Functional and anatomical evaluation of the effect of nepafenac in prevention of macular edema after phacoemulsification in diabetic patients

AIM: To evaluate the effect of prophylactic administration of nepafenac in prevention of macular edema occurring in diabetic patients after phacoemulsification and to investigate the correlation between optical coherence tomography(OCT) foveal thickness and multifocal electroretinogram(MF-ERG) parameters.METHODS: The study included two groups. Group 1 included 50 diabetic patients with senile cataract(50 eyes, 30 females, 20 males, aged 55±7 y) received nepafenac 0.1% eye drop. Group 2 included another 50 diabetic patients with senile cataract(50 eyes, 22 female, 28 males, aged 53.8±8 y) did not receive nepafenac. All patients were followed up for 3 mo postoperatively. OCT and MF-ERG were done preoperative and at 1 wk, 1, 2 and 3 mo.RESULTS: The mean foveal thickness was statistically significantly lower in Group 1. Five eyes in Group 2 developed clinical cystoid macular oedema(CMO)(10%), and no patients in Group 1 developed central macular thickening more than 50 μm. There were insignificant differences in MF-ERG amplitudes and latencies between the two groups except in the five eyes that developed CMO, there statistically significant reduction of MF-ERG amplitude with increase in foveal thickness. CONCLUSION: Perioperative nepafenac reduces the incidence of CMO following uncomplicated phacoemulsification significantly. Nepafenac has no side effects.

Long-term results of Ahmed glaucoma valve implantation in Egyptian population

AIM： To evaluate the long-term results and complications of Ahmed glaucoma valve （AGV） implantation in a cohort of Egyptian patients. METHODS： A retrospective study of 124 eyes of 99 patients with refractory glaucoma who underwent AGV implantation and had a minimum follow-up of 5y was performed. All patients underwent complete ophthalmic examination and intraocular pressure （lOP） measurement before surgery and at ld, weekly for the 1st month, 3, 6mo, and ly after surgery and yearly afterward for 5y. lOP was measured by Goldmann applanation tonometry and/or Tono-Pen. Complications and the number of anti-glaucoma medications needed were recorded. Success was defined as lOP less than 21 mm Hg with or without anti-glaucoma medication and without additional glaucoma surgery. RESULTS： Mean age was 23.1±19.9y. All eyes had at least one prior glaucoma surgery, lOP was reduced from a mean of 37.2±6.8 to 19.2±5.2 mm Hg after 5y follow-up with a reduced number of medications from 2.64±0.59 to 1.81±0.4. Complete and qualified success rates were 31.5% and 46.0% respectively at the end of follow-up. The most common complications were encapsulated cyst formation in 51 eyes （41.1%）, complicated cataract in 9 eyes （7.25%）, recessed tube in 8 eyes （6.45%）, tube exposure in 6 eyes （4.8%） and corneal touch in 6 eyes （4.8%）. Other complications included extruded AGV, endophthalmitis and persistent hypotony. Each of them was recorded in only 2 eyes （1.6%）. ~ CONCLUSION： Although refractory glaucoma is a difficult problem to manage, AGV is effective and relatively safe procedure in treating refractory glaucoma in Egyptian patients with long-term follow-up. Encapsulated cyst formation was the most common complication, which limits successful lOP control after AGV implantation. However, effective complications management can improve the rate of success.

Trabeculectomy with Ologen implant versus perfluoropropane gas bubble for open angle glaucoma in pseudophakic eyes

AIM:To evaluate the safety and efficacy of augmented trabeculotomy with Ologen versus perfluoropropane in management of pseudophakic glaucoma.METHODS:This is a comparative randomized study included 57 pseudophakic eyes of 57 patients with medically uncontrolled open angle glaucoma(OAG).Twentynine patients were allocated in group I(trabeculectomy with Ologen;trab-ologen group),while 28 patients were assigned in group II(trabeculectomy with perfluoropropane gas bubble;trab-C3 F8 gas bubble group).RESULTS:The intraocular pressure(IOP)was significantly reduced in both study groups at all postoperative follow up intervals(1 wk,3,6,12,18,24,30 and 36 mo,P<0.001).The differences between the mean IOP values of both groups remained statistically insignificance during the early 12 months of follow up.However,the trab-ologen group achieved a statistically significant reduction over the trab-C3 F8 gas bubble group during the last 24 months of follow up.CONCLUSION:Augmentation of trabeculectomy with either Ologen implant or perfluoropropane gas bubble are associated with strict long term IOP control and evident safety in medically-uncontrolled pseudophakic eyes with OAG.

Two-stage procedure in the management of selected cases of keratoconus: clear lens extraction with aspherical IOL implantation followed by WFG-PRK

AIM： To assess the objective and subjective results of a two-stage procedure for management of keratoconus： clear lensectomy with aspherical intraocular lens（IOL） implantation followed by wave front-guided photorefractive keratotomy（WFG-PRK）.METHODS： This prospective interventional non-randomized study included patients aged 35 years old or more with grade I and II stable keratoconus, a clear visual axis, minimal corneal thickness（MCT） 420 μm or more and average keratometric reading（K） less than 54 diopter（D）. Refraction of all selected eyes should be-8.00 D sphere or more with less than-6.00 D cylinder and could be corrected two lines or more with spectacles or contact lenses. All studied eyes underwent a two-stage approach treatment： first refractive lens exchange and aspherical IOL implantation followed, after at least 3 mo, by WFGPRK. Pre and postoperative complete ophthalmological examination were performed. Topographical, visual and aberrometric results were recorded and evaluated during 6 mo follow up period. Moreover, patient satisfaction and other subjective outcomes were also analyzed.RESULTS： The 13 eyes of 11 patients diagnosed with stable keratoconus and aged from 39 to 49 y（42.4±6.2 y） were enrolled in the study. At baseline, 8 eyes had grade I and 5 eyes had grade II keratoconus. The manifest sphere was-10.3±4.2 D（ranged from-8.0 to-14.0 D） and the manifest cylinder was-4.2±1.2 D（ranged from-1.75 to-5.50 D）. After the two-stage procedure, sphere and cylinder reduced significantly to-0.43±0.22 D and-1.3±0.72 D respectively（P〈0.001）. There was also a highly significant improvement in the mean uncorrected distance visual acuity（UDVA） from logMAR 1.41±0.49 preoperatively to 0.51±0.16 postoperatively（P〈0.001） and the mean corrected distance visual acuity（CDVA） from 0.76±0.24 preoperatively to 0.49±0.13 after the operation（P〈0.001）. All aberrometric and mesopic vision parameters and most of the topographical indices demonstrated highly significant improvement that remains stable until the end of follow up. All recorded subjective data revealed a high degree of patient satisfaction.CONCLUSION： Two-stage approach（clear lens exchange with monofocal IOL followed by WFG-PRK） in selected cases of keratoconus is a safe, effective and highly predictable procedure with satisfactory visual and refractive results.