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SYMPOSIUM - DIABETIC RETINOPATHY UPDATE
Screening for sight-threatening diabetic retinopathy: An update
Peter Henry Scanlon, Mohamed Dirani, Peter van Wijngaarden
January-April 2014, 2(1):3-18
DOI:10.4103/2347-5617.152479  
Aims: To review the literature on Screening for Diabetic Retinopathy. Materials and Methods: A comprehensive review of the English language literature, published from March 1980 to June 2014 using key words in Zetoc. Results: Several methods were found to achieve adequate sensitivities and specificities for diabetic retinopathy screening. Studies were compared with respect to (a) Classifications used to grade diabetic retinopathy (b) The evidence for population-based screening for diabetic retinopathy (c) Alternatives to digital photography for screening (d) Reference standards used to study the effectiveness of screening methods (e) The evidence for mydriatic versus non-mydriatic digital photography, or a combination of the two (f) The number of photographic fields captured (g) Measurement of distance visual acuity (h) Cost-effectiveness of screening for diabetic retinopathy (i) Future developments in screening for diabetic retinopathy Conclusion: Based on an assessment of available studies, the most effective DR screening strategy is the use of mydriatic or staged mydriasis with digital retinal photography. Variables between different screening strategies include whether Visual Acuity is measured and the number of fields captured.
  3 4,869 215
ORIGINAL ARTICLES
360° laser retinopexy in preventing retinal re-detachment after 23-gauge vitrectomy for primary repair of retinal detachment
Omar A Barrada, Mostafa H Nabih, Ayman M Khattabm, Ashraf A Nosseir
January-April 2015, 3(1):1-9
DOI:10.4103/2347-5617.179339  
Aims: To evaluate the role of intraoperative 360° laser retinopexy in the prevention of retinal re-detachment in cases of primary rhegmatogenous retinal detachment (RRD). Settings and Design: Prospective randomized controlled trial, 80 eyes of 80 patients with primary RRD. Subjects and Methods: Totally, 80 eyes of 80 patients with primary RRD will be divided into two groups. In Group (A), laser will be applied to all existing breaks as well as 360° laser retinopexy anterior to the equator will be performed while Group (B) laser will be applied only to the retinal breaks and will not receive the 360° laser treatment. Follow-up was for 3 months after clearance of the tamponading agent. Statistical Analysis Used: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474). Results: Backward logistic multi-regression analysis identified significant independent predictors of re-detachment (P < 0.01, Hosmer-Lemeshow, χ2: 7.593, P = 0.474): Duration of detachment and preoperative visual acuity. Specifically, for every day more of duration of detachment, the odds of re-detachment increased by a factor of 1.007 (P < 0.01). Likewise, for every day more of duration of detachment, the odds of re-detachment was increased by a factor of 8.840 if a preoperative visual acuity of hand motion with bad projection (HMBP) or worse was present (P = 0.05). Conclusions: We concluded that prophylactic intraoperative 360° laser retinopexy did not have a statistically significant role in the prevention of retinal re-detachment after primary retinal repair. The statistically significant preoperative risk factors that have a poor prognostic effect on surgical outcomes are preoperative visual acuity of ≤ HMBP or worse and a longer duration of the retinal detachment.
  2 5,439 119
CASE REPORTS
Temporary complete vision loss after intracameral lignocaine in a post-vitrectomy eye: A single case report
Sanjiv Kumar Gupta, Ajai Kumar
May-August 2014, 2(2):83-85
DOI:10.4103/2347-5617.158226  
We report a case of temporary complete vision loss in a phakic patient after intracameral lignocaine solution injection percolated to the posterior segment of the eye and anesthetized the retina. The main reason of this seepage of lignocaine solution from the anterior chamber to the posterior segment was presumably the hypotony and absence of the vitreous body as the patient had undergone pars plana vitrectomy for intravitreal cysticercus. Once the duration of anesthesia effect of lignocaine elapsed, the patient gained good vision with no obvious retinal damage as seen on fundus imaging and ocular coherence tomography. Thus, one should keep the possibility of intracameral medications to reach the posterior segment in therapeutic/toxic concentrations, especially in postvitrectomy eyes with hypotony.
  1 2,973 88
Unilateral acute angle-closure glaucoma as an unusual presentation of Vogt–Koyanagi–Harada disease: A diagnostic challenge
Mohsen Ahmed Abou Shousha, Rowayda Mohamed Amin
September-December 2014, 2(3):108-110
DOI:10.4103/2347-5617.164630  
Vogt–Koyanagi–Harada syndrome is an inflammatory multisystem disorder with ocular, cutaneous and neurological manifestations occurring more commonly in certain dark-skinned ethnic groups such as Asians, patients of Middle-Eastern heritage, and hispanics. Only a few reports have described a masquerade presentation of acute angle closure as an initial manifestation for this uveitic entity, which is typically characterized by panuveitis with serous retinal detachments. This has almost always led to misdiagnosis, unwarranted surgical interventions, and a delay of appropriate timely therapy. In this report, we describe an unusual case of acute unilateral Harada disease presenting as acute angle-closure glaucoma that has remitted following institution of appropriate therapy.
  1 3,791 95
ORIGINAL ARTICLES
Early versus late silicone oil removal after pars plana vitrectomy for rhegmatogenous retinal detachment in Upper Egypt
Ahmed M Fathalla, Tarek A Mohamed, Dalia M Al-Sebaity
May-August 2015, 3(2):39-44
DOI:10.4103/2347-5617.193468  
Objective: To compare the results of silicone oil removal (SOR) 2 months after vitrectomy for retinal detachment with delayed removal for 6 months or more. Study: Prospective and retrospective study. Patients and Methods: A total of 32 patients (32 eyes) in the prospective series of early SOR and 19 patients (22 eyes) in the retrospective series of late removal. The two groups were compared as to the condition of the eye at the time of SOR and 6 months following SOR. Results: Patient compliance with the scheduled time for SOR was more in the early removal series. The outcome was comparable in the two groups as to the risk of retinal re-detachment, while cataract, increased intraocular pressure, oil emulsification, keratopathy, and anterior segment inflammation were more frequently encountered at the time of removal in the late removal series, particularly when it was delayed beyond 6 months. Conclusion: A protocol of early removal of silicone oil after 2 months did not increase the risk of re-detachment, and ensured a better compliance of the time of removal. It can be particularly recommended when patients are less likely to comply with a protocol for delayed removal.
  1 14,219 214
Twin-light-assisted scleral buckle for primary rhegmatogenous retinal detachment
Walid Ibrahim
May-August 2015, 3(2):50-53
DOI:10.4103/2347-5617.193470  
Aims: Our aim is to evaluate the use of BIOM-3 (Oculus, Germany) and 27-gauge Eckardt twin-light chandelier endoillumination (DORC, Netherland) as an alternative to indirect ophthalmoscope. Settings and Design: A prospective, interventional case series study was conducted in T.E.H. (Private Practice), Assiut, Egypt. Subjects and Methods: Twenty patients (Twenty eyes) complaining of primary rhegmatogenous retinal detachment (RRD) with proliferative vitreoretinopathy ≤ Grade B from January 2013 to April 2014. All patients underwent 27-gauge twin-light chandelier endoillumination for retinal break localization. Break localization was followed by cryopexy (Cryomatic Cryo Console, Keeler Ltd., UK) and standard scleral buckling under surgical microscope. Anatomical and functional outcomes were evaluated at the end of 6 months. Results: Anatomical success (attachment of retina) was achieved in 18 (90%) of twenty eyes. All these eyes remained attached at the end of 6 months. Significant improvement in mean best-corrected visual acuity was achieved at the end of 6 months follow-up 0.05 ± 0.46 preoperatively compared with 0.5 ± 0.14 postoperatively (P = 0.023). Conclusion: Twin-light-assisted scleral buckling for primary RRD is a better alternative to classic surgery with indirect ophthalmoscope.
  1 2,460 84
Excellent results of scleral buckling in the era of microincision vitreous surgery
Balbir Khan, Vartika Sobat Anand, Amit Wasil, Meenu Kashyap
January-June 2017, 4(1):6-8
DOI:10.4103/erj.erj_15_16  
Purpose: The purpose of this study is to evaluate the anatomical and functional outcomes of sutureless scleral buckling for the repair of rhegmatogenous retinal detachment (RD). Materials and Methods: Retrospective analysis of fifty eyes of fifty patients with rhegmatogenous RD, who underwent sutureless scleral buckling from January 2014 to August 2015. Results: Primary retinal reattachment rate of 41 patients was achieved with single surgery, but final anatomical success was 94% with additional pars plana vitrectomy with silicone oil injection and with vitrectomy with epiretinal membrane removal. The mean follow-up was 6 months. Conclusion: Sutureless scleral buckling achieves excellent anatomical and functional success in majority of the patients with rhegmatogenous RD.
  1 2,605 101
Correlation between retinal and choroidal thickness in normal emmetropes
Amir Ramadan Gomaa
July-December 2017, 4(2):31-36
DOI:10.4103/erj.erj_12_17  
Context: An objective and quantitative analysis of the normal choroid and retina relation is required for a better understanding of changes that occur in retinal and choroidal diseases. Aims: This study aimed to evaluate choroidal thickness (CT) and corresponding retinal thickness (RT) using enhanced depth imaging mode of spectral-domain optical coherence tomography (SD-OCT) in normal emmetropic eyes. Methods: One hundred and six eyes of healthy, nearly emmetropic eyes of volunteers were examined by Spectralis OCT. Manual measurements of CT were done under the fovea and on the vertical and horizontal line scans at the ETDRS 1 and 3 mm circles. RT was measured in the center foveal subfield and at the same locations of CT measurements. Statistical Analysis Used: Data were analyzed using IBM SPSS software package version 20.0 (SPSS, Inc., Chicago, IL, USA). Results: With a mean age of 50.3 ± 16.5 years, the mean subfoveal choroidal thickness (SCT) was 297.5 ± 86.2 μ while the mean central RT was 264.3 ± 15.9 μ. The mean CT was thinnest at the nasal location but without statistical significance and SCT was higher in males than females. Significant and correlated age-related thinning was observed in both retina and choroid at all locations, except the fovea, where these changes were significant but not correlated. Conclusions: CT has an age-related thinning pattern that correlates with age-related retinal thinning in extrafoveal macular locations. In addition, age can be used as a guide in predicting the normal SCT in emmetropes.
  1 3,247 105
Evaluation of erythropoietin level in vitreous and serum with detection of erythropoietin gene polymorphism in Egyptian patients with proliferative diabetic retinopathy
Tarek Abdou Moustafa, Mona Mohamad Aly, Zakia Abu-Zahab, Radwa S Shahien
July-December 2017, 4(2):71-76
DOI:10.4103/erj.erj_16_17  
Purpose: To measure erythropoietin (EPO) level in vitreous and serum of patients with proliferative diabetic retinopathy (PDR) and to detect EPO single nucleotide polymorphism (SNP) genotyping expression in them. Materials and Methods: Concentrations of EPO in vitreous and serum of twenty diabetic patients with PDR undergoing vitrectomy (PDR group) were measured by chemiluminescent immunoassay and compared with those in nondiabetic (ND) patients undergoing vitrectomy for recent retinal detachment (ND group). Genotyping of EPO gene SNP (rs551238) was performed using real-time polymerase chain reaction technique. Results: There were a significant increase in serum EPO level in PDR group than in ND group and a highly significant increase in vitreous EPO level in PDR group than in ND group. Within the PDR group, vitreous EPO level was significantly higher than its serum level; there was up to 6-fold increase in the EPO vitreous level than its serum level. EPO gene SNP rs551238 was significantly associated with PDR in Egyptian patients. Conclusion: The results of the current study suggest the involvement of EPO in the pathogenesis of PDR. Hence, augmenting vascular endothelial growth factor inhibition with the use of EPO inhibitors may provide a better outcome in PDR treatment. The detection of EPO gene SNP rs551238 in Egyptian patients with PDR may help in the identification of the genetic predisposition to diabetic retinopathy in Egyptians and so may help in prevention and early detection of susceptible candidates to PDR.
  1 2,077 75
Macular thickness in healthy controls and diabetics without diabetic macular edema
Seham Samir Shawky, Mohammed Hussein Elagouz, Ali Mahmoud Ismail, Ashraf Mostafa Elhawwary
January-June 2018, 5(1):1-5
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.
  1 3,160 176
Optical coherence tomography findings in high myopia
Amir Ramadan Gomaa, Mahmoud Alaa Abouhussein
May-August 2013, 1(2):13-17
DOI:10.4103/2347-5617.135241  
Purpose: The purpose of this study is to describe the incidence and features of macular abnormalities in high myopic eyes detected by optical coherence tomography (OCT). Patients and Methods: This was a prospective observational study that involved 100 eyes of 100 patients with high myopia complaining of recent diminution of vision. OCT examination was done through dilated pupils, OCT examination was done through a dilated pupil using commercially available Cirrus HD-OCT Model 4000 - Carl Zeiss Meditec, Inc., Dublin, California, USA or Spectralis OCT Heidelberg Engineering, Heidelberg, Germany. Results: A total of 100 eyes of 100 patients were studied. There were 45 males and 55 females. The mean age of the patients was 52.9 ± 12.9 (range: 33-70) years. Mean spherical equivalent in these eyes was 14.5 ± 5.8 (range: 8.75-22.75) diopters. Epiretinal membrane was present in 65 eyes. Vitreomacular traction (anteroposterior traction) was detected in 10 eyes. Macular retinoschisis was present in 33 eyes. Conclusion: Macular changes detected by OCT are common pathological findings in high myopia.
  1 7,591 280
Normative macular cirrus spectral domain optical coherence tomography data in Indian pediatric population
Vishal Katiyar, Kumari Mugdha, Sonal Bangwal, Sanjiv Kumar Gupta
September-December 2013, 1(3):50-55
DOI:10.4103/2347-5617.143818  
Aim: Cirrus spectral-domain optical coherence tomography (SD-OCT) being noninvasive is gaining more popularity in identifying, monitoring, and classifying children with vitreo-retinal disorder. Normal values of cirrus SD-OCT from children are currently available from developed countries, but not from India. Objective: The primary objective of this study is to provide a normative pediatric database for macular thickness in healthy Indian children using the cirrus SD-OCT. Materials and Methods: The prospective observational study on 157 consecutive healthy children seen between January 2013 and January 2014. Included in the study were 157 subjects with no ocular abnormality, normal (20/20) visual acuity and normal fundoscopy. Cirrus HD-OCT (Carl Zeiss, Dublin, California, USA) device was used. Outcome: Study patients have a mean age of 12.59 ± 3.5 years, with 112 male (12.88 ± 3.5 years) and 45 female (11.8612.88 ± 3.5 years) children. In the linear regression analysis, changes in central subfield thickness and field of the outer macula were independently affected by increase in the age (β = −1.17-1.7, P = 0.004-0.022) and male are found to have significantly higher value when compared with the female (the t-test; t = 1.9-4.8, P = 0.00-0.24). Conclusion: This study established normal reference values for macular parameters measured by Cirrus SD-OCT in healthy Indian children 6-17 years of age, which is statistically different from the databases from other countries. It establishes the importance of the fact that age and gender warrants special consideration during cirrus SD-OCT interpretations in children.
  1 4,582 141
SYMPOSIUM - DIABETIC RETINOPATHY UPDATE
Proliferative diabetic retinopathy and the use of anti-vascular endothelial growth factors agents
Emily C Fletcher, Fadi Alkherdhaji
January-April 2014, 2(1):35-40
DOI:10.4103/2347-5617.152486  
Current gold standard treatment for proliferative diabetic retinopathy (PDR) is panretinal photocoagulation (PRP) aimed at reducing the drive for new vessel proliferation. The focus is now changing to include the use of anti-vascular endothelial growth factor (VEGF) agents in conjunction with the gold standard in order to improve efficacy and reduce known side-effects associated with PRP, thus providing better outcomes for this group of advanced retinopathy. This paper aims to summarize our current knowledge behind the development of PDR, with review of treatment with anti-VEGF agents. Systematic search of both PubMed and the Cochrane Central Register of Controlled Trials was performed to identify relevant articles. Only articles in the English-language were selected for review. The use of anti-VEGF agents in conjunction with PRP has been shown to be beneficial in the regression of new vessels, reduction of macular edema as well as reduced duration of vitreous hemorrhage. In addition, its use during surgical intervention for PDR can reduce the duration of surgery and early postoperative complications. Despite the lack of large randomized controlled trials in this area there is significant evidence from case series showing the beneficial as well as the adverse effects of this treatment modality. The need for a large randomized controlled trial is an important development for diabetic retinopathy management.
  1 2,808 165
Cataract surgery in diabetic patients
Tarek Hammam
January-April 2014, 2(1):55-61
DOI:10.4103/2347-5617.150212  
Cataract is a common condition observed in patients with diabetes mellitus frequently requiring surgical intervention. Cataract surgery in diabetic patients may result in poor visual outcomes due to the progression of diabetic retinopathy and accelerated development of diabetic macular edema. Researchers and surgeons are interested in learning whether patients with diabetes have increased risks for complications from cataract surgery. In this review, I will evaluate the current management of the adverse events that may occur due to cataract surgery in diabetic patients.
  1 4,582 211
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