BULL.
OPHTHALAMOLOGICAL SOCEITY EGYPT, 1997; 90, NUMBER 5 |
Color-Doppler
Imaging of the Central Retinal Artery in Patients with Open-Angle Glaucoma
Hala El-Mofiy , Ahmed Emad Mahfouz.
Purpose: The aim of our study was to
evaluate the circulation in the central retinal artery (CRA) in patients with open-angle
glaucoma and to correlate the findings with the intraocular pressure, field, and CID
changes
Methods: Forty-eight eyes of 24
patients (14 patients with open-angle glaucoma and 10 normal volunteers) were subjected to
full ophthalmological examination. The patients were then referred for color Doppler
imaging for the measurement of the peak-systolic velocity (PSV), end-diastolic velocity
(EDV), and resistivity index (RI).
Resufts: Our study has shown lower PSV
(p<0.05), lower EDV (p <0.05), and higher RI (p < 0.05) in the glaucoma patients
compared to the normal. Fundus ratio correlated positively with RI and negatively with
both PSV and EDV (r= -0.5).
Conclusion: There is definitely reduced
velocity and an increased resistance to flow in the CRA in patients with open-angle
glaucoma. The reduced blood velocity may be secondary as well as contributory to
glaucomatous optic nerve damage.
Key Words: Glaucoma, Color-Doppler
imaging, Optic nerve, Central retinal artery.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,653-657
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A
Comparative Study of Diurnal Pattern of Blood Pressure and Intraocular Pressure in
Glaucoma Patients
Moones A. Ali , Iman A. Fahmy & Tarek
Youssef
Purpose: Assuming that human circadian
rhythms affect both diurnal intraocular pressure (lOP), and blood pressure (B.P) curves
similarly, we aimed at finding a relation between both, in normal population and
glaucomatous patients, to evaluate the vascular theory of glaucoma.
Methods: Diurnal lOP and B.P curves of
869 primary open angle glaucoma (POAG), 157 normal tension glaucoma (NTG) patients and 49
normal controls were retrospectively studied. Four readings including maximum and minimum
diurnal lOP and B P mean readings were taken and statistically analysed.
Results: The results showed a definite
correlation between diurnal lOP and B.P giving mean peaks in the morning hours and troughs
in the afternoon. There was a significant difference between the mean peak and trough
values of both lOP and B. P within each group (P< 0.001). This magnitude of change was
also significantly different between groups for lOP only (P< 0.001).
Conclusion: With the known nocturnal
drop of B.P, with stable lOP, the rise of lOP in the early morning shown in the results
favors the vascular theory of pathogenesis of glaucoma specially with normal tension
assuming low perfusion pressure of the optic nerve head more than the nerve can tolerate.
Key words: Diurnal intraocular
pressure, diurnal blood pressure, primary open angle glaucoma, normal tension glaucoma.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,659-663
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Kinetic Versus Static
Perimetry in Open Angle Glaucoma
Soheir M. Esmat and Ehsan M. El Mehelmy
Purpose:
To evaluate and compare field changes in open angle glaucoma patients using kinetic and
static perimeters.
Methods: 42 eyes of
23 patients having primary open angle glaucoma were sui~ected to visual field testing
using Goldmann kinetic and automated Humphrey static perimeters. Follow up was done after
three and six months. Results were tabulated and statistically analyzed.
Results: Both
methods were acceptable in detection of scotomata size and location.
However, static automated perimetry was more
efficient in showing changes in generalized depression of retinal sensitivity and
enlargement and baring of the blind spot. Static perimetry was also more reliable in
detecting increased depth of scotomata during the follow up period.
Conclusion: Kinetic
perimetry is an arcuate and fast method for diagnosis and follow up of visual field
defects in open angle glaucoma, however static perimetry may be helpfiil in detection of
generalized depression of retinal sensitivity and baring of blind spot.
Key words : kinetic
perimetry, static perimetry, field defects.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,665-668
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Transscleral
Contact Diode Laser Cyclophotocoagulation for Intractable Glaucoma
Amr S. Abdel Hakim and Soheir M. Esmat
Purpose: To evaluate the efficacy of
the contact transscleral diode laser cyclophotocoagulation to achieve a control or
reduction of intraocular pressure (lOP) in uncontrolled glaucoma cases.
Methods: This study included 18 eyes of
16 patients (11 females and 5 males) suffering from uncontrolled rise of intraocular
pressure inspite of flill medical treatment or surgical approaches Ages ranged from 25-56
years. All cases had full ophthaliiiic examination, received contact transscleral diode
cyclophotocoagulation in the form of 18-20 applications in 180 degrees. Follow up of
intraocular pressure and postoperative inflammatory reaction was done up to 3 months.
Results were statistically evaluated.
Results: Significant reduction of
intraocular pressure following application of contact transscleral diode laser
cyclophotocoagulation was found. lOP was controlled in 16 eyes (88.8%) and significantly
reduced in 2 eyes (11.1%). Mild to moderate anterior uveitis and conjuctival oedema was
reported and was resolved on steroid drops.
Conclusion: Semiconductor diode laser
can be efficiently used for contact transscleral cyclophotocoagulation to reduce or
control resisting elevated intraocular pressure.
Key words: Diode-laser-
cyclophotocoagulation~ Intractable glaucoma.
BULL. OPHTHALMOL. SOC.
EGYPT; 1997; VOL 90, NUMBER 5,669-672
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Site of Mitomycin-C Application during Trabeculectomy
Hesham F. Elgoweini and Amgad M. Dowidar
Purpose: The
anti-neoplastic drug mitomycin-C (MMC) is an excellent option to modulate
post-trabeculectomy wound healing especially in eyes with poor surgical prognosis.
Recommendations as to the site of application of MMC during trabeculectomy vary. The
outcome and complications of trabeculectomy performed with episcleral versus scleral bed
application of MMC were compared.
Methods: Twenty eyes
of patients at risk for failure of glaucoma filtering surgery were included in the study.
In ten eyes, MMC was applied before scleral flap dissection i.e. episclerally. In the
other ten eyes, MMC was applied after flap dissection i.e. in the scleral bed. The success
of the procedure was evaluated by the bleb formed and the level of intraocular pressure.
The follow up period ranged from 6 to 8 months.
Results: Complete
success was defined as an intraocular pressure of 21 mmHg or less without glaucoma
medications, whereas a qualified success was defined as the same intraocular pressure with
medications. The rate of complete success was 50% in the episcleral group and 70% in the
scleral bed group. The rate of qualified success was 30% and 20% respectively and for
failure was 20% and 10% respectively.
Conclusion: During
trabeculectomy, applying MMC after scleral flap dissection appeared to be safe and
effective with a good success rate.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,673-676
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Is Glaucoma
Filtering Operation Risky for Patients with Advanced Visual Field Involvement?
Ahmed T. Shoeir
Purpose: This study was conducted to
evaluate the likelihood of visual loss following trabeculectomy for glaucoma with advanced
field defect.
Methods: Fifteen cases with advanced
glaucomatous field changes and uncontrolled intraocular pressure inspite of using maximum
tolerable medical treatment were subjected to subscleral trabeculectomy. They were
followed up for periods ranging between 3 months and 2 years.
Results: Non of the fifteen operated
upon eyes showed sudden, marked loss in visual acuity in the early postoperative period.
Two cases showed mild deterioration in visual acuity and field of vision due to
progression of cataract.
Conclusion: Subscleral trabeculectomy
with the modern surgical techniques proved to be a safe procedure for glaucomatous
patients with advanced field involvement.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,677-680
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Topical and
Intracameral Anesthesia for Glaucoma Filtering Surgery
Ahmed M.K. El Neil, Adel Kamal Abdeen, Ali
Khaleil Awadalla and M. Magdy Morshid
Purpose:
To evaluate the efficacy and complications of topical and intracameral anesthesia Vs.
retrobulbar anesthesia for glaucoma filtering surgery.
Methods: 50 patients
with chronic open angle and chronic closed angle glaucoma were randomly divided into 2
groups. In group I, retrobulbar anesthesia was used, while in group II, topical and
intracameral anesthesia was performed. Orbicularis and ocular akinesia, sensory
anesthesia, lOP and need for block supplementation were evaluated in the two groups.
Results: The results
demonstrated that retrobulbar anesthesia was a more effective technique as regards ocular
akinesia, but the rate of complications was less with the topical and intracameral
anesthesia.
Conclusion: Topical
and intracameral anesthesia may be considered as a good alternative to retrobulbar
anesthesia for glaucoma filtering surgery.
Keywords:
retrobulbar- topical- intracameral- anesthesia-akinesia.
BULL. OPHTHALMOL. SOC.
EGYPT; 1997; VOL 90, NUMBER 5,681-684
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Early Hypotony
after Trabeculectomy
Ali Ahmed Fathy
Purpose:
The clinical picture of hypotony after different types of glaucoma surgery is usually
characterized by concomitant development of one or more of the following complications:
extensive filtration through the operated area, shallow anterior chamber and choroidal
detachment. Two types of hypotony following trabeculectomy have been described: The
transient (early) which may last from 1 day to about 2 weeks after operation and the
persistent one. The aim of the present study was to define the occurrence of early
hypotony after trabeculectomy to determine if there were any factors related to the
hypotony and to evaluate the frnal intraocular pressure (1OP) attarned without and
cataract formation in the four study groups.
Methods: 60 patients
had undergone trabeculectomy operation (28 males and 32 females). The average lOP at
operation was 29.0i6.6 mmHg (range 20-51 mmHg). Data were collected in sheets and
analyzed.
Result: 31 patients
(52%) had lOP < 10 mmHg and 17 of them had marked hypotony (lOP <5 mmHg) on the
first postoperative day.
One week after operation, the lOP was <~ 5
mmHg in about one third of the eyes.
The average lOP at the last visit (about 2
years after operation) was 18.0~.0 mmHg.
Conclusions: About half of the glaucoma eyes
undergo a period of hypotony early after trabeculectomy despite the low prevalence of
flattening of anterior chamber.
· In a high pereentage of eyes, hypotony is
'marked (<5 mmHg) and lasts for 1-2 weeks after surgery.
· The eyes with early marked hypotony achieve
almost the same fmal untreated lOP as the eyes with slight hypotony or normotony.
· Cataract formation after operation is seen
in about half of the eyes and is not related to hypotony, anterior chamber depth of
hyphema after operation. However, the eyes with flat anterior chamber have a higher risk
of cornealens touch.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,685-689
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Contrast
Sensitivity as a Useful Clinical Tool in the Assessment of Visual Performance
Azza Shihab and Mohamed Ehab Elewa
Purpose:
The aim of the present work is to prove that contrast sensitivity testing is more
sensitive to visual changes and problems than ordinary visual acuity testing.
Method: The test was
performed in a well-lit surrounding. The patient wore his glasses. Each eye was tested
separately. Results were recorded and contrast sensitivity flinction was plotted for each
eye and compared to normal data.
Results: Patients
with definite eye disease had a significant changes in contrast sensitivity even with
normal visual acuity. Changes were either for the whole spatial frequency range or
selectively affecting low, intermediate, or high spatial frequency ranges.
Conclusion: Contrast
sensitivity testing should be performed for every patient instead of the usual visual
acuity testing. Contrast sensitivity flinction is a complete test for the visual
performance in real world situations.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,691-694
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Relaxing
Incision for Astigmatic Correction
Khaled A. Nagy and Alaa El-Dorghamy
Purpose: To evaluate the effect of
Relaxing Incision for the control of astigmatism
Methods: 20 patients were included in
our study, with high degree of astigmatism, either post-keratoplasty, post- cataract or
mere astigmatism.
Astigmatism was documented by keratometry,
auto-refractometer and some cases with corneal mapping. Corneal pachymetery to evaluate
corn. thickness was done.
Surgical technique: RJ was done to flatten the
steep meridian according to the degree of astigmatism. postoperative follow up for 2w, 2m,
6m to evaluate the degree of astigmatism.
Results: The mean pre-operative
astigmat. was (6.22 + 0.2) D, the mean postoperative astigmat. was (2.16 f 0.1) D. So that
Astigmatism was significantly reduced by (4.02 f 0.1) D, after 6 m, follow up.
Conclusion: R.I is very effective, safe
and reliable method to control astigmatism.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,695-697
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Centripetal
Incisions Versus Centrifugal Incisions in Radial Keratotomy
Hesham Ibrahim Abu-Hussain
Purpose:
This study aimed to compare between the centripetal and centrifligal incisions in radial
keratotomy ~K) regarding the refractive correction and complications.
Methods: 30 eyes of
moderate myopia (5.00 to -8.00 diopters ) without astigmatism were treated by RK. They
were divided into two groups: Group A; 15 eyes with centripetal incisions, and Group B; 15
eyes with centrifligal incisions. Incisions were executed by a double-edged diamond blade
with a micrometer. Thorough ophthalmological examination was done in all eyes.
Retinoscopy, corneal ultrasonic pachymetry, and corneal topography were mandatory. I used
the same nomogram and the same diamond blade for all eyes.
Results: This study
disclosed that centrifligal incisions carried less intraoperative hazards but tended to
undercorrection of myopia. Centripetal incisions were difficult to achieve and had a more
risk of perforation and extension into the clear zone although they gave a slightly more
refractive correction. The difference between both groups were statistically
insignificant.
Conclusion:
Centripetal incision technique gives a little increased refractive correction more than
centrifligal one. The centrifligal incision technique is safer and easy to perform than
the centripetal one.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,699-702
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Epithelial Growth under the
Corneal Flap after LASIK
Mounir Ahmed Khalifa, Mohamed Farouk El-Ashry,
and Sherif Lotfy Bayoumi.
Purpose: To report the occurrence,
follow up, and management of ectopic interface epithelial growth after laser in situ
keratomileusis (LASIK).
Methods: A retrospective study of 82
eyes in 52 patients; 30 patients with bilateral myopia and 22 patients with unilateral
high myopia. All the cases received LASIK using Chiron automated corneal shaper and Summet
Omnimed excimer Laser.
Resufts: The mean follow up time was
8.2 months. One case developed epithelial growth within the interface affecting the
central cornea. It is managed by blade scraping, irrigation and excimer laser interface
ablation. Histopathology of the removed specimen showed corneal epithelial cells with
cystic degenerations.
Conclusion: Epithelial growth within
the lamellar interface is a significant complication after LASIK.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,703-706
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Cycloplegic
Refraction in Children is it a Must?
Yasser R.Serag
As accomodation is greater in children than
adults, it is of great importance to use cycloplegic drugs to refract them accurately.
Purpose: This study was conducted to
evaluate the necessity of cycloplegic refraction in children and the easiest method for
inducing cycloplegia with minimal complications.
Patients and Methods: One thousand
child were included in this study. Their age ranged from 1.5 to 15 years. They were
divided into three groups accordin~ to their age: Group I from 1.5 to 5 years, Group II
above 5 to 10 years and Group ifi above 10 to 15 years. They were flirther classified into
three sub groups: Subgroup A received cyclopentolate hydrochloride 1% for two days,
Subgroup B received cyclopentolate hydrochloride 1% for three days and Subgroup C received
cyclopentolate hydrochloride 1% and phenyl ephrine 10% once before refraction by 30-45
minutes.
Results: There was a statistical
significant difference between cycloplegic and non cycloplegic refraction in the three
groups (p<0.05). The largest difference was in the group of hypermetropic children.
There was no statistical significant difference between cycloplegic refraction in the
three groups as regards their cycloplegic effect (p>0.05).
Conclus: Cycloplegia is a must in all
children for accurate refraction especially under 15 years of age and in hypermetropic
children. Using cyclopentolate hydrochloride 1% - phenyl ephrine hydrochloride 10%
combination once would make cycloplegic refraction an easy, safe procedure with great
accuracy.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,707-710
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Migraine and
Errors of Refraction
Shaker A. Khedr, Magda M. Sami, Hany M.
El-Ibiary, and Hatem I El-Khateeb
Purpose:
Study the relation between migraine and errors of refraction and to assess the potential
benefits of correct of such errors on the course of the disease.
Methods: One hundred
migrainous ametropic patients were selected and subjected to full ophthalmological
examination for 3 months follow-up after perfect optical correction of their errors.
Results: 23 patients
showed improvement of one or more of migraine symptoms. The most commonest symptoms showed
improvement was reduction of frequency of migraine attacks.
Conclusion: We can
conclude that there are slight improvement of migraine symptoms specially frequency, most
commonly in small errors, hypermetropia and hypermetropic astigmatism.
BULL. OPHTHALMOL. SOC.
EGYPT; 1997; VOL 90, NUMBER 5,711-714
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The Effect of
Flat Anterior Chamber on the Success of Trabeculectomy
Ali Ahmed Fathy and Ahmed A. Khallaf
Purpose: A flat anterior
chamber (AC) is common following trabeculectomy. Serious problems such as cataract
formation, corneal endothelial loss and peripheral anterior synechiae formation will
result if the AC is not restored promptly. Treatment modalities include cycloplegia,
pressure patching, scleral shelf and surgical intervention such as reformation of the AC
and choroidal tap. The aim of the present work was to evaluate the effect of flat AC on
the success of trabeculectomy and to find factors affecting the postoperative flat AC
formation.
Methods: Standard
trabeculectomy was done for 70 eyes in a period of 18 months. They were divided into 2
groups: flat AC group (23 eyes) and formed AC group (47 eyes) control group. Flat AC was
graded according to Spaeth's grading into 3 grades: I, II and ifi. Intraocular pressure
(lOP) was measured preoperatively, intraoperatively and postoperatively (follow up for 18
months).
Results: Age, sex, type of
glaucoma, type of conjunctival flap, shape of partial thickness scleral flap and wound
leak were not significantly different between the two groups. However, preoperative lOP
was significantly higher in flat AC group.
Conclusions: The postoperative
shallowness of the AC seemed to have no influence on the outcome of trabeculectomy and the
grade of flat AC did not affect the postoperative outcome. The postoperative iridocorneal
apposition pese is not the cause of early failure and the exact mechanisms of the effect
of flat AC on the success of trabeculectomy remains to be determined.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,715-718
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Selective Laser
Trabeculoplasty
Mounir A. Khalifa.
Purpose: Evaluate the effect of a
new technique called selective laser trabeculoplasty ( SLT) in the treatment of primary
open angle glaucoma (POAG).
Methods: 30 cases of bilateral POAG
were enrolled in a prospective study; 9 cases out of these 30 had had failed argon laser
trabeculoplasty (ALT). The eye with worst lOP and field defects received SLT and the other
eye used as a control.
Results: There was rapid reduction of
lOP, about 30 %, either in cases received only SLT or SLT after ALT. This reduction was
maintained till 4 months postoperatively.
Complications were:occasional spikes of
elevated lOP (20 %), transient blurred vision
(30 %), and anterior chamber cells and flare
(30 %).
Conclusions: SLT is a promising
alternative for the treatment of POAG. The technique needs longer follow up for more
evaluation.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,719-722
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Visual
Evoked Potential Changes before and after Treatment of Different Stages of Primary Open
Angle Glaucoma
Said Mohammad Shalaby , Abdel Basset
El Naggar , Mostafa Abdel Hafiz El Gohary and Abdel Aal Darwish
Purpose: Recording of the VEP have
proved very valuable in assessing glaucomatous damage of the optic nerve since a
significant delay may occur in the components of the response and so the aim of this work
was to correlate these changes to the clinical fmdings and evaluating these changes after
treatment
Methods: 27 patients (40 eyes ) were
included and were divided into 4 groups each contained 10 eyes: control, mild , moderate,
and severely glaucomatous. They were assessed by routine ophthalmologic examination
tonometry,Goldmann perimetry and PR-VEP before and after treatment.
Results: The latency of VEP was more
affected than the amplitude and no considerable changes occur after treatment.
Conclusion: VEP is a very useful
objective complementary rather than a substitute to primetry in evaluation and follow up
of patients with POAG.
Key words: Primary open angle
glaucoma-Visual evoked response Glaucoma treatment-Glaucoma
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,723-728
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Color
Perimetry in Glaucoma Suspects
Adel A. Selima, El-Said I El-Desouky &
Abdel-Basset M. El-Naggar.
Purpose : To compare the overall
central color perimetry procedure for both mean deviation and defective points in normal
and glaucoma suspect.
Methods: Twinty four patients, 10
control and 14 Glaucoma suspects underwent color perimetry.
Results: Glaucoma suspects showed
manifested field defect by blue perimetry which is highly significant (P<0.001) if
compared to their white and red visual field.
Conclusion: short wavelength blue color
perimetry is more sensitive than standard white perimetry for detecting glaucoma suspects
at risk when their white visual fields are normal.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,729-731
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Comparative
Study between Latanoprost and Timolol as B-blocker in Patients with Primary Open Angle
glaucoma
Ahmed Tarek El-Emary and Tarek Mouneer
Shaarawy
Purpose: Latanoprost
is an ester prodrug analogue of prostaglandin F2 alpha which effectively reduces
intraocular pressure(IOP) by increasing uveoscleral outflow rather than altering
conventional trabeculo-canalicular aqueous outflow. We tried to compare the lOP reducing
effect and side-effects of Latanoprost, with those of B-blocker.
Methods: Twenty nine
glaucomatous patients, were divided into two groups. One receiving Latanoprost 0.005% once
daily, and the other receiving Timolol 0.5% administered twice daily. The first group was
further subdivided in two groups, one receiving a morning single dose and the other
receiving an evening single dose, the lOP was evaluated by applanation tonometer.
Results: The ocular
hypotensive effect of Latanoprost administered once daily was at least as effective, or
slightly superior to Timolol 0.5% administered twice daily. Evening single dose was
superior to morning single dose of Latanoprost. There was no significant difference in
conjunctival hyperemia between the two groups and there were few subjective symptoms in
any of the patients.
Conclusion:
Latanoprost offers a considerable advantage of a single dose regimen in reducing the lOP,
but its wide spread use is currently hindered by its high cost, and its comparative study
between Latanoprost and Timolol as ~-blocker in patients with primary open angle glaucoma
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,733-737
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Non-Penetrating
Trabeculectomy with Mitomycin in Cases of Open-Angle Glaucoma
Mohamed Saad Morsy
Purpose:
Mitomycin-C (MMC) is an excellent option to modulate posttrabeculectomy wound healing. The
outcomes of non-penetrating trabeculectomy performed with or without the application of
MMC were compared.
Methods: 24 eyes of
24 patients with uncontrolled primary open - angle glaucoma were randoraly assigned either
to non-penetrating trabeculectomy alone or with the application of MMC. The mean follow-up
was about 10 months in both groups. Success was defmded as an intraocular pressure of 21
InIdIg or less without glaucoma medications.
Results: The rates
of success were 50% in the non-penetrating trabeculectomy group without MMC versus 76% in
the group where MMC was used.
Conclusion: The
application of MMC significantly improved the success rate of non-penetrating
trabeculectomy in patients with primary open-angle glaucoma.
BULL. OPHTHALMOL. SOC.
EGYPT; 1997; VOL 90, NUMBER 5,739-741
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Laser Suture
Lysis after Trabeculectomy
AbdullaH. Hamed
Purpose:
To evaluate the efficacy of laser suture lysis in lowering the intraocular pressure and
promotion of bleb formation after tight scleral flap trabeculectomy and its complications.
Methods: The study
included 20 eyes of 20 patients that underwent tight scleral flap trabeculectomy Laser
suture lysis was indicated if after a trial period of ocular massage the intraocular
pressure was > 21 mmHg in the presence of a deep quiet anterior chamber with no bleb
formation following trabeculectomy. Suture lysis was performed using argon laser and a
Hoskins lens.
Results: Following
trabeculectomy 14 eyes (70%) required laser lysis of the scleral flap sutures. In these 14
eye the mean preoperative intraocular pressure was 33.6 f 5.5 mmHg whereas postoperative
and pre-laser treatment mean intraocular pressure was 28.2 i 4.5 mmHg. Laser suture lysis
was done successfully in 13 eyes and failed in one eye.
Immediately following suture lysis the mean
intraocular pressure dropped to 10.4 j 4.6 mmHg with good functioning blebs in all 13
treated eyes. After a mean follow up of 8 + 6.6 months intraocular pressure was controlled
in 10 the 13 eyes treated (77%). The complication that occurred included shallowing of
anterior chamber in 2 eyes (15%), conjunctival wound leak in 1 eye (7.5%), and complicated
cataract in eye (7.5%).
Conclusion: Laser
suture lysis after tight scleral flap trabeculectomy is a safe and effective method of
promoting filtration following trabeculectomy.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,743-746
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Early Trabeculectomy in
Treatment of Open Angle Glaucoma (OAG)
M. Magdy Morshed, Hassan Ali Zaki and Ahmed
M.K. El-Neil
Purpose: The concept that
OAG is a medical problem has been changed in the last years. Here we suggest the early
surgical interference as an alternative instead of waiting with medical treatment.
Methods: 23 eyes of 20
patients were included in this study, classified into 2 groups. Group I: 12 eyes of 10,
patients were treated with trabeculectomy after period of medical treatment more than 1
year (2.5 years) group 11:11 eyes of 10 patients operated with trabeculectomy after
medical treatment for less than 1 year (0.7 years).
Results: The results as
regard the visual outcome, LO.P, field changes and complications were better in the group
with short time medical treatment before the operation.
Conclusion: Early surgical
interference in OAG gives better functional results than late surgery after long time of
medical treatment.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,747-749
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Low Tension
Glaucoma : A Magnetic Resonance and Colour Doppler Imaging Study
Kamal A.M. Soliman, and Khaled M.
Shawky
Purpose: To search for a
vascular evidence (s) in the pathogenesis of low tension glaucoma (LTG) by studing the
results of brain magnetic resonance imaging (MRI) and the colour Doppler imaging (CDI) of
the retrobulbar circulation.
Methods: The study involved
12 patients with low tension glaucoma and 12 normal controls of same age and gender
distribution . Axial and midsagittal MRI scans were performed for every case . The deep
white matter lesions were graded from 0 to 3 and the corpus callosum thickness was
measured. CDI was performed using a 7.5 MHz transducer, and the resistance index was
calculated in both the ophthalmic and central retinal arteries.
Results: The number and
extent of cerebral ischaemic lesions were significantly more in LTG patients (p < 0.05
). The body of the corpus callosum was significantly thinner in patients with LTG (p <
0.05). The resistance index was significantly higher (p <0.05) in LTG patients.
Conclusion: The significantly
greater cerebral ischaemic lesions and higher resistance in the ophthalmic and central
retinal arteries add more evidences for the vascular aetiology involved in LTG. Further
research is needed to explain this vascular pathogenesis.
Key words: Low tension
glaucoma, brain MRI, ophthalmic artery CDI, ischaemic cerebral lesions.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,751-755
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Non-Traditional
Criteria for Evaluation of Visual Field Changes after Argon Laser Trabeculoplasty
Nashwa M. Lamie and Adel M. Abd
El-Wahab
Purpose: To evaluate
visual field changes after argon laser trabeculoplasty in patients with open angle
glaucoma.
Patients and Methods:
A prospective study was carried out on 38 eyes with primary open angle glaucoma for argon
laser trabeculoplasty. All patients had glaucomatous visual field defects with inadequate
medical control for intraocular pressure. Automated perimetry was performed before laser
treatment, then at 1,3,6,12 and 18 months after treatment.
The criteria for diagnosis and follow up of a
reliably performed glaucomatous visual field include 2 or more contiguous points with a 10
dB loss or greater in superior or inferior arcuate zones or 3 or more contiguous points
with 5 dB loss or greater in the superior or inferior arcuate zones.
Results: Intraocular
pressure (lOP) showed a statistically significant reduction after laser therapy. Visual
field improvement was observed in 6 eyes at one month and 18 eyes after 6 months of laser
treatment. Thirteen eyes showed stable visual field, while 7 eyes showed progressive
visual field deterioration during the follow up period. There was a statistically
significant relationship between visual field improvement and the depth of visual field
defects , the early the visual field defect the higher is the incidence of post laser
improvement.
Conclusion: Argon
laser trabeculoplasty may be very beneficial in control of lOP and improvement of visual
field, particularly with early visual field defect.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,757-761
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Phacoemulsification -
Complication of the Procedure
Mohsen Gaber
Purpose: The more
experience is gained by shifting to phacoemulsification procedure, the more complications
and difficulties are encountered. The aim of the work is tO show these difficulties and
the possible ways of avoiding them.
Patients and Methods:
Thirty cases of cataract extraction that were done with phacoemulsification procedure over
8 months of follow up. Twenty five cases were done with the use of all PMMA intraocular
lens 5.0 mm one piece. Five cases were done with the use of soft intraocular lens use. The
grade of nucleus hardness was between grade, I, II and five cases only of grade ll-W
nuclei. The difficulties of procedure and complications were enrolled.
Discussion and Results:
The results of the procedure over all show that it is feasible to shift to
phaccemulsification with the right procedure and selection of cases and the know how of
the machine and sterilizations pits are also mentioned in this thesis.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,763-765
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Scleral
Tunnel Versus Clear Corneal Incision in Phacoemulsification with Rigid and Foldable I.O.L.
Riad Fikry and Hani Nasr
Purpose: This
paper compares scleral tunnel to clear corneal incision in
phacoemulsificafion regarding advantages,
difficulties and inconveniences of each approach with rigid and foldable I.O.L.
Methods: This work
describes the technique of both incisions used in 64 eyes with implantation of both rigid
and foldable LO.L.
Results: This work
shows the results with both incisions regarding operative difficulties, post-operative
reaction and astigmatism.
Conclusion: Corneal
incision in phacoemulsification is easier to perform with less operative difficulties and
compares well with scleral tunnel incision with respect to visual acuity, astigmatism and
complications.
BULL. OPHTHALMOL. SOC.
EGYPT; 1997; VOL 90, NUMBER 5,767-770
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A Direct -
Closed Technique for Scleral Fixation Intraocular Lens Implantation
Essam A. Baddour; and Nader R El-Metwally
Purpose: Scieral
fixation of PC4OLs has been considered as an alterative for avoiding potential
complications of AC-IOL and in the absence of sufficient irjs support for an AC lens.
Several methods of trans-scieral suture fixation of PC-IOL have been developed and refmed
recently. This report describes a direct method for suture fixation with several
advantages.
Methods:
Thirty-three eyes (33 patients) underwent scleral fixation PC4OL implantation adopting a
new modified direct approach through a closed globe Cperative details are described.
The follow-up period ranged from 4-27 months
(mean 11.5) months.
Results: Twenty-two
patients had a postoperative V.A of 6/18 or better. No distressing difficulties had been
noticed during surgery. No major complications such as retinal detachment, secondary
glaucoma, comeal decompensation, chronic uveitis or suture related problems were observed
. Trace amounts of bleeding at the time of surgery occurred in few cases . All lOLs were
perfectly centered. Only one case showed mild tilt.
Conclusions: This
direct closed technique for scleral fixation of PC-IOL is safe, rather easy4o-do, with
minimal operative manipulations and postoperative complications.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,771-774
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Dialing vs Non-Dialing
in Posterior Chamber IOL Implantation
M Sherif Elwan, Sameer Kassem and Rafeek
El-Ghazawi
Purpose: Dialing is
the rotation of an intra~ular lens (IOL) after introduction. It may be utilized as a
method of introduction, to verif~ that the lens is in the bag, or to avoid ocular
tenderness. we investigated 2 groups of patients to compare the effect of dialing to
non-dialing on the incidence of intraoperative and postoperative complications, and on the
surgical outcome.
Methods: We excluded
diabetic and bilateral patients, those with preoperative astigmatism, and those who
developed intraoperative complications prior to implantation. Group 1 included patients
with dialed lOLs (19 eyes), and Group 2 non-dialed lOLs (15 eyes).
Results: Statistical
analysis showed only intraoperative comeal clouding and posterior capsular ruptures to
increase significantly with dialing. Ocular tenderness did not develop with any of the
patients. Postoperative astigmatism did not show a statistically significant difference
Conclusions:
Dialing, therefore, should be reserved to the situation when it might be found necessary
for introduction of an IOL.
Key Words: IOL,
dialing, astigmatism.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,775-777
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Is
Pre-operative Nd-YAG LASER Anterior Capsulotomy an Advisable Procedure?
Nashwa M. Lamie
Purpose: Is to study
the effect of Nd-YAG laser anterior capsulotomy just before ECCE.
Methods: Forty one
cataractous eyes (38 patients) were included in this study. Ml patients we~ admitted for
ECCE without intraocular lens implantation.
Opbthalmological examination for all patients
included visual acuity, Slit lamp examination , intraocular pressure measurement. Nd-YAG
laser anterior capsulotomy was performed using Ziess Visual YAG FLQ switched laser.
Ophthalmological examination of patients after
laser therapy then ECCE was performed immediately.
Results: There was a
statistically insignificant elevation of lOP in 9.75% of patients with a mean of 3.0 mmHg.
Mild constriction in 17.07%. Mild comeal oedema in 12.19%. Two eyes showed opacification
of posterior capsule needed Nd.YAG laser during the follow up period.
Conclusion: ND-YAG
laser anterior capsulotomy is a very safe procedure provided that it is performed just
before ECCE in properly selected cases.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,779-782
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Iris Sutured Posterior Chamber
Intraocular Lenses
Khaled Fawzy Bruce A Noble
Evaluation of the technique of posterior
chamber iris sutured intraocular lens implantation.
Setting: Department
of Ophthalmology, Leeds General Infinnary, Leeds, United Kingdom.
Methods: We reviewed
the records of all the patients who had implantation of an iris-sutured intraocular lens
between March 1994 and December 1996. This included 25 patients, the mean age was 59 years
(range 23-81), 10 females and 15 males, with a mean follow up of 12 months (range 5-33
months). Eight eyes underwent simultaneous keratoplasty.
Results: There was
no serious operative or post-operative complications, 56% of the patients achieved a
visual acuity of 20/40 or better, 16% between 20/5 0 to 20/1 00 and 28% had 20/200 visual
acuity or worse.
Conclusions: Our
results seem encouraging. However larger samples and longer follow up are needed.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,783-788
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Comparison
of the Toxicity of Subconjunctival Gentamicin and Amikin in Cataract Surgery
Mohamed Ehab Elawa, and Azza Abdul
fattah Shihab.
Purpose: The present
work compares postoperative effects on the conjunctiva of gentamicin and amikin given
subeonjunctivally at routine uncomplicated cataract and implant surgery.
Methods: The study
was performed on 50 patients who were undergoing extra-capsular cataract extraction and
posterior chamber IOL implant surgery. At the end of 4 the surgery the antibiotic was
injected under the inferior bulbar conjunctiva. Either 1 ml of lOOmg amikin or 0.5 ml of
20 mg gentamicin. Twenty four hours after surgery, colored photographs were taken for the
inferior bulbar conjunctiva and fluorescein angiography of the site of injection was also
performed in some patients.
Results: Our results
suggest that gentamicin is associated with more postoperative discomfort, conjunctival
edema and subeonjunctival hemorrhage than amikin.
Conclusion: The
present study has clearly demonstrated the superiority of amikin on gentamicin in terms of
conjunctival toxicity and patient tolerance. So, we recommend the postoperative use of
amikin rather than gentamicin for the prevention of endophthalmitis.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,789-791.
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Hepatorenal
Risk Factors Predisposing to Development of Age Related Cataract
Siham Ahmed Mahmoud, Hager Emam Amer, and
Mohamed Ahmed El Mattarawy
The present study was undertaken to assess the
levels of serum bilirubin, total protein, albumin, albutnin/globulin ratio, alkaline
phosphatase, transaminase enzymes, 6-Glutamyl transferase, urea, creatinine and uric acid
in 40-patients with age-related cataract. All cases were selected among those attending
the Research Institute of Ophthalmology for lens extraction surgery. A group of 20 healthy
subjects of matched age and sex with no history of ophthalmological disease was included
as control group.
In all types of senile cataract patients,
there was no significantly change in blood glucose, total globulins urea, and creatinine.
The levels of serum transaminases, alkaline phosphatase, bilirubin, 6-Glutamyl
transpeptidase, and uric acid were significantly high as compared to control subjects.
Serum total proteins, albumin and albumin/globulin ratio were significantly decreased as
compared to control subjects.
Conclusion: It was
concluded that subdinscal liver dysfiinction is a risk factor predisposing to development
of all types of age related cataract, even if individual mean concentrations are well
within normal litnits.
Key Words: Senile
Cataract; transaminases, alkaline phosphatase bilirubin, 6-Glutamyl transpeptidase, total
proteins, albumin, total globulins, urea, creatinine, uric acid.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,793-796
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Management of
Subincisional Cortex in Phacoemulsification
Hala El Helali, Hala El Cheweikh, and Tarek
Purpose:
Subincisional cortex is difficult to remove in phacoemulsification. This study compares
two techniques in removal of subincisional cortex namely bimanual irrigation aspiration
and removal of cortex using irrigation aspiration handpiece after implantation of the
intraocular lens.
Methods: 36 patients
undergoing cataract extraction by phacoemulsification were randomly divided into two
groups. Bimanual irrigation aspiration was used for cortical removal in one group while in
the second group cortical removal was performed after intraocular lens implantation.
Results: The first
technique proved easy and effective in removal of subincisional cortex, whereas the second
technique was found to be difficult and lengthy. Complications such as incomplete cortical
removal and creating extensions in the capsulorhexis opening were encountered.
Conclusion: Bimanual
irrigation aspiration is a safer, easier and more effective technique for removal of
subincisional cortex than removal of cortex after intraocular lens implantation.
Key Words:
Phacoemulsification, Cortical clean-up, Bimanual irrigation aspiration
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,797-800
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Evidence for Mitosis in
the Adult Human Corneal Endothelium
Mamdouh H. El. Kafrawy
Purpose: To prove
the presence of mltosis in the adult human comeal endothelium.
Subjects and Methods: 40 eyes of 40 patients
were examined by the wide field specular microscope. The patients were classified into 3
groups: Keratoplasty after graft rejection 10 cases. - E.C.C.E. and I.O.L. 20 cases -
Glaucoma surgery
-Laser 3 cases
- Subscleral trabeculectomy S.S.T. 5 cases
-Peripheral indectomy P.1. 2 cases
Results:
Intracellular structures probably representative of mitotic figures were seen by specular
microscopy. Clusters of small cells and rosette appearance were also observed. Also
binucleated cells and very small cells were observed.
Conclusion: Mitosis
can occur in the adult human comeal endothelium both in vivo and in vitro.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,801-804
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Diurnal
Variations in Human Corneal Thickness
Mohamed Hany A. E,El-Hatew
Purpose: To detect
if there is diurnal variations in human conical thickness were measured over 48 hours
perio&
Methods: Diurnal
changes in central corneal thickness were measured in 10 healthy persons rising an
ultrasonic pachymeter. Measurments were made over 48 hours period, immediately upon
waking, immediately before sleep and at 3 hours in terval through out the remainder of
each day.
Resutts: The mean
central corneal thickness for the group was 501+~8 um being high in the morning 516 um and
decrease at the end of the day to become 483 urn. Mean over-night changes were 7.85% and
7.05% with mean maximum diurnal variation of 8.91% and 8.66% on 2 consective days.
Conclusion: These
data confirm that there are diurnal variations in human corneal thickness being highest in
the morning and tends to decrease in the evening.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,805-807
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Topical
Clotrimazole Versus Topical Miconazole Nitrate in the Treatment of Experimental
Keratomycosis
Ashraf K Al-Hlissaini' Abdel-Rahim
El-Shanawany2 Enas A Daef3 and MM. Abd El-Latif
Purpose: Fungal
infections of the cornea constitute a common serious cause of loss of vision in Egypt, yet
no topical antifungal agents are available for ophthalmic use in this country. We tested
in-vitro- the efficacy of topical clotrimazole (CTZ) and miconazole nitrate (MN)
antifungal drugs against a variety of common fungal corneal pathogens and to test, m vivo,
the efficacy of those agents in the control of Aspergillus fumigatus fungal infections of
the rabbit cornea (an animal model).
Methods: The agar
cup diffusion method was used to test the efficacy of both drugs in various dosage forms
against a variety of known corneal pathogens in-vitro. An animal model of Aspergillus
fumigatus infection of the cornea was used to test the efficacy of the drugs in vivo.
Results: Solutions
of both drugs showed higher antifungal activity against the tested fungi compared to gels
. The most susceptible fungi were A.flavus, A.fumlgatus and A. terreus. The most resistant
one was Necteria haematococca. Clotrimazole preparations showed higher antifungal activity
compared to the respective preparations of miconazole nitrate both in vitro and in vivo.
Conclusion:
Clotrimazole 1% solution is more effective than miconazole nitrate 1% solution in the
control of experimental A.fumigatus infection of the rabbit cornea.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,809-812
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Topical
Clotrimazole for the Treatment of Fungal Keratitis in Humans
Ashraf K. Al-Hussaini', El-Said A. Ibrahim ,
Abdel-Rahim El-Shanawany3, Muhamed M. Abd El-LatŁ/ and Tarek A. Ali1.
Purpose: Although
mycotic keratitis has been recognized as a serious and a seriously increasing problem in
Egypt, no topical antifungal preparations are available yet for the treatment of this
condition in Egypt. We tested the efficacy of topical 1% clotrimazole solution and gel in
the treatment of mycotic keratitis in humans.
Patients & Methods:
Seventeen consecutive cases of culture positive mycotic keratitis were treated with
topical 1% clotrimazole solution.
Results: The
etiologic fungi isolated in this study belonged to the genera Aspergillus, Candida,
Gibberella fujikuroi (Fusanum moniliformi), Mucor, Mycosphaerella tassiana (Cladosporium
herbarum) and Rhizopus. Treatment was successful in 11 cases (6S%) out of 17.
Conclusion: Topical
1% clotrimazole has a potential for clinical use in the treatment of mycotic keratitis in
humans.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,813-815
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Conjunctival
Covering of the Sclera after Pterygium Excision Cons and Pros.
Ahmed Abd El-Abu Ghadir
Purpose: Govering
the bare sclera after pterygium excision with conjunctiva is an accepted technique to
avoid or to minimize recurrence. The techniques are multiple including autografting and
flapping. The technique has its difficulties that necessitated certain precautions, and
also some operative details were found important to be stressed. Final evaluation of the
technique was given.
Methods: Eighty five
eyes with pterygia were operated upon utilizing both techniques. Grafting for 12 eyes (6
eyes with primary pterygium and 6 eyes with recurrent pterygium). Covering using
conjunctival flaps was done for 73 eyes. Of them 59 eyes were with primary pterygium and
14 eyes were with recurrent pterygium
Results: Grafting
the recurrent cases was done successfully in all cases, while grafting the primary cases
showed recurrence in 16.7 %
Flaps were used successfully in 96.6 % of the
primary cases, while in recurrent cases the success rate was only 78.6 %
Conclusion: both
techniques were found effective in minimizing recurrence. The post operative complications
were minimal and manageable with satisfactory surgical outcome. Grafting was found better
for recurrent cases while flapping was better for primary cases. Alternation of the
techniques was possible (grafting failed flaps and flapping the failed grafts.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,817-820
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Surgery for
Pterygium Using Conjunctival Pedunculated Flap Slide
Mohamed Hany A.E, EL-Hatew
Purpose: To reduce
rate of recurrence of pterygium after simple excision.
Methods: 20 cases of
primary small pterygium with minimal vascularity were included in this study. Reverse
cutting of pterygium and a conjunctival pedunculated flap were used.
Resufts: One case of
recurrence after one year follow up was recorded. Incidence was (5%).
Conclusion: This
technique is safe, simple and effective in pterygium surgery to reduce rate of recurrence
with minimal complications.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,821-823
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Glaucoma
after Penetrating Keratoplasty for Pseudophakic Bullous Keratopthy
Dr. Samir M.Kasim
Purpose: To determine the frequency
and duration of intraocular pressure spikes, risk factor and response to treatment.
Patients on medication for glaucoma preoperatively were maintained on there treatment the
intraocular pressure were measured every 12 hours for one day, every day for 3 days then
every week. Intraocular pressure of 30 mm Hg was considered an increase in pressure.
Methods: In this
study 6 consecutive patients underwent penetrating keratoplasty for psudophakic Bullous
keratopthy were examined for post operative increase in intraocular pressure
Resutts: In this
group of patients one patient had posterior chamber implant, three patients with anterior
chamber implant design, and two patients with implant designed for posterior chamber
"three pieces modified C" but inserted in the anterior chamber, five patients
underwent anterior vetrectomy and sodium hyaluronate was used in all patients.
In the post operative period three patients
received medical treatment for five weeks two patient had cyclocryopexy to control their
glaucoma beside their medical treatment.
Conclusion: We
advice not to implant posterior chamber lenses in the anterior chamber under any condition
to avoid the damage to Angle and refractory glaucoma.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,825-826
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Conjunctival
Endometriosis : A New Indication for Ophthalmic Cryotherapy
Adel M. Abd El Wahab and Nashwa El
Shennawy
Purpose: This study
introduces a new indication for ophthalmic cryotherapy.
Padents and methods:
Two eyes in 2 female patients were presented by periodic small subconjunctival hematomata
about 1 mm in diameter with the onset of menstruation and increase gradually in diameter
to about 7mm..
Diagnostic and therapeutic disc shaped
excision of the conjunctiva and tenon's capsule (about 5 mm in diameter and centered by
the bleeding point) was done during the 1st day of menstruation for the fimt case.
Histopathological examination proved the diagnosis of endometriosis.
Ophthalmic cryotherapy was applied to the
second case during the 1st day of menstruation over the bleeding point.
Results: Stoppage of
the occurrence of perodic subeonjunctival hematomata was observed in all cases for a
follow up period of 18 months.
Conclusion:
Cryotherapy is an effective procedure for the treatment of conjunctival endometriosis as
surgical excision of the bleeding point.
Keywords:
Cryotherapy, subeonjunctival hematoma, endometriosis.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER
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Evaluation
of the Conjunctival Condition in Rheumatoid Arthritis by Impression Cytology
Iman M. A. Zaki
Purpose: To evaluate
the cellular damage of the conjunctival surface in Egyptian patients with rheumatoid
arthritis by impression cytology technique.
Methods: This study
included 50 female patients with rheumatoid arthritis with reference to a control group of
10 female individuals without any systematic disease. lmpression cytology techmque was
used and the patients were scored into 6 stages starting from stage 0 with normal
conjunctival epithelium and passing to stage 5 with advanced keratinization. The presence
of snake like chromatin in the nuclei of conjunctival cells and the presence of
inflammatory cells and mucous strands were recorded.
Results: Patients
with rheumatoid arthritis may experience manifestations secondary to dryness of the eye.
These manifestations are pronounced in periods of exacerbation of the disease. The
prevalence of snake like chromatin in nuclei of conjunctival cells, the presence of
inflammatory cells and mucous strands, all are more obvious as the condition of
conjunctival epithelium is worse and the score is increased.
Conclusion:
Physicians should include ophthalmic examination as a routine in their protocol for
patients with rheumatoid arthritis to facilitate early diagnosis and treatment of ocular
complications.
Key words:
Rheumatoid arthritis, dry eye, impression cytology.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,831-835
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Prevalent
Organisms Cases of Acute Bacterial Conjunctivitis (Epidemiological Study)
Abdel Hamid EZ-Senbawy', Yousry Fekry1,
Abdel Samea Khalil1, Ahmed El-Gazzar2 and Esmaeel Mostafa
Purpose: We aimed at
evaluating cases of a~ute bacterial conjunctivitis both clinically and bacteriologically
to determine the most prevalent causative pathogens and their antibiotic sensitivities as
an epidemiological study in Banha.
Methods: 500
patients of different age groups clinically diagnosed to have acute bacterial
conjunctivitis were selected and studied climcobacteriologically to determine the
causative or organisms. 60 cases were taken as control.
Results: Of 500
cases, 384(76.8%) gave+ve growths. Staph aureus was isolated in 30.6% of cases followed by
H.influenzae 14%, Neisseria catarrhalis 12% , Staph . albus 11%, Streptococci 9.4%,
Diphtheroids 6%, Streptococcus pneumoniae 4.6% and others.
Conclusion: Staph.
aureus was the commonest organism isolated in different age groups and different seasons
in an incidance of 30.6% of cases. 232% of the selected cases gave no growth.
Tobramycin, Gentamicin and chloramphenicol
were the most powerful antibiotics in the majority of cases..
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,837-839
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Diode Laser
Photothrombotic Occlusion of Corneal neovascularization
Alaa F.M. El-Sayed, Abdallah K. Hassouna, and
Osama A. Salem
Purpose: This study
was designed to evaluate the possibility of using infrared diode laser which wavelength is
not absorbed by blood haemoglobin to occlude corneal neovessels.
Subjects & Methods:
Twenty-five mgm of indocyanine green were injected LV. followed by diode laser
phototlirombosis of corneal neovessels, the procedure was done in ten eyes of ten patients
with vascularized corneal opacities.
Results: Effective
occlusion of corneal neovessels was achieved, the vessels remained occluded during the
follow up period which was three months.
Conclusion: Diode
laser can be used in occlusion of comeal neovascularization.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER
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Topical
Clotrimazole Versus Topical Miconazole Nitrate in the Treatment of Experimental
Keratomycosis
Ashraf K Al-Hussaini; Abdel-Rahim
EL-Shanawany; Enas A Daef; and M. M. Abd El-Latif
Purpose: Fungal
infections of the cornea constitute a common serious cause of loss of vision in Egypt, yet
no topical antifungal agents are available for ophthalmic use in this country. We tested
in-vitro- the efficacy of topical clotrimazole (CTZ) and miconazole nitrate (MN)
antifungal drugs against a variety of common flingal comeal-pathogens and to test, m vivo,
the efficacy of those agents in the control of Aspergillus filmigatus fungal infections of
the rabbit cornea (an animal model).
Methods: The agar
cup diffusion method was used to test the efficacy of both drugs in various dosage forms
against a variety of known comeal pathogens in-vitro. An animal model of Aspergillus
fumigatus infection of the cornea was used to test the efficacy of the drugs in vivo.
Results: Solutions
of both drugs showed higher antifungal activity against the tested fungi compared to gels
. The most susceptible fungi were A.flavus, A.fumigatus and A. terreus. The most resistant
one was Necteria haematococca. Clotrimazole preparations showed higher antifungal activity
compared to the respective preparations of miconazole nitrate both in vitro and in vivo.
Conclusion:
Clotrimazole 1 % solution is more effective than miconazole nitrate 1% solution in the
control of experimental A.fumigatus infection of the rabbit cornea.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,809-812
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Virus Isolation in Acute
Haemorrhagic Conjunctivitis
Rabei M. Hassanin and Mohamed I. Bassyouni
Purpose: Acute
haemorrhagic conjunctivitis (AHC) is a viral infection caused by enterovirus 70 and
occasionally caused by coxsackie virus tupe A-24. The disease is fairly rare, highly
contagious but self limiting
Methods: 16 cases of
(AHC) in El Minia area were subjected to careful ophthalmological examination, regional
lymph nodes examination and conjunctival scraping. All conjunctival scraping specimens
were obtained in the very early stage of the disease (within 48 hours), and were
transported immediately (within 2 hours) to the laboratory. All specimens were inoculated
in tissue culture and examined under transmission electron microscope.
Results: Enterovirus
70 was isolated from 4 patients (25% of total cases Conclusion: For successful isolation
of the virus, conjunctival scrapings should be obtained in very early stage of the disease
(within 48 hours) and should be transported immediately (within 2 hours) to the
laboratory.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,845-847
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Genetic
Predisposition to the Development of Autoimmune Acute Anterior Uveitis
Seham A. Mahmoud ; Fatma S. El-Motagali
; Ragia H. Badawy ; Amr H. El Samra, and Raafat H. Taha
Pupose: To delimit
the clinical features, complications and associated rheumatologic complications, in
particular ankylosing spondylitis in HLA-B27-positive and TILA-B27~negative acute anterior
uveitis patients.
Methods: Thirty
subjects were included in this study, 20 patients with acute anterior uveitis and 10
healthy subjects as a control group. All subjects underwent complete ophthalmic
examination (I.O.P, slit4amp examination and fundoscopy), rheumatologic examination,
HLA-B27 typing and some laboratory tests (E.S.R. alkaline phosphatase, rheumatoid factor
and antinuclear antibody).
Results: No
statistically significant difference in ocular complication were between HLA-B27- positive
and HLA-B27- negative patients with acute anterior uveitis. However rheumatologic
complications developed in statistically significant higher percent (77%) of the former
group compared to 45% of the latter group.
Conclusions:
Although HLA-B27 associated uveitis is usually a disease of young men, women may be also
effected. Ocular complications associated with acute anterior uveitis were related to many
factors other than the genetic one. Rheumatologic complications occurred more with
HLA-B27-positive acute anterior uveitis patients.
Keywords: Acute anterior uveitis, autoimmune,
HLA-B27.
BULL. OPHTHALMOL. SOC. EGYPT; 1997;
VOL 90, NUMBER 5,849-852
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