BULL.
OPHTHALAMOLOGICAL SOCEITY EGYPT, 1997; 90, NUMBER 1 |
Vitrectomy for Complications of Proliferative Diabetic
Retinopathy
Rasheed El- Lakkany
Purpose:
To evaluate the role of vitrectomy in management of various complications of
proliferative diabetic retinopathy (P.D.R) and study of both anatomical and visual
outcomes.
Methods:
Pars plana vitrectomy with other intravitreal techniques were performed to
manage eyes presented with different complications of P.D.R. Postoperative outcomes were
followed up for one year.
Resufts:
The results of vitreous surgery for simple diabetic vitreous hemorrhage were
excellent . 31 eyes out 42 eyes showed a significant improvement in vision (73.8%).
In eyes
with diabetic traction retinal detachment and combined traction -rhegmatogenous retinal
detachment the visual improvement was acheived in 15 out of 28 eyes treated with
vitrectomy techniques (53.6%). Two eyes with dense premacular hemorrhage and two eyes with
premacular fibrosis showed marked increase in their visual acuity after vitrectomy.
Postoperative
corneal complications, cataract, glaucomas, retinal detachment and recurrent vitreous
hemorrhage were recorded in some cases.
Conclusion:
Vitrectomy techniques have developed dramatic improvements in the surgical treatment of
advanced cases of diabetic retinopathy. Although the visual outeome and potantial for
usable vision is quite promising, the risk of surgery must always be weighed against the
advantages of the technique.
BULL. OPHTHALMOL. SOC. EGYPT,
1997; VOL 90, NUMBER 1,5-10 SOC. EGYPT,
1997; VOL 90, NUMBER 1, 5-10
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Evaluation
of Vitrectomy in Cases of Diabetic Tractional Macular Detachment
Ashraf Shaarawy, Mohamed Rageb,
Ahmad Sabry Sheta, Ibrahim Sabry Kaled Sameh, and Thomas Aaberg
Purpose:
The aim of this work was to evaluate the preoperative anatomic,
physiologic(medical), and intraoperative surgical techmque variables, to prognostically
determine the most favorable surgical outcomes of vitrectomy for cases of fractional
macular detachment in diabetic patients.
Methods:
This study included 34 eyes (of 32 patients) diagnosed as tractional macular
detachment cases secondary to diabetic neovascular proliferative retinopathy.
In
actuality, a "modified en-bloc" technique was usually in use, where all
posterior hyaloid except for portions essential for membrane dissection, were excised.
Intraocular tamponade of iatrogenic breaks with air or non-expansible gas/air mixtures,
depended primarily on the phakic stattis of the eye, as well as on the number and position
of breaks.
If
there was no PVL), the "reverse en-bloc" technique was used. The trial to access
the plane between the posterior hyaloid/fibrovascular membrane and the retina began at the
optic nerve head and proceeded "centrifugally" to the periphery.
When a
bullous retinal detachment occurred early in the procedure, secondary to an iatrogenic
retinal break, the retina failed to fatten in areas where traction has been relieved
obviating the advantages of this procedure. Conversion to segmentation, and delamination,
followin~ discontinuation of the "en-bloc" resection might be then necessary.
With iatrogenic posterior retinal breaks, endodiathermy was used to mark its edges, and
after completion of the dissection, air/fluid exchange was necessary, then to flatten the
retina.
Results:
The en-bloc technique showed a higher percentage (56.25%) for an improved V.A. versus the
reverse en-bloc technique (33.33%). Statistically, that was not significant (P value:
0.4109)
Conclusion: Eyes in which the
"reverse en-bloc" technique was used, did not show a statistically significant
difference, neither in the rate of creation of iatrogeinnic breaks, nor in the
postoperative change in visual acuity, from those in which the "en-bloc"
technique was used.
BULL.
OPHTHALMOL . SOC. EGYPT; 1997; 90, NUMBER 1, 11-22
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Study of Vitreoretinal Pathoanatomy of Diabetic Eyes as
Diagnosed during Vitrectomy Procedures
Ashraf
Shaarawy.
Purpose:
Purpose: Purpose:
To study the vitreoretinal relationship in diabetic eyes undergoing vitrectomy for
different indiations and to prognostically relate the influeuce of this relationship to
anatoinical and surgical outcome.
Methods : Methods : Forty five eyes with complications of PDR indicated for vitrectomy were
included in the study.
Results : Results : Broad adhesions without underlying retinal folding was the commonest
type of vitreoretinal adhesions . Vacuum suction was the commonest method used in group I (85%).
Reverse in bloc excision was the commonest method used in group II (50%)
Conclusion : Vitreoretinal
Pathoanatomy is an important key factor in determining the anatomic and visual success in
eyes undergoing vitrectomy for complications of PDR. Conclusion : Vitreoretinal Pathoanatomy is an important key factor in determining
the anatomic and visual success in eyes undergoing vitrectomy for complications of PDR.
BULL. OPHTHALMOL SOC. EGYPT, 1997; 90, NUMBER 1, 23-29
Methods
: Forty five eyes with complications of PDR indicated for vitrectomy were included in the
study.
Results : Results : Broad adhesions without underlying
retinal folding was the commonest type of vitreoretinal adhesions . Vacuum suction was the
commonest method used in group I (85%). Reverse in bloc excision was the commonest
method used in group II (50%)
Conclusion : Vitreoretinal Pathoanatomy is an important key
factor in determining the anatomic and visual success in eyes undergoing vitrectomy for
complications of PDR. Conclusion : Vitreoretinal Pathoanatomy is an important key
factor in determining the anatomic and visual success in eyes undergoing vitrectomy for
complications of PDR.
BULL. OPHTHALMOL SOC. EGYPT, 1997; 90, NUMBER 1, 23-29
BULL. OPHTHALMOL SOC. EGYPT, 1997; 90, NUMBER 1, 23-29
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Supplemental Pneumatic Retinopexy for Failed Scleral
Buckling Procedures
M.N. Abou
Sedah and M.B. Awad
Purpose: To reattach the retina by the simplest
effective method as soon as progressive redelachment was observed. Supplemental gas
tamponade after failed conventional scleral buckling was tried.
Methods:
Early postoperatively, intravitral SF6 was injected in 17 cases with failed iry scleral
buckling procedures. The criteria for patient selection were increasing or reappearance of
fluid, avisible open retinal break, all breaks in the area above 4 to 8 O'Clock. All
patients with static SRF were excluded.
Results:
14 out of 17 patients has successfu 1 anatomical retinal reattachment (82.35%).
Conclusion:
Pneumatic retinopexy is a simple and c affective procedure to supplement failed scleral
buckling in selected cases.
BULL. OPHTHALMOL SOC. EGYPT, 1997; VOL 90, NUMBER 1, 31-33
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Radial Buckle as an Effective Procedure in Rhegmatogenous
Retinal Detachment
Khaled Selim, Magdy Tawakol..
Purpose:
This study was constructed to evaluate the efficacy of radial buckling procedures in the
management of rhiegmatogenous retinal detachment.
Methods: Fourty
eyes of 40 patients were included in the study. Twenty-eight showed one horse shoe or
rounded tear while 12 showed multiple tears. Radial buckles were used to close the tears.
Results: After a
minimum,period of six months follow up successful retinal reattachment was achieved in 38
eyes, twenty-seven after single procedure and 11 after 2 procedures.
Conclusion: Radial
buckling procedure is effective in treating rhegmatogenous retinal detachment due to
single or closed related tears with minimal complications.
Key words: Radial
buckling - Retinal detachment.
BULL.
OPIHHALMOL. SOC. EGYPT, 1997; VOL.90, NUMBER 1, 35-37
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The Use of Autologus Serum in Closure of Retinal
Breaks.
I. Animal Study.
Ehab N. El-Rayes, Mohamed Hassan El-Hoshy, Mahmoud Hamdi
Ibrahim, Laila M. R. Abdel-Khalek, Micheal T. Trese
Purpose: The
standard methods of creating choriodoretinal adhesion is ~ermal. Recently, the use of
biological glues as cytokinines was explored as a chorioretinal adhesives. Serum has been
shown to contain chemoattractants, mitogens as well as cytokines. The authors studied the
histological effect of autologous serum application to retinal breaks in an experimental
model as a new biological glue.
Method: Eighteen rabbits were
used as a model of retinal breaks after performing vitrectomy on them. Autologous serum,
TGFb2 or balanced saline solution (BSS) were injected over the retinotomy. Histological
study of the retinotomy site was done to all retinotomies after one week, two weeks and
one month of the operation.
Results: Non of the serum nor the
TGFb2 treated eyes showed retinal detachment compared to the BSS treated rabbits.
Histologically, a well formed chorioretinal scar was formed at the break site in serum
treated eyes with sealing of the retina to the choriod.
Conclusion: The present study
suggests that serum induces a localized fibrocellular reaction at the retinotomy edges.
This response involves a mixed cell population of glial, retinal pigment epithelial and
fibroblast cells. These cells enhances adhesion and subsequent reattachment of the edges
of the retinotomy, thus forming a good choriodal adhesion.
BULL.
OPHTHALMOL SOC. EGYPT, 1997; VOL 90, NUMBER 1, 39-44
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The use of Autologous Serumin Closure of Retinal Breaks.
II Human Study
Ehab N. El-Rayes, Mohamed Hassan El-Hoshy. Mahmoud Hamdi Ibrahim, Laila MR.
Abdel Khalek, and Michael T Trese.
Purpose:
Retinal breaks are a major cause of retinal detachments . They have been treated by
various methods in hopes of treating retinal detachment and preseving vision. Most of the
methods used to create chorioretinal adhesion relay on thermal modalities which are not
the ideal resort specially in sensitive areas as the macula. The purpose of this study is
to test the efficacy of autologous serun in conjunction with current surgical techniques
to repair macular breaks.
Methods: 10
patients with stage 3 and 4 macular holes were treated with vitrectomy and application of
either autologous serum or transforming growth factor beta (TGFb2) on the macular hole.
Results: All 10
patients had resolution of the surruonding subretinal fluid and closure of the macular
hole. 9 out of 1 0 eyes showed improved visual acuity with no difference between the serum
or the TGFb2 treated eyes.
Conclusion: This
study suggests the possible benefits of serum as a safe, inexpensive biological glue that
can be used to treat macular holes where other thermal modalities can be avoided.
BULL.
OPHTHALMOL. SOC. EGYPT, 1997; VOL.90. NUMBER 1, 45-48
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Management of Macular Hole Detachments Among Egyptians
Aly A. M. El-Mofty, Khalid G. Ali, Osman A. Z. Mohamed, Abd El-Monem
Hamed, Mamdouh S. EI-Shafei Gamil Fikry.
Purpose:
To report the retrospective results of management of myopic macular hole causing
rhegmatogenous retinal detachments among Egyptian patients.
Methods:
Sixty-five patients were operated upon by standard pars plana vitrectomy with removal of
the posterior hyaloid and existing epiretinal membranes. The subretinal fluid was drained
through the macular hole 34 patients. Of these patients C2
- F6 gas intemal tamponade was used in 15
patients and 5000 Cs Silicone oil tamponade was used in 19 patients. Subretinal fluid
drainage through a separate retinotomy was done in 31 patients using peffluorocarbon
liquid to displace the subretinal fluid away from the macular hole followed by Silicone
oil tamponade.
Results: In the
cases drained through the macular hole anatomical reattachment was achieved in 400% of
cases with C2-F6 used as intemal tamponade in primary surgery. When silicone oil was used
as intemal tamponade anatomical reattachment was achieved in 73.68% of cases. Failed cases
of C2-F6 were re-operated using silicone oil as intemal tamponade. The overall success
rate in the cases drained through the macular hole using silicone oil intemal tamponade
was 75%. In the cases drained through a separate retinotomy with silicone oil used as
intemal tamponade anatomical reattachment was achieved in 93.54%. Postoperative visual
acuity was 5160 or better in 40.74% of cases drained through the macular hole and in
58.62% of cases drained through a separate retinotomy.
Conclusions:
Drainage of subretinal flujd through a separate drainage retinotomy resulted in higher
anatomical reattachinent rate and helped to preserve macular flinctions in these myopic
eyes. Myopic macular holes are of a differcnt category from senile macular holes and
constitute 9% of the overall rhegmatogenous retinal detachment cases in our Egyptian
population.
BULL. OPHTHALMOL. SOC. EGYPT, 1997; VOL 90, NUMBER
1, 49-52
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Retinal Detachment with Proliferative Vitreoretinopathy:
Intraoperative and Post operative Complications
Ahmed Magdy Bedda and Hesham F. El Goweini
Purpose: Analysis
of the data of 74 eyes operated for retinal detachment with proliferative
vitreoretinopathy was done in order to find out the complications encountered during and
after surgery. Means to avoid and manage these complications will be discussed.
Methods:
Vitrectomy, peeling of epiretinal membranes and internal tamponade with either
peffluoropropane gas in 60 eyes (83.78%) or silicone oil in 12 eyes (16.22%) was done.
Relaxing retinotomies were done in 3 eyes (4.05%), while a 360 degree retinotomy was done
in one eye (1.35%).
Resufts:
Operative complications included faulty insertion of the infusion cannula in the
subretinal space in 2 eyes (2.70%), comeal epithelial oedema in 10 eyes (13.50%), lens
opacities in 3 eyes (4.05%), iatrogenic breaks in 8 eyes (10.81%), retinal incarceration
in 2 eyes (2.70%) and significant choroidal haemorrhage in 2 eyes (2.70%). Postoperative
complications included keratopathy in 9 eyes (12.16%), cataract in 20 eyes (27 %),
hypotony in 6 eyes (8.1 0%), phthisis bulbi in 2 eyes (2.70%), subretinal peffluorocarbon
liquid (PFC) bubble in one eye (1.35%), silicone oil in anterior chamber in 2 eyes (2.70%)
and failure of retinal reattachment following one procedure was seen in 20 eyes (27%).
Conclusion:
Discussion of the probable causes of these complications and the suitable means to avoid
them were done.
BULL. OPHTHALMOL. SOC. EGYPT, 1997; VOL.90, NUMBER 1, 53-58
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Vitrectomy Techniques for the Management of Posteriorly
Dislocated Intraocular Lenses
Mostafa Hamed Nabih, and Hala El Cheweikh.
Purpose : The
aim of this work is to evaluate the results of surgical management of posteriorly
dislocated lOLs by closed vitrectomy techniques.
Medthod : A
series of 16 patients with extracapsular cataract extraction and IOL imptation complicated
by posterior dislocation of IMP the intraocular lens have been treated surgically by pars
plangia vitrectomy 9 and re- implantation of the PC IOL with scleral fixation in eleven
cases(68.75 %). In two cases (12.5%) the PC IOL was removed and repositioned in the
ciliary sulcus using capsular support. In one case (6.25%) the PC IOL was removed and
exchanged with an AC IOL and in two cases (12.5 %) the PC IOL was removed..
Resufts : All
cases were carried out successfully, the final visual acuity achieved was 6/24 or better
in 10 cases (63 %)0f the repositioned lOLs withscleral fixation.
6 cases (37 %)achieved a final visual
acuity ranging from 6/24 to 6/60 or less in these cases the PC lOLwas removed or exchanged
with an AC IOL the diminution of vision was mainly attributed to comeal decompensation.
Conclusion :
Closed vitrectomy techniques with scleral fixation IOL offers the best chance for visual
rehabilitation in cases of posteriorly dislocated intraocular lenses.
Key words :
Dislocated PC lOLs, pars plana vitrectomy, reposition, scieral fixaidon
BULL. OPHTHAIMOL. SOC.
EGYPT, 1997; VOL.90, NUMBER 1, 59-62
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Long Term Follow-up for Silicone
Filled Eyes.
Dr. Samir El Baha, Dr. Hesham
Farouk Idriss, and Dr. Amin El Karamani
Purpose:
To evaluate the effect of silicone oil injection used for managing
complicated retinal detachments.
Methods: Fiffy
eyes of 50 consecutive patients who underwent pars plana vitrectomy and silicone oil
injection for management of complicated retinal detachments.
Results:
Twenty-four eyes had postoperative Glaucoma Cataract was present in fourty one eyes
Conclusion: Intraocu~ar
pressure elevation and Cataract are common occurrence after intravitreal silicone oil
injection.
BULL.
OPHTHALMOL SOC. EGYPT, 1995; VOL 89, NUMBER 1, 63-67
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The
Incidence and Clinical Manifestations of Diabetic Retinopathy in Myopia
Magdi S. Moussa, and
Yasser R. Scrag
Purpose:
The purpose of this study is to define the incidence and the clinical manifestations of
diabetic involvement of the retina in myopic patients according to the degreeofmyopia.
Methods: One
hundred diabetic patients (170 eyes) with different degrees of myopia were included in
this study. Patients were classified into three groups according to the degree of myopia :
Low-grade myopia (ranged from -1 to -5 diopters) , medium-grade myopia (>-5 to -10
diopters) and high-grade myopia (> -10 diopters). Diabetic changes were recorded in
each group as background, preproliferative or proliferative diabetic retinopathy based on
clinical examination and fluorescein angiography (FA) which was done for all cases. All
patients had diabetes mellitus for at least 10 years with stable refraction.
Results : In the
first group of low grade myopia 60% of eyes showed manifestations of diabetic retinopwith
its different grades: background, preproliferative and proliferative diabetic retinopathy.
In the second group of moderate myopia only 33.5% showed diabetic changes while only 30 %
of eyes showed diabetic changes in high-grade myopia. The seventy of involvement were
lesser in high-grade myopic eyes than in eyes of the other two groups. No proliferative
changes of diabetic retinopathy were observed in the medium or high grade myopia groups.
In high myopia ( > -10 diopters) diabetic changes were minimal compared to the other
groups and only evidenced by fluorescein angiography in some cases. In anisometropic
patients diabetic manifestations were either absent or poorly manifest in the more myopic
eye.
Conclusion: These
findings point out to the role of intraocular status and refraction in the pathogenesis of
diabetic retinopathy and its progression. Diabetic retinopathy is not uncommon in
association with myopia but never reaches the proliferative stage in lughly myopic eyes.
Key Words:
myopia, diabetic retinopathy
BULL. OPIHHALMOL SOC.
EGYPT, 1996; VOL 89, NUMBER 1, 69-74
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Effect of Direct Blunt Ocular Trauma on the Macula
Samir Said Shebl and Lucy Shafik
Hanna
Purpose:
Eye trauma is considered a leading cause of significant visual impairment involving a
large number of population all over the world, yet it has not received the attention it
merits. The aim of this work is to study macular changes which occur after direct blunt
ocular trauma.
Patients and Methods:
Pluorescein angiography and perimetry using the Kowa 3000 automated perimeter was done for
every patient of the study to evaluate the extent of the lesion and to evaluate its effect
on the visual function.
Results: Out of
g2 patients with direct blunt non perforating ocular trauma, 25 patients were suffering
from variable degrees of macular affection. Such affections were commotio retinae in 10
cases, RPE contusion in 4 cases, macular hole in 4 cases, macular scar in 2 cases,
choroidal ruptiffe in 2 cases and RPE atrophy in 2 cases. One of the important findings in
this study was the late presentation (1 to 6 months) of large number of patients (15 cases
) and this may attributed to neglicance and/or misdiagnos.
Conclusion: Although
no treatment exists for many of those macular lesions, preventive measures and early
diagnosis are the first line of management.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; VOL 90, NUMBER 1,75-78
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Argon
Green Laser Photocoagulation for Choroidal Neovascularization Secondary to Age Related
Macular Degeneration
Hesham Elwy and Mahmoud Afifi
Purpose:
To determine the visual outcome, rate of persistent choroidal neovascularization, rate of
recurrent choroidal neovascularization, and complications in eyes undergoing argon green
laser photocoagulation for choroidal neovascularization secondary to age related macular
degeneration.
Methods: Fourteen
eyes with age-related macular degeneration and a well-defined choroidal neovascular
membrane were treated with argon green laser photocoagulation. Follow up ranged from 6 to
16 months (mean 9 months). The membrane was extrafoveal in 6 eyes, and juxtafoveal in 8
eyes.
Results:
Angiographically proved closure of the membrane was achieved in all eyes with extrafoveal
membranes, and in 6 eyes with juxtafoveal membranes. Visual acuity of 6/18 or better was
obtained in 4 eyes with extrafoveal membranes, and in one eye with a juxtafo veal
membrane. Persistent choroidal neovascularization was observed in 2 eyes with juxtafoveal
membranes. Recurrent choroidal neovascularization was observed iji 2 eyes with extrafoveal
membranes, and in 3 eyes with juxtafoveal membranes.
Conclusion: Laser
photocoagulation of choroidal neovascularization secondary to age related macular
degeneration is beneficial in selected cases. However, the relatively high incidence of
recurrence suggests that other lines of treatment have to be introduced.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; VOL.90, NUMBER 1,79-83
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Relationship
between Floaters Light Flashes, Vitreous Pigment Granules and Acute Posterior Vitreous
Detachment
Mahmoad Y. Bayoumi.
Purpose: To
determine the relationship between floaters, light flashes, vitreous pigment grantiles and
retinal breaks associated with PVD.
Methods:
The vitreous and retinal conditions of 251 consecutive symptomatic eyes (240 patients)
were examined to ascertain the relationship between floaters, light flashes, vitreous
pigment granules and acute posterior detachment Of 240 patients, 251 symptomatic eyes were
divided as follows:
gp.
1. 96 with floaters alone: gp. II with floaters and flashes, and gp.III, 67 with flashes
alone. The fellow asymptomatic eyes (gp. Iv), 244 were examined too.
Results : The
prevalence of posterior vitreous detachment associated with retinal breaks was
significantly higher in group II than other groups. Also, by dynamic biomicroscopic
examination of the vitreous. Vitreous pigment granules were found in 88% of cases of acute
vitreous detachment with retinal breaks.
Conclusion: The
presence, of' both floaters and light, flaches carries the highest risk of development of
acute posterior vitreous detachment and retinal breaks amonkg these symptoms, and the
presence of pigment gramules in vitreous is a good indicator of retirnal breaks in these
eyes.
BULL. OPHTHALMOL. SOC. EGYPT, 1997; 90,
NUMBER 1, 91-95
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Threshold
Amsler Grid Testing to Detect Reserving Power of the Macula and Optic Nerve
Moustafa K.
Nassar
Histological studies of the
optic nerve in glaucoma suspects with nonnal finding from kinetic field examination may
have a loss up to 40% of the retinal ganglion cell axon. Astonishingly it is estimated
that no more than 44% of the foveolar neuroretinal thannels are required to have 6/6
vision (2). Thus 6/6 vision is not a prove of having no pathology
Amsler grid testing is a suprathreshoJd
stimulus and on lowering the luminance conditions by viewing the white grid on a black
background through two cross-polarizing filters that create low luminance , change the
condition to Threshold Amsler Grid Testing (TAG ) test.
Methods: A total
number of 273 patients (normal, smoker, diabetics, glaucomatous, thyrotoxic, pale optic
disc, and hereditary chorioretinal dystrophy) with 6/6 vision was tested to detect the
least degree of luminance required by a subject to perceive the small squares of the
Amsler chart.
It is proved that the optic nerve and
macula have their reserving power as any organ in the body and our mission is to search
for the extent of that reserving power.
Conclusion: 6/6
vision in a patient with local or systemic diseases, dose not exclude pathology and
investigations for early diagnoses should be done.
BULL. OPHTHALMOL. SOC.
EGYPT, VOL.90, NUMBER 1,97-101
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Ophthalmic
Colour Doppler in Diabetes
Tarek H.El-Bromboly
& Hamed Ghobran
Purpose:
This study describes haemodynamic characteristics of ophthalmic and central retinal
arteries in diabetic patients. Understanding the haemodynamic characteristics of
retrobulbar circulation in diabetics may help in assessing current therapies and
developing new pharmacological and surgical strategies for diabetes.
Methods: Colour
Doppler imaging - a procedure that permits rapid imaging of ophthalmic and central retinal
arteries.was used to quantitative peak systolic and end diastolic blood flow velocities
and resistive and pulsatility indices within these vessels in 36 diabetic patients and in
11 age - matched control.
Results:
Ophthalmic colour Doppler showed an increase in vascular resistance (pulsatility index) of
both ophthalmic and central retinal arteries in diabetic with proliferate diabetic
retinopathy. We demonstrated also an increase of resistive index of ophthalmic artery with
the progress of diabetes. On the other hand no significant correlation were found between
resistive index of central retinal artery and retinopathy stages.
Conclusion: We
believe that Colour Doppler imaging is a non4nvasive, rapid) and useful technique for
assessing retrobulbar circulation in patients with diabetes. Pulsatility index and
resistive index of ophthalmic artery may be useful inidentification of those patients with
proliferative diabetic retinopathy especially in cases with opaque ocular media.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; 90, NUMBER 1,103-108
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Color
Doppler Imaging in Patients with Proliferative Diabetic Retinopathy and Healthy Volunteers
Alaa F. El-Sayed and Mona A. Nour
El-Dein
Purpose:
To compare blood flow velocities in ocular vessels of proliferative diabetic retinopathy
patients with that of age matched healthy volunteers.
Methods: Color
Doppler imaging was done in twenty patients with proliferative diabetic retinopathy and in
twenty age matched healthy volunteers. Peak systolic and end diastolic velocities were
measured and resistive index was calculated in the ophthalmic, posterior cilliaries and
central retinal arteries.
Results: The
diabetic patients had lower blood velocities than the volunteers.
Conclusion:
Ocular blood 'flow velocity was decreased in diabetic patients with proliferative diabetic
retinopathy.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; 90, NUMBER 1,109-112
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Intraocular
Penetration of Verapamilo
Hamdy A. EI-Koumy , and Mokhtar M.
Mabrouk
Purpose: Is to estimate the concentrations of verapamil
in the aqueous humour) vitreous body) and serum following topical and systemic
administration of the drug.
Material and Methods:
Verapamil drops (0.125%) were topically instilled into 40 eyes of patients planned for
cataract surgery and into both eyes of 40 rabbits. Verapamil ( in a dose of 0.2 mg~kgm
body weight ) were given intramuscularly into another 40 rabbits. Aqueous samples were
collected from rabbits and patients, but vitreous and serum samples were only taken from
rabbits, at 15, 30,45 minutes and I, 2, 3, 4, 6, 8 and 10 hours after drug application .
The drug concentrations were estimated by spectrofluorimetry.
Results: The
aqueous and vitreous concentrations of the drug were much greater after topical
application than following systemic administration . In both routes, the mean peak level
of the drug was higher and ealier than that detected in the vitreous. A little amount of
verapamil was detected in the serum of rabbits after topical intstillation. Human aqueous
drug levels were comparable to those detected in rabbits.
Conclusion: Good
intraocular peneration with minnnal systemic absorption of topically instilled verapamil
0.1 25% may allow clinical uses of the drug for ophthalmic patients without concomitant
cardio vascular disorders.
BULL. OPHTHALMOL
SOC. EGYPT, 1997; VOL 90, NUMBER 1,113-117
BULL. OPHTHALMOL SOC. EGYPT,
1997; VOL 90, NUMBER 1,113-117
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Antioxidant
Vitamins in Axial Myopia
Mohammed S. EI-Balkini , Anhar M. Gomaa,
& Fawzi A El-Shobaki
Purpose:
This work was designed to evaluate the role of antioxidant vitamin S (A, C, E &
0-carotene) in the development of axially myopia in a trial to detect an aetiological
relationship. Age, sex distribution as well as the degree of myopia were put into
consideration.
Methods: Sixty
eight persons suffering from axially myopia were included in this study, seventeen of them
were emmetropic subjects. All subjects were classified into subgroups according to sex,
age and the degree of myopia. They were classified according to age, into 3 subgroups
(<30 yrs, 30-50 & >50 yrs), According to the degree of myopia into 4 groups
(< -2 D, up to -6 D, up t~l0 D and> - 10 D). Antioxidant vitamins were determined in
all subjects.
Results: Our
results showed a significant decrease (P <0.05-P <0.001) of all antioxidant vitamin
levels for the total number of myopic patients. The significant decrease was found in all
age groups and for both sexes. Vitamin C and 0-carotene were particular among other
antioxidant vitamins.
Conclusion: It
was concluded that antioxidant vitamins play a role in the pathogenesis of axial myopia on
the assumption that: (1) Deficiency of antioxidant vitamins might lead to release of lipid
peroxidation products which may have a toxic effect on scleral proteins. (2) Deficiency of
vitamin C might lead to improper crosslinkage of scleral proteins in normal collagen
fibrils. (3) Vitamin C inhibits the glycosylation process of scleral proteins, thus
preventing accumulation of proteoglycans which cause weakness of sclera.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; VOL 90, NUMBER 1,119-123
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Study of Epiretinal
Membranes in Silicone Oil Filled Eyes.
Ahmed Darwish, OmarRashed, and
Ahmed Mohy El-Din
Purpose:
To study, both clinically and histopathologically, epiretinal membranes removed surgically
from eyes previously treated for PYR by vitrectomy and silicone oil tamponade.
Methods: 81
vitrectomized silicone oil filled eyes were followed for 2 years for the development of
epiretinal membranes. The membranes removed from seven of these cases were compared to
those removed from eight PYR cases by light microscopy, using routine and differential
stains, and by electron microscopy.
ResuIts:
Epiretinal membranes were formed most frequently in postAraumatic cases.
Histopathologically the presence of extra-and intracellular silicone oil with occasional
foreign body giant cells is the outstanding feature of epiretinal membranes in silicone
oil filled eyes.
Conclusion: Early
removal of silicone oil is recommended.
BULL. OPHTHALMOL SOC. EGYPT,
1997; VOL 90, NUMBER 1, 125-130
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Chemotherapy
in Management of Intraocular Retinoblastoma - "Preliminary Study"
Abd El-Nasser A., Mohammad Amal E.
Kalefa Sami M Ali
Purpose:
Is to evaluate the efficacy of systemic chemotherapy in treatment of small and moderate
sized ocular retinoblastoma.
Methods: Seven
eyes of four patients with intraocular retinoblastoma were treated with systemic
chemotherapy. The lesion was bilateral in three patients, while unilateral in one patient.
In all cases, the mass volume was less than half of the vitreous cavity. C.T. and ocular
ultrasonography were used to evaluate the mass pre-and post-chemotherapy.
Results: The mass
was completely resoluted in five eyes, while a very small non progressing residue was
reported in two eyes. these findings were documented on repeated C.T. and ultrasonography
over a period of follow up ranging from six months to one year.
Conclusion: This
initial good response makes systemic chemotherapy, a highly promising approach in
management of intraocular retinoblastoma particularly the small or moderate sized tumors.
However, a long term follow up with extension of this preliminary study is essential.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; VOL 90, NUMBER 1,131-135
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Fibronectin
as a Potential Biologic Chorioretinal Tissue Adhesive: An Experimental In-Vivo Study.
Ali M T. ElDiri , and Peter E. Liggett
Purpose:
To study the possible role of the serum component fibronectin (EN) as a potential biologic
chorloretinal tissue adhesive in retinal detachment (RD) Surgery.
Methods: Twenty
pigmented rabbits; divided into 3 groups, underwent lensectomy,3 vitrectomy, large
inferior retinotomy and fluid air exchange. In one group (A), no material was injected
over the edges of the qduced retinotomy (control group), while in the other two groups,
either FN alone; group (B) or EN and subsequent 250,000 autologous cultured rabbit
fibroblasts were injected. In subgroups (B2) and (C2) FN was chemically precipitated out
of the solution over the edges of the induced retinotomy. 4
Results: Varying
degrees of traction retinal detachment (TkD) was reported in all groups during the
follow-up period of 3 months. Healed edges of the induced retinotomy was reported both
clinically and histopathologically in the subgroups (B2) and (C2) in which EN was
chemically precipitated out of the solution.
Conclusion: The
results of our in vivo study have demonstrated another potential function of EN; that is
its chorioretinal adhesive property. However, the technique of EN precipitation needs
flirther investigations especially in the management of recurrent RD.
BULL. OPHTHALMOL.
SOC. EGYPT, 1997; VOL 90, NUMBER 1,137-143
BULL. OPHTHALMOL. SOC. EGYPT,
1997; VOL 90, NUMBER 1,137-143
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Retinal
Tolerance to Short and Long-Term Intravitreal Injection of Perfluorooctane: A
Combined Experimental and Histopathologic Study
Ali M. T. El Diri ,
Hisham FathAllah, Essam Abdul-Ghaffar and Munir Al-Didi
Purpose:
To evaluate the short and longretinal changes after intravitreal injection of
peffluorooctane (PFOC) in vitrectomized rabbit eyes.
Methods: 24
rabbits; divided into 4 groups were subjected to pars plana vitrectomy and intravitreal
injection of 1.5-2 CC of PFOC in three groups and of small d~oplets (0.2~ CC) injected in
the fourth group. Regular follow-up was done by indirect ophthalmoscopy for 2-3 weeks.
Histopatliologic sections of these rabbit retinae were then evaluated and studied.
Results: Short-term
(between 2 hours and 3 days) of intravitreal injection of 1.5-2 CC, as well as long4erm
injection (2-3 weeks) of small amount (0.25 CC) of PFOC revealed no retinal changes to be
compared to the long4enn changes as focal or difluse retinal thinning; indicating retinal
toxicity.
Conclusion: PFOC
retinal toxicity is a time-related factor, residual droplets which might be left following
the operation showed no deleterious retinal effects. We assumed that, it is the mechanical
rather than the chemical effect of PFOC that carried the potential role for these retinal
changes. We recommended that, PFOC should be removed after being used as an intraoperative
tool in complicated retinal detachment surgery.If this perfluorocarbon liquid (PFCL) has
to be left inside the eye to achieve more prolonged tamponading effect, it should be
removed within 3-5 days maximally; otherwise toxic retinal changes would defmitely occur.
Keywords: Perfluorocarbon
liquids-retinal toxicity.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; VOL 90, NUMBER 1,145-150
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Readout
of Photographic Fundus Image. in Myopes Using the Microdensitometer
Hisham Gamal El Din, and
Neveen Mostafa Sabra
Purpose:
To we the microdensitometer to read out the photonegatives of the fundes of myopic
patients.
Methods: Thirteen
myopic patients were elamined fimdes photography was done using microdensitometer and data
record was fed to a computer with special program to represent it in a 3 dimentional curve
plot.
Results: Six
cases with retinal degeneration showed marked changes in thin curve plott, 3 cases with
minimal retinal changes also showed moderate changes in them curve and and even the cases
with normal fundees showed light charges in their curve.
Conclusion: What
ever the degree of myopia, almost all myopic patients may have certain degree of changes
which may not be apparent to ophthalmobgist. by clinical examination and thus follow up to
all myopic patients is recommended.
BULL. OPHTHALMOL. SOC. EGYPT,
1997; VOL 90, NUMBER 1,151-154
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Experimental
Histopathological Study of Conditions Predisposing to Serous Retinal Detachment (Electron
Microscopic Study)
Sahar M. Mansour , Anisa S. Mohamed and
Rawia A. H. Mohamed
Objective: To
evaluate the conditions necessary for the formation of retinal serous detachments.
Methods: Selective
injury to the retinal pigment epithelium (RPE) and choriocapillaris was produced in
rabbits using weak laser bums and intense diffuse light with or without
photosensitizfation with rose bengal. The flindi were analysed by tluorescein angiography,
light and electron microscopic examination.
Resufts: Injury
of the RPE alone did not cause detachment. Degenerative changes of RPE and discontinuity
of Bruch9s membrane were detected by electron microscopy. Focal injury to RPE
and choriocapilaris caused moderate detachment only when an area surrounding the focal
leakage site had been sub jected to light damage. Here, the choroidal blood vessels and
choriocapilaris were widened while Bruch's membrane was continuous. Diffuse injury to RPE
and choriocapilaris caused broader detachments and obvious thrombosis in the lumen of
choroidal blood vessels. Bruch's membrane appeared electron dense.
Conclusion: Four
conditions are necessary for serous detachment to from. (I) A defect in the blood retinal
barrier. (2) A sourse of fluid pressure. (3) Impairment of fluid transport beyond the site
of leakage. (4) Abnorm8lity of the retinal adhesive force.
BULL. OPHTHALMOL. SOC. EGYPT,
1997; VOL.90, NUMBER 1,155-161
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Posterior
Vitreous Detachment among Diabetics
Omar Afify , M. Abd El Ghany and
Waleed Nada
Purpose: To
detect posterior vitreous detachment (PVD) in diabetic retinopathy and diabetic macular
edema, influence of age of the patient and duration of diabetes on PVD and the role of PVD
in retinal and disc neovascularization in diabetic retinopathy.
Methods: Slit
lamp biomicroscopy and B - scaii ultrasonography were used to detect PVD (no, partial or
complete) in 100 eyes (50 diabetic patients).
Results: In non
proliferative diabetic retinopathy (NPDR) :75 % had no PVD, 10.7% had partial PVD and
14.3% had complete PYD. In proliferative diabetic retinopathy (PDR) 31.6% had no PYD,
42.1% had partial PVD and 26.3% had complete PVD.The relation between PVD and age of the
patient and duration of diabetes was statistically insignificant (P > 0.05). No PVD was
found in 76.9 % of eyes with diabetic macular Iedema. During a mean follow up of6 months
no neovascularization developed.
Conclusion:
Partial PVD has considerably more influence on proliferative changes than complete PVD.
Complete PVD may prevent retinal or disc neovascularization in diabetic retinopathy.
Complete PVD Protect diabetics from macular edema.
BULL. OPHTHALMOL. SOC.
EGYPT, 1997; VOL 90, NUMBER 1,163-166
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