Middle East African Journal of Ophthalmology最新文献

Purpose: The purpose of the study was to study the relationship between the timing of pars plana vitrectomy (PPV) with corrected distance visual acuity (CDVA) in cases of nucleus drop during phacoemulsification.

Methods: This retrospective analysis included 83 patients, who underwent PPV for nucleus or nuclear fragment drop from July 2017 to November 2019. Timing of PPV (≤2 weeks and >2 weeks) after the primary cataract surgery was noted. The primary endpoint was CDVA at 1 month, which was compared with the time of PPV. Visual outcome was assessed as good if CDVA was better than or equal to 20/40 and poor if CDVA was worse than 20/40. Mode of management along with type of secondary intraocular lens (IOL) implanted was also evaluated.

Results: Out of the 83 cases (55 males and 28 females) in which vitrectomy for nucleus drop was performed, 36 cases were operated within 2 weeks and 47 were operated between 2 weeks and 1 month. In cases which were operated within 2 weeks, CDVA of 20/20-20/40 was achieved in 33 cases. For those who were operated on after 2 weeks, CDVA of 20/20-20/40 was achieved in 43 cases. The difference in visual outcome in both the groups was statistically nonsignificant (Fisher's exact t-test, P = 0.97). In 64 (77%) cases, adequate sulcus was present, in which foldable 3-piece IOL was placed in 29 (35%) cases.

Conclusion: Timing of intervention has no bearing on the final visual outcome after vitrectomy in cases of nucleus drop during phacoemulsification. The continuity of the capsulorrhexis and the availability of capsular support determines the type of placement of the lens. A foldable lens can be placed in the sulcus if continuous capsulorrhexis is present.

Purpose: The objective is to analyze the radiological diagnosis of orbital lesions and their correlation with the final histopathological findings. We compared the initial reports by extramural radiologists and an in-house radiologist specialized in orbital imaging to evaluate the diagnostic accuracy in the interpretation of orbital imaging.

Methods: This was a retrospective chart review of forty patients referred to a Tertiary Eye Care Center in South India over a period of 7 years. These patients already had their imaging done elsewhere. The imaging was re-evaluated by an in-house radiologist. The radiological findings were correlated with the histopathological diagnosis. The diagnostic accuracy between the two radiologists was compared. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value in differentiating malignant from benign lesions were calculated in both groups. The sensitivity and PPV of the radiological diagnosis for neoplastic and inflammatory lesions in both groups were analyzed.

Results: The accuracy in differentiating malignant from benign and inflammatory lesions by our in-house radiologist and extramural radiologists was 95% (κ = 0.9 [0.764, 0.997]) and 50% (κ = 0.036 [-0.160, 0.232]), respectively. The sensitivity and PPV of the radiological diagnosis by our in-house radiologist were 93.31% and 100% for benign lesions and 95.24% and 95.24% for malignant lesions. On the contrary, reports from the extramural radiologists showed a sensitivity and PPV of 76.92% and 66.67% for benign lesions and 14.28% and 60% for malignant lesions.

Conclusion: A high radiological diagnostic accuracy is possible when analyzed by radiologists experienced in orbital imaging.

Purpose: The high recurrence rate of idiopathic orbital inflammation (IOI) has been reported. This study aims to determine existing predictive factors for the recurrence of IOI.

Methods: This was an 11-year retrospective study with at least a 12-month follow-up. Fifty patients with biopsy-proven IOI admitted between 2006 and 2017 at our tertiary hospital were observed. We compared the clinical characteristics, histopathological profile, and biomarker expressions (mast cell, immunoglobulin G4, tumor necrosis factor-alpha, and transforming growth factor-beta) of 16 patients with recurrence (Group I) and 34 patients with no recurrence (Group II). Statistical comparison and multivariate analysis were performed to establish the predictive factors.

Results: We discovered five recurrence predictive factors: presentation of proptosis (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.36-18.03), visual impairment (OR 15, 95% CI 1.58-142.72), extraocular muscle (EOM) restriction (OR 3.86, 95% CI 1.07-13.94), nonanterior involvement (OR 7.94, 95% CI 1.88-33.5), and corticosteroid (CS) alone treatment (OR 7.20, 95% CI 1.87-27.8). On multivariate analysis, nonanterior involvement and CS alone treatment were validated as predictive factors (area under the curve = 0.807 [95% CI 0.69-0.92]). Histopathological profile and biomarker expressions were not associated with recurrence. However, there was a 22-fold higher recurrence risk for granulomatous-type patients given CS alone treatment.

Conclusion: Unlike the five clinical characteristics mentioned, both histopathology and biomarker variables were not associated with recurrence. CS alone treatment for patients with nonanterior involvement or granulomatous type is proven to increase the risk of recurrence. Therefore, we suggest not giving CS without any combination treatment with other modalities for this group of patients.

We report two glaucoma patients who experienced unusual instances of spontaneous globe rupture. The patients arrived at the Bowen University Teaching Hospital's emergency ophthalmology unit with a history of bleeding from one eye without any history of ocular trauma. They were known glaucoma patients with poor control of their intraocular pressures (IOP). They eventually underwent evisceration shortly after presentation. Spontaneous eyeball rupture in glaucomatous eyes is extremely unusual and has a very poor prognosis for vision. Proper management and appropriate follow-up of glaucoma patients are very important to avert this dreaded complication of uncontrolled IOP.

Purpose: The purpose of this study was to evaluate pre- and perioperative factors related to time for the evolution of ectopic inner foveal layers (EIFL) following pars plana vitrectomy (PPV) for epiretinal membrane (ERM) peeling.

Methods: This retrospective study included 81 consecutive eyes with idiopathic ERM that underwent vitrectomy surgery. Standard PPV + internal limiting membrane peeling was performed in all cases. A comprehensive ophthalmic examination was performed for all patients before and 1, 3, 6, and 12 months, and the last follow-up after surgery. We observed the postoperative improvement in EIFL severity in the short-term and longest follow-up and evaluated anatomical and functional improvement. Several parameters were assessed using the multivariate COX proportional hazard analysis.

Results: Eighty patients (81 eyes) with a mean age of 70.33 ± 7.75 years were followed for a mean of 34.37 ± 23.61 months, and 55.5% of eyes (45 eyes) with EIFL ERM showed improvement of foveal contour to a better stage at the last follow-up. The median estimated time for evolving to a better stage was 29.73 months for stage 2, 49.68 months for stage 3, and 38.67 months for stage 4 (P = 0.001, log-rank test). The severity of EIFL was the only significant factor for time to evolution of EIFL ERM to a better stage, where the eyes with stage 4 EIFL ERM showed faster foveal contour improvement compared to those with stage 3 EIFL ERM (hazard ratio: 0.317, 95% confidence interval = 0.164-0.615, P = 0.001).

Conclusion: On assessing preoperative factors, the preoperative EIFL stage emerged as the sole significant factor for EIFL ERM improvement to a better disease stage. This study reports some of the longest follow-up durations for patients undergoing PPV for EIFL ERM, and both functional and anatomical improvements were observed across all stages of EIFL, including in the advanced stage 4 EIFL ERM.

Purpose: The objective of the study was to examine the effect of dorzolamide-timolol (DT) eye drop used before intravitreal ranibizumab (IVR) injection on intraocular pressure (IOP) change.

Methods: 50 eyes of 50 patients who received DT eye drops 1 h before IVR injection due to diabetic retinopathy and macular edema were considered Group 1, and 50 eyes of 50 patients who did not receive DT eye drops were considered Group 2. Those patients who had previously undergone intravitreal injection had intraocular surgery, and used any eye drops were not included in the study. Before the injection, IOP values were measured with a Tonopen contact handheld tonometer before the blepharostat was placed (BIOP), after the blepharostat was placed (AIOP), and at the 1^st min after the injection (IIOP).

Results: There were 25 males and 25 females in Group 1 and 25 males and 25 females in Group 2; the mean age was 65.66 ± 9.94 years in Group 1 and 65.54 ± 7.43 years in Group 2 (P = 0.98). In Group 1, BIOP was 18.91 ± 18.91, AIOP was 21.62 ± 6.16 mmHg, and IIOP was 49.21 ± 10.95 mmHg. In Group 2, BIOP was 20.18 ± 4.19 mmHg, AIOP was 24.60 ± 4.90 mmHg, and IIOP was 49.96 ± 9.72 mmHg. IIOP-BIOP difference was 30.30 ± 9.85 mmHg in Group 1 and 29.78 ± 9.33 mmHg in Group 2 and the difference was not statistically significant (P = 0.78). In Group 1, the IIOP-AIOP difference was 27.58 ± 10.60 mmHg and in Group 2, 25.36 ± 10.46 mmHg. The difference between IIOP and AIOP was not statistically significant (P = 0.27).

Conclusion: The use of topical DT eye drops before IVR injection does not affect the intraocular pressure change.

Purpose: The purpose of this study was to assess the refractive outcomes of patients who underwent indirect laser photocoagulation for prethreshold type 1 retinopathy of prematurity (ROP) and high-risk type 2 prethreshold ROP in comparison to conservatively managed low-risk prethreshold type 2 ROP.

Methods: A retrospective analysis was carried out on infants screened for ROP between the years 2015 and 2020. Surviving children who had developed ROP in one or both eyes and received diode laser photocoagulation and those with conservatively managed regressed type 2 ROP who underwent at least one cycloplegic retinoscopy were included in the study.

Results: A total of 144 patients were screened for ROP between 2015 and 2020 at our institution. One hundred and thirty patients (260 eyes) fulfilled the study criteria and were included in this study. The treated group consisted of 132 eyes of 66 infants, of which 38 (14.6%) eyes had prethreshold type 1 ROP while 94 (36.2%) eyes had high-risk prethreshold type 2. The nontreated control group consisted of 128 (49.2%) eyes of 64 infants with low-risk type 2 prethreshold ROP. Earlier prematurity was found to be a significant determinant of the mean change in spherical equivalent among different gestational age groups (P = 0.035). In our cohort, we found that myopia is significantly related to Zone II ROP in comparison to Zone III ROP in the treated eyes (22% vs. 9%) (P = 0.002). No statistically significant difference was found in the final refraction among the treated eyes in relation to the birth weight or stage of prematurity.

Conclusion: In the present study, the majority of patients who were treated with diode laser for ROP had favorable anatomical and refractive outcomes. In contrast to previous studies that had suggested a trend toward myopia in laser-treated patients, in our study, the majority (71%) were hyperopes. This study suggests that other factors such as the stage and zone of ROP possibly contribute more to the development of myopia than the laser photocoagulation itself.

Purpose: The purpose was to study the choroidal thickness and its profile, derived from different point locations in healthy Asian Indian subjects using RTVue XR 100 optical coherence tomography (OCT) and to determine its correlation with age, refractive error, and axial length.

Methods: In this cross-sectional study, 300 eyes of 150 healthy subjects, with no ocular pathology, were scanned in a single session, using a line scan protocol of RTVue XR 100 OCT. Choroidal thickness was measured at the subfoveal region, and six measurements were obtained on either side of the fovea (temporal and nasal) at 500 μm interval apart, up to 3000 μm. The correlation between subfoveal choroidal thickness and age, refractive error, and axial length was assessed.

Results: Three hundred eyes of 150 healthy subjects were included in the analysis. Median age of the study participants was 55 years (interquartile range [IQR]: 44-61). The median subfoveal choroidal thickness was 235 μm (IQR: 210-263). The choroidal thickness was minimum at nasal 3000 μm from the fovea, while it was maximum in the subfoveal region. The point zones which were near the fovea showed thicker choroidal thickness than the outer zones, both nasally and temporally (P < 0.00001 at all locations), and at all point locations the choroid were thicker temporally than nasally (All P < 0.00001). Subfoveal choroidal thickness showed negative correlation with age (coefficient = -0.62, P = 0.03) and axial length (correlation = -8.52, P = 0.02). A decrease in subfoveal choroidal thickness of 0.62 μm/year was found by regression analysis.

Conclusion: Our study provides normative database and topographic profile of choroidal thickness in the normal Asian Indian eyes using RTVue XR 100 OCT.

Purpose: The purpose of this study was to conduct a bibliometric analysis of articles published in Ophthalmology Journals from Arab countries from 2012 to 2022.

Methods: This cross-sectional analysis of all original ophthalmology research and review articles published by authors with an affiliation with an institution from Arab countries and indexed in the ISI Web of Science between January 2012 and December 2022.

Results: For the years 2012-2022, 4292 articles published in Ophthalmology Journals by authors from Arab-based institutions were identified. A 2.11-fold progressive increase in the number of publications was observed over the last decade with a substantial increase in publication volume during the first 2 years of the COVID-19 pandemic. The countries with the highest number of publications were Egypt (38.51%), Saudi Arabia (35.56%), and the United Arab Emirates (7.88%). According to affiliation, authors from King Khaled Eye Specialist Hospital (KKESH) (n = 644) published the highest number of ophthalmology articles, followed by King Saud University (n = 585) and Cairo University (n = 393).

Conclusion: Over the last decade, the overall productivity of research in the field of ophthalmology has significantly increased. Majority of the articles in ophthalmology were published by authors from Egypt and Saudi Arabia with KKESH as the most productive institution among Arab nations.