Τρίτη, 19 Φεβρουαρίου 2019

Retina

Optical coherence tomography characteristics of active and regressed retinal neovessels secondary to proliferative diabetic retinopathy before and after panretinal photocoagulation
Islam Shereen Hamdy Ahmed

Egyptian Retina Journal 2018 5(2):25-31

Aim: To describe the changes in the appearance of diabetic neovascularization and vitreoretinal interface before and after panretinal photocoagulation (PRP) using high-resolution spectral-domain optical coherence tomography (SD-OCT). Design: A prospective noncomparative observational case series study was performed on 15 eyes with proliferative diabetic retinopathy (PDR). Patients and Methods: Patients with PDR were scanned using SD-OCT scans directly over the region of the neovessels before and after PRP treatment. Results: The study included 15 treatment-naive eyes with PDR of 11 patients, 8 females and 3 males with a mean age of 54.18 ± 10.9 years (range 29–65 years). The mean best-corrected logarithm of the minimum angle of resolution visual acuity was 0.68 ± 0.19 (range 0.4–1). One (9.1%) case had insulin-dependent diabetes mellitus (type 1) and 10 (9.1%) cases had noninsulin-dependent diabetes (type 2). Posterior hyaloid was detached and identifiable in pretreatment SD-OCT scans in 11 (73.33% of studied eyes) eyes and not identifiable in 4 (36.67%) eyes. Changes in SD-OCT scan appearance after PRP included progression of posterior hyaloid separation with possible progressive retinal traction and retinoschisis, consolidation of the neovessels, regression of neovessels, or occurrence of preretinal hemorrhage. One case showed no visible change at the vitreoretinal interface. Conclusion: There are changes in the appearance of the diabetic neovessels and the vitreoretinal interface after PRP treatment that could be detected by SD-OCT. 


Role of retrobulbar dexamethasone in the treatment of optic neuritis
Sourav Kumar Bose, Gitanjali Bose

Egyptian Retina Journal 2018 5(2):32-34

Optic neuritis is a disease entity characterized by, as the name clearly suggests, inflammation of the optic nerve. Over many years, the treatment of optic neuritis has been the use of steroids. The Optic Neuritis Treatment Trial laid the foundation stone for calibrating the use of steroids. However, all modalities have their own adverse effects, in terms of cost, patient compliance, adverse effects, etc. The purpose of this article is to evaluate the role of retrobulbar dexamethasone in the treatment of optic neuritis. After proper patient preparation, a neuritic cocktail of dexamethasone and lignocaine, in pretitrated amounts, is injected in the retrobulbar space. This was administered 3 times at an interval of 48 h, followed by oral prednisolone and supplemented with oral Vitamin B complex. Of 14 patients, 8 (57.1%) patients gained to a best-corrected visual acuity (BCVA) of 6/12 or more, 4 (28.5%) patients had BCVA between 6/24 and 6/18, and 2 (14.2%) patients had BCVA of 6/60. Hence, we conclude that such affordable drug combination can provide a cost-effective measure to treat optic neuritis. 


Factors affecting choroidal thickness in normal myopic eyes in Egyptians using swept-source optical coherence tomography
Esraa R Mokhtar, Khaled Abdelazeem, Abdelsalam Abdalla, Hassan L Fahmy

Egyptian Retina Journal 2018 5(2):35-40

Purpose: To study the influence of age, sex, refractive error, and axial length (AL) on choroidal thickness (CT) in normal myopic eyes, among Egyptian population, using swept-source optical coherence tomography (SS-OCT). Patients and Methods: CT was measured by an SS-OCT in 97 eyes of 49 normal myopic volunteers. The subjects were classified according to age, degree of myopia, and AL. Correlation between CT and age, AL, and myopia was done for different groups. AL was measured using IOL Master. OCT measurements were performed using Topcon DRI-1 SS-OCT. CT was automatically calculated and shown as a colored topographic map with nine subfields defined by the Early Treatment Diabetic Retinopathy Study style grid. Results: CT tends to decrease with advance of age. A negative correlation found between the central subfoveal CT (SFCT) and the age (r = −0.329, P = 0.001, R2 = 0.108). Although there was no significant correlation between CT and degree of myopia (r = 0.159, P = 0.120, R2 = 0.025), CT decreases with increase of myopia except with >−8 D group. CT tends to decrease as the AL increases. A negative correlation found between the central SFCT and AL (r = −0.340, P = 0.001, R2 = 0.115). Conclusions: AL and age have a negative correlation with CT, while the sex and spherical equivalent of refractive error in myopes do not affect CT. 


Comparative study between single session pattern short pulse laser and conventional pan-retinal photocoagulation regarding efficacy and macular thickening in patients with diabetic retinopathy
Ahmed Mahmoud Abdel Hadi

Egyptian Retina Journal 2018 5(2):41-46

Aim: The aim of this study is to compare the effect of pan-retinal photocoagulation (PRP) using short-pulse laser (SPL) performed in a single session and conventional laser, regardless of the number of spots, in terms of their effect on the progression of diabetic macular edema (DME) and efficacy of regression of signs in patients with proliferative and high-risk nonproliferative diabetic retinopathy (NPDR). Methods: A prospective comparative case series was carried out, in which eyes with a similar degree of severe nonPDR or high-risk PDR underwent four-session PRP using a conventional laser in one eye (Group a) and a single session SPL in the other eye (Group b). After the session, colored photographs were taken to show immediate laser reaction. A follow-up visit was scheduled at 6 weeks to detect any complication. Finally, fluorescein angiography and optical coherence tomography were repeated at 3 months to assess the efficacy of laser treatment and the remeasure the macular thickness. Best-corrected visual acuity (BCVA) was remeasured after 12 weeks and compared to the prelaser VA. Results: The 20 patients included had a mean age of 53.4 ± 6.4 years. All patients had hemoglobin A1c (HBA1c) ranging from 7.2 to 8.4 with a mean of 7.7 ± 0.5. Before PRP initiation, there was no statistically significant difference between the two groups as regards mean age, duration of DM, and mean HBA1c. The mean power of laser was 198.7 ± 13.26 mW and 393.2 ± 17.7 mW (P < 0 0001), the total energy delivered was 49.7 ± 11.4 mJ and 12.1 ± 5.3 mJ (P < 0 0001), and the number of spots were 1784.2 ± 89.7 and 2773.2 ± 159.2 (P < 0 0001) in the Conventional (Conv) group and SPL group, respectively. At the final follow-up visit at 12 weeks, there was no statistically significant difference regarding the mean central macular thickness (P = 0.84) and BCVA (P = 1.0). One eye from each group was diagnosed with persistent diabetic retinopathy activity at 12 weeks, for which intravitreal ranibizumab was given twice, 1 month apart. The FA was repeated 3 months later with the disappearance of signs of activity. Conclusion: The current study revealed that SPL in a single session is as effective as conventional laser-performed in the same patient with a similar degree of DR in both eyes-to cause regression of diabetic retinopathy signs without causing progression of DME. This was achieved with a total number of laser shots approximately 1.5 times the number in the conventional laser-treated eyes. 


Central serous chorioretinopathy: A report of two unusual causes
Imran Ahmed Ansari, Ossama Abdelwahed El Haddad

Egyptian Retina Journal 2018 5(2):47-49

Two cases of central serous chorioretinopathy due to unusual etiology are presented, one after sustaining a head injury following a fall and the other after being treated for allergic conjunctivitis with topical steroids. Both cases showed resolution of their condition and return of their visual acuity to normal on follow-up. 


Bilateral central retinal artery occlusion in a case of eclampsia
YD Shilpa, BN Kalpana, Sheetal Devaru

Egyptian Retina Journal 2018 5(2):50-52

A 19-year-old primigravida admitted in eclampsia ward noticed sudden loss vision in both the eyes. On the same day, she underwent emergency cesarean section due to her deteriorating systemic condition. After her general condition improved, loss of vision in both the eyes continued. On ocular examination, she had bilateral central retinal artery occlusion (CRAO). This is the second case of bilateral CRAO in eclampsia reported in the English literature till date. In our case, the hematological changes occurring in pregnancy and pregnancy-induced hypertension could have caused CRAO in both the eyes. 


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