Saudi Journal of Ophthalmology

Editorial Board

2010-07-01

Image guidance surgery – Is it useful to the orbital surgeon?

Vikram D. Durairaj — 2010-07-01

Image-guided surgery (IGS) refers to a surgical system that is able to incorporate pre-operative imaging to a real-time correlation of a surgical instrumentation within the surgical field. The use of IGS in otolaryngology and neurosurgery has gained considerable acceptance and is especially useful to the endoscopic sinus surgeon in sphenoid, posterior ethmoid, and frontal sinus surgery, pterygopalantine tumor surgery, and cerebrospinal fluid leak closure. Although IGS has only recently been applied to complex orbital and sino-orbital surgery, it is not new to the field of medicine. Stereotactic surgery in early 1900s evolved from animal neuro-functional experimentation to human neurosurgical use in 1947 (). In 1978 an American physician, Russell Brown, is credited with the inventing the use of CT scans in stereotactic surgery. In the 1990s, frameless stereotactic systems allowed surgical instrumentation to be tracked while imaging was displayed.

Role of Avastin in management of central serous chorioretinopathy

Shaaban A. Mehany, Ahmad M. Shawkat, Mohamed F. Sayed, Khaled M. Mourad — 2010-07-01

Abstract: Purpose: To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to central serous chorioretinopathy (CSC).Design: Prospective interventional series non-comparative study.Setting: Department of Ophthalmology, Al-Minya University Faculty of Medicine, Egypt.Methods: The study included 20 eyes of 20 patients with central serous chorioretinopathy (CSC), Out of them 10 eyes with acute CSC (group I), 6 eyes with chronic CSC (defined as symptoms present for longer than 6months) and four eyes with recurrent (defined as more than one episode of the disease) chronic and recurrent cases are considered in one group (group II), all patients were injected with intravitreal Avastin (IVA) 1.25mg (0.05mL) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] as a primary treatment. At baseline and follow up visits patients had best corrected visual acuity (BCVA), IOP assessment, dilated fundus examination, fundus photography, fluorescein angiography (FA) and optical coherence tomography (OCT) imaging is used for measurement of central retinal thickness (CRT). Main outcome measures were the resolution of neurosensory detachment, improvement in visual symptoms and visual acuity, and resolution of leakage in FA. Secondary outcome and measures were the need for re-injection and the adverse effects. The mean number of injections was 2 (range 1–3 injections) 6–8weeks intervals and follow up for 6months (range 5–7months). All finding at baseline and each follow up visit were reported and compared.Results: The mean age of all patients was 40.3years±6.5 (range 25–50years), 15 males and five females patients. In acute CSC group, the mean baseline BCVA was 20/60 (log MAR 0.48) and improved to 20/30 (log MAR 0.18) with statistically significance difference change (P<0.003) and in (chronic and recurrent group), the mean baseline VA was 20/80 (log MAR 0.60) and improved to 20/40 (log MAR 0.30) with statistically significance difference change (P<0.002). The mean baseline CRT for all patients was 486±86μm (range, 386–580), decreased to 316±56μm (range, 276–368) after 1months with statistically significance difference change (P<0.02) and to 272±52μm (range 220–338) at last follow up with statistically significance difference change from the baseline (P<0.001).Conclusions: Intravitreal Avastin (IVA) injection was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further randomized controlled studies would be helpful to understand this therapy for patients with CSC.

Intra-ocular lens power calculation in patients with high axial myopia before cataract surgery

Raouf El-Nafees, Ashraf Moawad, Hanem Kishk, Walid Gaafar — 2010-07-01

Abstract: Purpose: To evaluate the accuracy of different formulas used for IOL power calculation in patients with high axial myopia undergoing cataract surgery.Methods: A prospective clinical study was carried out on 53 eyes of 51 patients with an axial length from 25.5 to 31.4mm including 21 males (41.2%) and 30 females (58.8%). Calculation of the IOL power to be implanted was done by three available IOL power formulas; Haigis formula, SRK/T formula, and Holladay I formula. The mean error (ME) was calculated from the difference between the formula predicted refractive error and the actual post operative refractive error.Results: There was no statistically significant difference between the mean error of the three formulas used in the overall performance or in the axial length subcategories. SRK/T formula caused the smallest mean error, (+0.17D). Haigis formula showed a higher ME (+0.21D) and Holladay formula caused a myopic postoperative refractive error (−0.20D).Conclusion: The calculation of IOL power in patients with high axial myopia using the third or the fourth generation formulas help in improvement of the accuracy of the calculation and decreasing the post operative refractive error. SRK/T formula showed the lowest mean error, however, there was not statistically significant difference between the three formulas used, neither in the overall performance, nor in axial length subcategories.

Evaluation of the role of timolol 0.1% gel in myopic regression after laser in situ keratomileusis

Hatem E. El-Awady, Asaad A. Ghanem, Mohamed A. Gad — 2010-07-01

Abstract: Purpose: To evaluate the efficacy of the concomitant administration of antiglaucoma medications namely timolol 0.1% gel in cases with myopic regression after myopic laser in situ keratomileusis (LASIK).Design: Prospective observational clinical trial.Subjects and methods: Ninty five eyes of 75 patients were included in this study prospectively. The mean myopic regression was −1.29±0.83 diopters (range −0.5 to −4.62) after myopic LASIK. The eyes were divided into two groups: 50 eyes administrated timolol 0.1% gel once daily for 12months (treated group), and 45 eyes were age matched (control group). We assessed the amounts of myopic regression in terms of changes in the refraction (spherical equivalent and astigmatism), intraocular pressure (IOP), pachymetry and the refractive power of the cornea measurements for all participants.Results: The refractive error and visual acuity were similar between the two groups at baseline. The treated group had an improvement in spherical equivalent significantly from −1.29±0.83 to −0.94±1.07 diopters (P=0.012). Astigmatism was changed from −0.94±0.53 to −0.86±0.60 diopters but this change was not statistically significant (P=0.20). The IOP was decreased significantly from 12.6±1.9 to 9.0±1.1mmHg (P<0.001). Central corneal thickness was changed from 425.6±19.86 to 429±18.1μm but not statistically significant (P=0.56). The central corneal power decreased significantly from 37.2±1.8 to 36.4±1.3 diopters (P<0.05).Conclusion: Timolol 0.1% gel was effective for reduction and improvement of myopic regression especially the spherical errors after myopic LASIK.

Early Avastin management in acute retinal vein occlusion

Shaaban A. Mehany, Khaled M. Mourad, Ahmad M. Shawkat, Mohammed F. Sayed — 2010-07-01

Abstract: Purpose: To evaluate the safety, functional and anatomical effects of intravitreal Avastin (bevacizumab) in treatment of recent retinal venous occlusion.Design: Prospective interventional series non-comparative study.Setting: Department of Ophthalmology, Faculty of Medicine, El-Minia University, Egypt.Methods: The study included 30 eyes of 30 patients with recent retinal venous occlusion of less than 3months duration 12 eyes (40%) of patients with central retinal vein occlusion (CRVO) and 18 eyes (60%) with branch retinal vein occlusion (BRVO) were injected with intravitreal bevacizumab 1.25mg (0.05ml) of commercially available bevacizumab [Avastin; Genentech, Inc., San Francisco, CA] at a concentration of 25mg/ml as a primary treatment. The mean number of injections was 2.7 (range, 1–6 injections) 6–8weeks intervals and follow-up for 12months (range, 9–13months). Patients underwent visual acuity testing (VA) as functional assessment. Anatomically, optical coherence tomography (OCT) is used for measurement of central retinal thickness (CRT) to detect macular edema (ME), fundus photography and fluorescein angiography (FA) to detect venous tortuosity, optic disc edema and surface wrinkling rather than ME. All finding at baseline and each follow-up visit were reported.Results: The mean age of all patients was 65.3years±8.5 (range, 55–82years), 20 males and 10 females patients. The mean baseline VA was 20/240 (logMAR 1.08±0.52) and improved to 20/60 (logMAR 0.48±0.32) with statistically significance difference change (P<0.001). The mean baseline CRT was 455μm±126 (range, 386–510), decreased to 356μm±118 (range, 296–416) after 1month with statistically significance difference change (P<0.02) and to 402μm±170 (range, 338–468) after 6months (P<0.067) and to 250μm±48 (range, 200–298) at last follow-up with statistically significance difference change from the baseline (P<0.001). There were great proportional decrease in venous tortuosity, optic disc edema and surface wrinkling after 1month of injection. Neither systemic nor intraocular adverse events were reported.Conclusions: Intravitreal Avastin (IVA) is safe well tolerated, effectively improve VA, fundus picture and stabilize anterior segment neo-vascular activity in patients with recent retinal venous occlusion.

Completing phaco following anterior capsular tear

Brian Little — 2010-07-01

Abstract: A primary tear-out of the capsulorrhexis or a later anterior capsule tear occurs in less than 1% of phacoemulsification procedures (). It is a relatively uncommon complication but a hazardous and important one, although comparatively little has been published on its management. With the nucleus still in the bag at this stage, the surgeon is faced with the sizeable challenge of completing surgery without propagating a wrap-around tear to the posterior capsule.These are perilous conditions to face, but by using the right techniques the surgeon can still prevail. There is a clear set of principles that are based on self-knowledge of the surgeon’s own skills and experience, combined with their understanding of how to control the forces acting on the tear and the tolerances of the capsular bag to surgical manipulation.Applying these principles in practice has enabled the development of a range of techniques now available to safely remove the nucleus under these challenging conditions. However, by far the most important principle of all is that if in doubt, not to proceed.

Primary orbital ganglioneuroma in a 2-year-old healthy boy

Hattan Al-Khiary, Ayman Ayoubi, Sahar M. Elkhamary — 2010-07-01

Abstract: A 2-year-old healthy child presented with progressive unilateral proptosis.Complete work up including: general examination, detailed ophthalmic evaluation and radiological imaging were done. He underwent orbital exploration via anterior orbitotomy incision and debulking of the tumor was done.The histopathological examination confirmed the diagnosis of orbital ganglioneuroma.Ganglioneuroma is an unusual benign tumor of neuroplastic origin with extremely rare orbital involvement with only one prior reported case in a youth. The tumor is slow growing and non-metastasizing. Biopsy is necessary to differentiate it from the malignant neuroblastoma and excision is usually curative.

Long-term corneal complication of retained anterior chamber-angle foreign body

Sabah S. Jastaneiah — 2010-07-01

Abstract: A 33-year-old patient referred to the cornea and anterior segment department to evaluate inferior corneal edema related to a retained intraocular foreign body (IOFB) in the anterior chamber-angle. The foreign body, which was a single piece of glass caused by an exploded light bulb twenty years back, was surgically removed; edema resolved and vision improved to 20/30. In the presence of an anterior chamber IOFB; long-term adverse effects should be considered. We would advise removal of the FB regardless of the inertness and location facts, as long as the risk and benefits of the surgical intervention are carefully evaluated.