  PMID:29899651
Exposure of the suture after transscleral suture fixation of posterior chamber intraocular lenses is a known late complication that typically requires intervention. Patch grafts of sclera, cornea, or pericardium have been described. We describe a novel autologous scleral flap to cover an exposed 10–0 polypropylene suture. This technique requires no exogenous graft material and avoids the risks of intraocular manipulation of the lens. Every effort should be made to avoid external exposure of the suture, but in cases that develop suture erosion, an autologous scleral flap may be a useful intervention.
  1,528 73 -
Bilateral deep sclerectomy with microperforations as a successful secondary procedure in aniridia-associated glaucoma
Abdulrahman AlDarrab, Rizwan Malik
January-March 2018, 25(1):52-55
DOI:10.4103/meajo.MEAJO_291_17  PMID:29899653
Aniridia-associated glaucoma is often refractory to medical treatment. Glaucoma drainage device surgery is often considered after failed angle surgery. However, the potential complications of tube surgery in young children are not negligible. The failure rate of conventional trabeculectomy may be high and can require close and multiple postoperative follow-up visits. Here, we describe a child with aniridia who achieved good short-term results with deep sclerectomy. A 14-month-old girl was referred to our unit following bilateral trabeculotomies for aniridia-associated glaucoma and persistent uncontrolled intraocular pressure (IOP) in both eyes. She underwent sequential bilateral deep sclerectomies with microperforations. The patient achieved normalized IOP in both eyes after 6-month follow-up without any complications. Deep sclerectomy, with microperforations, may be a reasonable surgical procedure to perform in children with aniridia with failed angle surgery before contemplating tube shunt surgery.
  1,502 96 -
Palmoplantar keratoderma with keratoconus
Ved Prakash Gupta, Isha Chaudhari
January-March 2018, 25(1):49-51
DOI:10.4103/meajo.MEAJO_221_17  PMID:29899652
Palmoplantar keratodermas (PPKs) are a rare heterogeneous group of disorders characterized by abnormal thickening of the skin of palms and soles. Ocular manifestations reported with palmer planter keratosis include scleral melanosis, macular deposits, and congenital cataract. We report, for the first time, a case of bilateral keratoconus in a patient with PPK.
  1,526 52 -
Relationship between refraction, anthropometrics, and educational status in a nigerian young adult population
Sarat A Badmus, Ayotunde I Ajaiyeoba, Bernice O Adegbehingbe, Oluwatoyin H Onakpoya, Adenike O Adeoye, Sanyaolu A Ameye
January-March 2018, 25(1):30-34
DOI:10.4103/meajo.MEAJO_16_16  PMID:29899648
PURPOSE: The study aimed at determining the relationship between refraction and anthropometric measurements and the relationship between the level of education and refractive status in a Nigerian young adult population. MATERIALS AND METHODS: Healthy volunteers from the students and staff of a teaching hospital in South-Western Nigeria were studied. Demographic profiles including participants' highest educational status, parental educational level, and the age at first formal school enrollment were documented. The height and weight of the participants were measured. Noncycloplegic objective refraction was determined with autorefractor, and the spherical equivalent refraction (SER) of the right eye was used for analysis. SPSS 16 was used to explore the relationships between refraction, height, weight, and body mass index and the educational status of the participants. RESULTS: Two hundred and thirty-nine adults with a mean age of 28.4 ± 6.5 years comprising 116 males and 123 females were studied. The mean height, weight, body mass index, and right eye SER were 1.7 ± 0.1 m, 64.4 ± 12.2 kg, 23.6 ± 4.3 kg/m2, and −0.8 ± 1.4 D, respectively. Height was negatively correlated with the SER (R = −0.3, P < 0.01) in males but not in females. Refraction was not significantly related to weight or body mass index. Participants with higher levels of education were more likely to be myopic. Higher parental education and early formal school enrollment were significantly associated with myopia. CONCLUSION: This study demonstrated a significant positive relationship between height and myopia in male participants but not in females. Individual as well as parental higher levels of education have also shown a positive association with myopic tendency.
  1,463 80 -
Bacterial flora of the conjunctiva one year after dacryocystorhinostomy
Naser Owji, Alireza Zareifard
January-March 2018, 25(1):35-39
DOI:10.4103/meajo.MEAJO_225_17  PMID:29899649
PURPOSE: The purpose of this study was to evaluate the changes of conjunctival bacterial flora 1 year after successful dacryocystorhinostomy (DCR). METHODS: Seventy-two consecutive adult patients with successful DCR were enrolled in this study. We obtained conjunctival cultures from the operated eyes, fellow eyes, and nasal mucosa of the operated side 1 year after the operation. After the period of incubation, further evaluation was performed using standard laboratory techniques. RESULTS: In the conventional media, positive bacterial growth was detected in 48 (66.7%) of the 72 operated eyes and in 31 of the 72 normal fellow eyes (43.1%). Nasal specimens were positive for bacterial growth in 65 (90.3%) patients. Isolation rate was significantly different between the operated and the fellow (nonoperated) eyes (P = 0.0074). Colony count, type, and frequencies of bacterial isolation from the operated eyes were similar to nonoperated eyes. CONCLUSION: One year after DCR, conjunctival bacterial isolation rate increased compared with the normal fellow eyes. Remote DCR may be considered as a local risk factor for developing postoperative endophthalmitis.
  1,471 66 -