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   Table of Contents - Current issue
January-June 2019
Volume 6 | Issue 1
Page Nos. 1-25

Online since Friday, August 16, 2019

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One-year follow-up of patients after yttrium aluminum garnet laser vitreolysis for vitreous floaters p. 1
Amr Saad Bessa
Background: This study was performed to evaluate the efficacy, complications, and patient satisfaction and follow-up for 1 year after neodymium yttrium aluminum garnet (Nd:YAG) laser vitreolysis for visually disturbing vitreous floaters. Aims: To evaluate the role of Nd:YAG laser vitreolysis in visually disturbing vitreous floaters. Settings and Design: This was an institutional, observational, cross-sectional retrospective study. Subjects and Methods: A retrospective observational study was conducted on 86 eyes of 71 patients suffering from persistent vitreous floaters with complete posterior vitreous detachment who underwent laser vitreolysis with the Ultra Q Reflex™ (Ellex Medical Lasers, Adelaide, Australia), in the first half of 2015. Follow-up was done for 1 year. Patient satisfaction was graded from 0% to 100%. Laser settings and complications were recorded. Results: Average subjective symptomatic improvement was 66.23%; 44.2% of patients reported excellent satisfaction (75%–100%) and 32.6% reported good satisfaction (50%–74%). 45.3% of patients required 3–4 sessions. Average power setting was 5.3 mJ. One case of iatrogenic cataract treated by phacoemulsification and intraocular lens implantation occurred. Another case suffered limited vitreous hemorrhage which completely resolved. Conclusions: Laser vitreolysis is a safe, effective method for the treatment of symptomatic visually disturbing floaters.
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Microperimetric findings after vitrectomy for dense traumatic vitreous hemorrhage p. 5
Nehal M Samy El Gendy
Purpose: The purpose of this study was to evaluate the functional outcome after early and late surgical evacuation of traumatic vitreous hemorrhage (VH) due to blunt trauma. Patients and Methods: Cases who had already undergone pars plana vitrectomy for dense traumatic VH were investigated. Microperimetry (MP) using the OPKO spectral optical coherence tomography (OCT)/scanning laser ophthalmoscopy combination imaging system (OPKO instrumentation, LLC, USA, version 1.89) was done 6–8 months after surgery. Patients were divided into two groups according to the time of surgical interference: patients who were operated upon 6 weeks or less after the onset of hemorrhage (Group A) and patients who had VH for more than 10 weeks before surgery (Group B). Primary outcome included mean and fovea retinal sensitivity (mean retinal sensitivity [MRS], foveal retinal sensitivity [FRS]) and its correlation to timing of surgical interference. Secondary outcome included spectral domain-OCT findings such as epiretinal membrane, subretinal fluid, ellipsoid zone integrity, and central subfoveal thickness. Results: Twenty-three eyes were sorted to Group A and 26 eyes to Group B. The average age was 36.2 ± 3.8 years for Group A, compared to 35.2 ± 3.9 years for Group B (P = 0.4). The average duration of hemorrhage was 27.1 ± 7.3 days for Group A and 60.5 ± 6.7 days for Group B. FRS was significantly higher in Group A (19.2 ± 1.9 dB) compared to 17.7 dB ± 2.4 dB in Group B (P = 0.02). MRS was comparable between the two groups (P = 0.5). FRS and MRS were negatively correlated to duration r = -0.49, P <0.001, r = -0.07, P = 0.61. Conclusion: Delayed surgery affects FRS (6–8 months) after surgery even with the absence of structural changes. Persistence of such changes is recommended to be evaluated by further follow-up.
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Timing of phacoemulsification in relation to intravitreal ranibizumab injection in diabetic patients type 2 with cataract and mild center involved macular edema p. 9
Nehal M Samy El Gendy, Dina El-Fayoumi
Purpose: To compare preoperative ranibizumab (RBZ) 0.5 mg/0.05 ml three-injection protocol to postoperative protocol in cases with center involved macular edema (CiME), undergoing phacoemulsification. Patients and Methods: Cases with non-ischemic clinically significant diabetic macular edema (CSDME) were randomized into two groups. Both groups received three intravitreal RBZ injections on monthly basis. Group 1, received the first two injection 2 months before phacoemulsification and the third one was injected intraoperative by the end of surgey. Group 2 received the first injection intraoperatively followed by 2 other injections, 1 and 2 months postoperatively. Central subfield thickness (CST) was measured using spectral-domain optical coherence tomography (RTvue-100), 1 month after third injection for both groups. Results: The mean postoperative corrected distance visual acuity (CDVA) at 3 months postoperatively was significantly improved (P = 0.005) in Group 1 than in Group 2. The postoperative CST 1 month after the third injection for Group 1 was 252.5 μm ± 16 versus 270.1 μm ± 24.4 for Group 2, which was statistically significant (P = 0.02). Percentage of reduction in central foveal thickness (CFT) was 15.4% and 8%, Groups 1 and 2, respectively. The ellipsoid zone integrity showed Interruption in Group 1 in 19.4% of eyes, which was lower than in Group 2 (28%), however this was not statistically significant (P = 0.4). None of our cases developed epiretinal membranes in either groups. In Group 2 only, four cases developed subretinal fluid (SRF), and one case had cystoid changes. None of the cases developed SRF or de novo cystoid changes, till the last follow-up visit, in Group 1. Conclusion: Using RBZ repeated intravitreal injections protocol prior to phacoemulsification improved significantly CDVA and reduced the CST, than when injected postoperatively. In addition, the number of postoperative intravitreal injections that might be needed was significantly reduced when it is used preoperatively.
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Needle subretinal fluid drainage assisted pneumatic retinopexy for primary rhegmatogenous retinal detachment p. 16
A Raghuram, K Divya, V Narendran, M Raaja Ganesh, VR Saravanan
Purpose: Pneumatic retinopexy (PR) continues to remain an important technique in the management of rhegmatogenous retinal detachment (RRD). We describe the results of a novel surgical technique of PR with subretinal fluid (SRF) drainage in this retrospective, nonrandomized case series. Subjects and Methods: Medical records of patients with primary RRD who underwent PR with SRF drainage and had been followed up for 6 months or more were reviewed. The procedure involved transconjunctival cryotherapy followed by drainage of SRF using a 26G needle and intravitreal injection of perfluoropropane. Outcome data measured included final visual acuity, anatomical success with single surgical procedure, surgical complications, and need for subsequent procedures. Results: Out of the 12 patients, there were 7 males and 5 females. The 12 patients aged in range from 24 to 64 years (average - 43 ± 15.55 years). Average duration of follow-up was 10 ± 3.56 months (range: 6–14 months). Eleven eyes achieved anatomical reattachment of the retina with a single procedure (91.6%). Redetachment was noted in one patient who was successfully treated with pars plana vitrectomy and scleral buckle.The final anatomical success rate was 100%. Visual acuity improved in all the eyes treated, and no major complications related to SRF drainage were encountered. Conclusion: PR with needle-assisted SRF drainage is a safe and useful technique for selected cases of primary RRDs with good anatomical and functional outcomes.
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Analysis of retinal nerve fiber layer thickness and visual function in road traffic accident patients with ocular complains p. 21
Vipin Singh, Rajat Mohan Srivastava, Sandeep Saxena, Ankita , Pramod Kumar
Background: Trauma to eye can cause severe and permanent visual impairment. In some instances there may be vitreous hemorrhage, choroidal hemorrhage, globe rupture and traumatic optic neuropathy. Spectral domain optical coherence tomography (SD-OCT) is a quick, sensitive, non-invasive device that provides high-resolution images of the circumpapillary retinal nerve fiber layer (cp RNFL), yielding reproducible and reliable measurements. Aims and Objectives: TO study visual functions (BCVA, CV, CS) and retinal nerve fiber layer thickness by SD-OCT. Materials and Methods: This was a prospective observational study on 108 patients, performed from Sept 2016 to July 2017. RTA patients with visual loss/visual complaints between ages of 18 – 60 years included. Log Mar BCVA, Colour vision and contrast were noted. RNFL analysis was done by SD-OCT. Results: The mean age was 28.33± 8.70 yrs, There were 19 (17.6%) female, 89(82.4%) male in case group. At first visit, there were significant difference between BCVA, CV and CS between right and left eyes of cases and controls. Significant difference were seen in mean RNFL in right and left eye of cases and control. After follow up,insignificant change in BCVA and CV in both right and left eye. Significant change in CS in both right and left eye. Mean change in RNFL thickness was insignificant. Conclusion: Decrease in visual function occurs following RTA. Also, RNFL thinning occurs which remains persistently thin thereafter.
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