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   Table of Contents - Current issue
Coverpage
January-June 2018
Volume 5 | Issue 1
Page Nos. 1-23

Online since Monday, August 20, 2018

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ORIGINAL ARTICLES  

Macular thickness in healthy controls and diabetics without diabetic macular edema p. 1
Seham Samir Shawky, Mohammed Hussein Elagouz, Ali Mahmoud Ismail, Ashraf Mostafa Elhawwary
DOI:10.4103/erj.erj_13_17  
Aim of the Study: This study aims to evaluate the thickness of the macula in patients with diabetes but without diabetic macular edema (DME) using optical coherence tomography (OCT) and compare these findings with measurements from normal controls which may be useful for early detection of macular thickening. Patients and Methods: Two hundred subjects were included and divided into 4 equal groups: normal controls, diabetics without diabetic retinopathy (DR), diabetics with NPDR and without DME, and diabetics with PDR and without DME. Full ophthalmological evaluation was done and the fast macular OCT scan was done that divides the macula into 9 sectors. The mean ± standard deviation of macular thicknesses by area were analyzed and compared. Results: A central subfield (CS) was statistically significantly thicker in normal controls compared to diabetics with no DR with no significant difference in other sectors. Furthermore, all of the inner sectors (IS, IN, IT, II) and the ON sector were significantly thicker in normal compared to diabetics with nonproliferative DR (NPDR) group with no significant difference in other sectors. Furthermore, between all sectors except IS and IT on comparing normal versus diabetics with PDR, between nasal sectors (IN and ON) but not in other sectors on comparing diabetics with no DR versus diabetics with NPDR, between all sectors except IS on comparing diabetics with no DR versus diabetics with PDR, and between all sectors on comparing diabetics with NPDR versus diabetics with PDR. Conclusion: This study found that the fovea and perifoveal subfields of the ETDRS grid tended to be thinner in diabetics without DR than in healthy controls and still thinner in eyes with DR, but thicker in eyes with PDR than in healthy controls thus confirming that the loss of neural tissue begins in the early stages of diabetes. As diabetes develops, neurodegeneration may be masked by changes in vascular permeability that cause thickening of the retinal layers.
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Bevacizumab as an adjunct to vitrectomy for diabetic retinopathy: A retrospective study p. 6
Balbir Khan, Rajwinder Kaur, Mandeep Kaur, Prithpal Singh Matreja
DOI:10.4103/erj.erj_15_17  
Purpose: The purpose of this study is to evaluate the effect of a single preoperative injection of intravitreal bevacizumab (IVB) on the visual and anatomical outcome of patients undergoing 23-gauge pars plana vitrectomy (23G PPV) for proliferative diabetic retinopathy (PDR). Materials and Methods: Medical record from patients undergoing vitrectomy for PDR were retrospectively analyzed for the last 3 years. IVB has been a routine procedure for patients fulfilling eligibility criteria for the past 3 years. Patients who did not receive IVB preoperatively were assigned as control group (Group A). Patients who received a single IVB injection (1.25 mg in 0.05 ml) preoperatively were assigned to Group B. Medical record of 100 patients who had completed 12-month follow-up were included in each group. Results: The primary outcome measure was visual outcome which was better in Group B as compared to Group A, anatomical outcome observed was 65% patients in Group A and 85% patients in Group B. The secondary outcomes were intraoperative hemorrhage and postoperative vitreous hemorrhage (VH). Intraoperative hemorrhage was seen in 40% patients in Group A and 20% patients in Group B, whereas postoperative VH was seen in 45% patients in Group A and 15% patients in Group B. Conclusion: Preoperative use of bevacizumab achieves excellent anatomical and functional success in majority of patients undergoing PPV for PDR and significantly reduced occurrence of postoperative VH. The results are encouraging when combined with transconjunctival 23 GPPV.
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Anatomical and visual outcomes of retinectomy in eyes with advanced proliferative vitreoretinopathy p. 12
Amr Bessa
DOI:10.4103/erj.erj_20_17  
Background: Visual and anatomical success of inferior retinectomy in proliferative vitreoretinopathy complicating recurrent retinal detachment (RD). Aims: The aim of this study was to evaluate anatomical and visual outcomes of retinectomy in eyes with recurrent RD with advanced proliferative vitreoretinopathy. Settings and Design: Institutional, observational, cross-sectional retrospective study. Subjects and Methods: Records of 56 eyes of 56 patients with recurrent RD and proliferative vitreoretinopathy (PVR) were evaluated, three-port incision sclerotomies followed by standard vitrectomy were done. Retinal reattachment was achieved with the aid of perfluorocarbon and retinectomy. Retinectomy was performed at the time of surgery based on retinal shortening (inferior 180°). Silicon oil (SO) was used as a tamponade. Retinal attachment and visual acuity (VA) after 6 months were evaluated. Statistical Analysis Used: Chi-squared test. Results: In all 52 of 56 (93%) eyes, retinal reattachment was successful, with a mean follow-up of 25 months (range, 6–70 months). After retinal reattachment, VA improved or stabilized in 39 of 56 patients (70%). Conclusion: When combined with anterior base dissection, inferior retinectomy may be useful in the surgical treatment of complex PVR-related RD. It was found that with lensectomy, radical anterior base dissection, and inferior retinectomy, anatomic success rates are improved and visual function can be maintained.
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Benefits of anti-vascular endothelial growth factor therapy for diabetic macular edema with and without vitreomacular adhesions p. 15
Yasmine Salah Salem, Ahmed Abdel El Alim Mohamed, Mohamed Hanafy Hashem, Mohamed Maher El Hefny
DOI:10.4103/erj.erj_2_18  
Purpose: We aimed to evaluate the effect of vitreomacular adhesion (VMA) in visual and anatomic outcomes in patients with diabetic macular edema (DME) after intravitreal injection of ranibizumab (Lucentis®). Patients and Methods: This was a prospective cohort study that included thirty eyes of DME patients, divided into two groups according to their spectral-domain-optical coherence tomography image analysis at the baseline visit to identify the presence (VMA+) or absence (VMA−) of VMA. Patients with any degree of vitreomacular traction were not included in this study. VMA was classified by the size of adhesion into either focal (<1500 mm) or broad (>1500 mm). All patients received monthly 0.5 mg of intravitreal ranibizumab injection for 6 months. Patients were observed monthly for a 6-month period and their best-corrected visual acuity (BCVA) and central macular thickness (CMT) were recorded. The incidence of posterior vitreous detachment (PVD) was observed. Results: Compared with baseline, there was a significant decrease in CMT after 6 months by 151.46 ± 121.47 and 139.33 ± 144.23 μm in VMA+ and VMA− groups, respectively (P = 0.681). The mean average improvement in BCVA was 10.21 ± 6.33 and 6.68 ± 6.35 letters in the VMA+ and VMA− groups, respectively. The difference between the two groups was statistically significant (P = 0.007). At 6 months, among the 15 eyes of VMA+ at baseline, 4 eyes demonstrated PVD and 11 eyes showed no change in VMA status. Conclusion: Patients having DME with VMA may achieve higher visual gain with anti-vascular endothelial growth factor therapy. Presence of VMA should not preclude patients with DME from receiving anti-vascular endothelial growth factor therapy.
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Utility of smartphone-based fundus camera device in a social outreach setting p. 21
Siddhartha Bose, Arup Kumar Bose
DOI:10.4103/erj.erj_5_18  
Context: Fundus photography. Aim: To demonstrate the use of smartphone-based fundus camera device for detecting retinal pathology in social outreach camps. Settings and Design: Prospective comparative study. Subjects and Methods: Two investigators were recruited, one trained in conventional indirect ophthalmoscopy and the other in smartphone-based fundus photography. A smartphone and a 20D lens were used to record the fundus in video mode. Thirty-six patients having nonproliferative diabetic retinopathy were included in the study and examined by both the investigators. Clinical staging done by them on the basis of their individual photographs were compared. Statistical Analysis Used: Chi-square test. Results: Smartphone-based fundus photography was able to capture quality images of the retina. The investigators were able to deduce the same clinical staging for 33 out of 36 patients (P = 0.02). Conclusions: The images can be forwarded to the retina specialist via E-mail or digital messenger and opinion on management or referral can thus be sought. This will help bring specialized medical expertise to masses at remote places.
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