cataract

Comparative analysis of outcomes after wavefront-guided and wavefront-optimized laser in-situ keratomileusis in high myopic eyes Ahmed Ghoneim, Tamer Wasfy, Sayed Abass, Hazem Elbedewy, Mohammed Khater, Mounir A Khalifa, Amr F Sharaf, Mohammed H Nasef, Heba M Shafik, Ahmed F Elmaria The Egyptian Journal of Cataract and Refractive Surgery 2018 24(1):1-7 Purpose The aim was to evaluate and compare the clinical outcomes after laser in-situ keratomileusis (LASIK) in high myopia using wavefront-guided (WFG) and wavefront-optimized (WFO) ablation profiles provided by two different excimer laser platforms. Patients and methods Prospective, consecutive, comparative, and masked clinical trial including 41 high myopic eyes treated with WFG LASIK using the Advanced CustomVue system (WFG group) and 40 eyes treated with a WFO profile using the Allegretto EX-500 platform (WFO group). Visual, refractive, contrast sensitivity (CVS-1000), and aberrometric outcomes were evaluated in both groups of eyes during a 6-month follow-up. Results The efficacy index was significantly better in the WFG group compared with the WFO (1.01±0.11 vs. 0.96±0.12, P=0.038). The safety index was also significantly better in the WFG group (1.03±0.12 vs. 0.94±0.11, P=0.011). All eyes achieved postoperatively an uncorrected distance visual acuity of 20/25 or better in the WFG group, whereas 87.5% of eyes achieved this uncorrected distance visual acuity in the WFO group. More eyes gained one line of corrected distance visual acuity in the WFG group (36.5 vs. 15.0%, P=0.015). Significantly lower postoperative manifest refraction spherical equivalent (P=0.045) and cylinder (P=0.005) were found in the WFG group. Manifest refraction spherical equivalent was within ±1.00 D in 90.3% and 80% of eyes in WFG and WFO groups, respectively (P=0.001). Contrast sensitivity decreased significantly only in the WFO group (P≤0.0397). More significant increase in high-order aberrations was found in the WFO group (P≤0.005). Conclusion WFG LASIK provides better efficacy, safety, predictability, and preservation of visual quality in high myopic eyes than WFO LASIK.

Histological comparison between the anterior capsule integrity in femtosecond laser-assisted capsulotomy and traditional continuous curvilinear capsulotomy in cataract surgeries Omar Attar, Alaa Al-Zawawi, Ibrahim Allam, Noha Zahran, Ihab Othman The Egyptian Journal of Cataract and Refractive Surgery 2018 24(1):8-17 Purpose To compare the histological edge structures of anterior lens capsule specimens obtained from laser-assisted cataract surgery capsulotomies using two different laser platforms (LenSx post-soft-fit and Victus II) with that of traditional continuous curvilinear capsulorhexis (CCC) using scanning electron microscopy (SEM). Setting I-Care Center, Alex Eye Center, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Design Prospective comparative series. Patients and methods Anterior capsule specimens following CCC (n=15) or femtosecond laser-assisted capsulotomy using two platforms (LenSx, n=15 and Victus, n=15) were studied by SEM. Irregularity of the capsule edge was quantified using two parameters (angular second moment and contrast) using ImageJ software. The clinical features and laser parameters were correlated with angular second moment and contrast. SEM images were analyzed for the coefficient of variation (CoV) of pixilation along the capsule edge and homogeneity using gray-level co-occurrence matrix analysis. Subjective analysis for cut-surface irregularities and assessment for complications and anomalies, such as tags and misdirected laser shots, were also made. Results The femtosecond laser-assisted capsulotomy edge surfaces created by both laser platforms showed marked irregularity compared with the smoother edge of the CCC. The angular second moment and contrast measures for both lasers differed significantly from those obtained for CCC (P<0.001). There was little between-laser difference in angular second moment and contrast measures. The mean CoV values from the regression analysis showed the manual edge (16.47%) was smoother than the edges created with LenSx post-soft-fit (20.88%) and Victus II (23.04%) platforms. In the manual group, there is dishomogeneous thickness along the capsulorhexis edge, while in the femtosecond laser samples; the cuts are more homogeneous in thickness throughout the whole capsulorhexis edge. Tags occurred with a mean of 4. Misdirected pulses were seen with Victus II (5/15) cases. Conclusion Laser capsulotomies are approaching the smoothness of manual capsulorhexis. The LenSx post-soft-fit platform shows less anomalies and smaller difference for the CoV and homogeneity metrics compared with the Victus II platform. In the manual group, there is dishomogeneous thickness along the capsulorhexis edge, while in the femtosecond laser samples the cuts are more homogeneous regarding thickness throughout the whole capsulorhexis edge.

Evaluation of intrastromal corneal rings (two segments vs. keraring 355) in central keratoconus using femtosecond laser Abdelkhalek El-Saadany, Asmaa Ibrahim, Sherif Esaa The Egyptian Journal of Cataract and Refractive Surgery 2018 24(1):18-22 Purpose The aim was to compare visual acuity, refraction of intrastromal segment 355, and two, 160° symmetrical segments in central keratoconus. Setting Al-Fath Eye Hospital, Zagazig, Egypt. Design Prospective case series. Patients and methods Surgeries were performed using a femtosecond laser for tunnel creation for the 355° near-total ring (group 1) and the 160° two-segment device (group 2). The preoperative and 6-month postoperative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) distance visual acuities were acquired. Results The study included 40 eyes. No statistically significant differences were found in the preoperative parameters between groups (P>0.05). The postoperative UCVA and CDVA were statistically better than the preoperative parameters in all study groups (P<0.001). A statistically significant increase in the median UCVA and BCVA occurred in group 2 compared with group 1 (P<0.01). Conclusions All devices were effective in improving UCVA and BCVA. The UCVA results in the two separated 160° segment better than the 355 segment. Patients with high spherical than cylindrical power had better vision and satisfaction with the 355 segment, while the two separated segments had better vision in high cylindrical patients than spherical power patients.

Visual and topographic outcomes of accelerated corneal cross-linking in keratoconus: 1-year follow-up Sherif H Emerah, Hazem Helmy The Egyptian Journal of Cataract and Refractive Surgery 2018 24(1):23-27 Purpose The aim of this study was to evaluate the visual and topographic outcomes of accelerated corneal collagen cross-linking (ACXL) in mild and moderate progressive keratoconus. Patients and methods This retrospective study evaluated the visual and topographic outcomes of 54 eyes of 36 patients of progressive keratoconus who had ACXL (9 mW/cm; 10 min). Data were collected 12 months after corneal collagen cross-linking. Results Uncorrected distance visual acuity was improved from 0.84±0.49 logMAR preoperatively to 0.79±0.3 logMAR postoperatively which is not statistically significant (P=0.1). Corrected distance visual acuity was not significantly changed. The mean preoperative corrected distance visual acuity was 0.25±0.18 and 0.23±0.2 logMAR preoperatively and postoperatively, respectively (P=0.4). Manifest spherical equivalent was not significantly changed, from −4.1±2.77 D preoperatively to −4.02±2.4 D postoperatively, which was not statistically significant (P=0.4). There were no significant changes of steep K, flat K, average K, and Kmax compared with preoperative measurements at 12 months. Conclusion ACXL (9 mW/cm; 10 min) is effective in stabilizing the keratoconus at 1-year follow-up.

The effect of strabismus on the quality of life in adult strabismus patients in Egypt Ahmed M Osman, Nihal A. El shkankiri, Amr ElKamshoushy, Mohamed M Elashry The Egyptian Journal of Cataract and Refractive Surgery 2018 24(1):28-33 Purpose The study aims at identifying the main concerns affecting quality of life (QOL) in adult strabismus patients in Egypt. Patients and methods Seventy adults with strabismus, 20 with diplopia and 50 without the disease were recruited. Individual interviews, using 11 open-ended questions, were audiotaped, transcribed, and transcripts reviewed. Phrases regarding how strabismus affected everyday life were grouped into topic areas and the frequency of each topic analyzed for patients with and without diplopia. Results With self-esteem, interpersonal relationships, and social anxiety was not surprising based on previous studies of the psychosocial effects of strabismus in adults. Nevertheless, some concerns identified in this study were more unexpected, for example appearance in photos, education, marriage, and no treatment for squint. Other concerns in this study were unexpected as most of the patients did not express these problems, for example, in-depth perception, driving, and sports. Conclusion Multiple individual interviews have shown many topics which negatively affect the QOL in strabismic adults. The frequency and type of concerns confirm the importance of health-related QOL assessment as an important aspect of strabismus management. Cultural difference resulted in a different pattern of patient responses and health-related QOL concerns.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00306932607174,00302841026182,alsfakia@gmail.com