Can opposite clear corneal incisions have a role with post-laser in situ keratomileusis astigmatism?

To evaluate the astigmatic correcting effect of paired opposite clear corneal incisions [OCCIs] on the steep axis in patients with residual astigmatism after laser in situ keratomileusis [LASIK] Thirty-one eyes of 24 patients with a mean age of 28.4 years +/- 2.46 [range, 19-36 years] were recruited for the study. Inclusion criteria included residual astigmatism of=1.5 diopter [D] after LASIK with inadequate residual stromal bed thickness that precluded ablation. The cohort was divided into two groups; group I [with astigmatism ranging from-1.5 D to-2.5 D] and group II [with astigmatism>-2.5 D]. The steep axis was marked prior to surgery. Paired three-step self-sealing opposite clear corneal incisions were performed 1-mm anterior to the limbus on the steep axis with 3.2-mm keratome for group I and 4.1 mm for group II. Patients were examined 1 day, 1 week, 1 month, 3 months and 6 months, postoperatively. Visual acuity, refraction, keratometry, and corneal topography were evaluated preoperatively and postoperatively. Analysis of the difference between groups was performed with the Student t-test. P<0.05 was considered statistically significant. The mean uncorrected visual acuity [UCVA] improved from 0.35 +/- 0.13 [range, 0.1-0.6] to 0.78 +/- 0.19 [range, 0.5-1] in group I and from 0.26 +/- 0.19 [range, 0.1-0.5] to 0.7 +/- 0.18 [range, 0.4-1] in group II. The increase in UCVA was statistically significant in both groups [P=0.001, both cases]. The mean preoperative and postoperative keratometric astigmatism in group I was 2.0 +/- 0.48 D [range, 1.5-2.5 D] and 0.8 +/- 0.37 D [range, 0.1-1.4 D], respectively. The decrease in keratometric astigmatism was highly statistically significant in group II [P=0.001.]. Mean surgically induced astigmatic reduction by vector analysis was 1.47 +/- 0.85 D and 2.21 +/- 0.97 D in groups I and II respectively. There were no incision-related complications. Conclusions: Paired OCCIs were predictable and effective in correcting post-LASIK astigmatism and required no extra surgical skill or expensive instruments. OCCIs are especially useful in eyes with insufficient corneal thickness for LASIK retreatment

Accuracy of intraocular lens power calculation in high myopia

To study the accuracy of different recent intraocular lens [IOL] calculation formulas in predicting a target postoperative refraction +/- 1.0D [Diopters] in patients with long eyes [axial length >/= 26.0 mm] undergoing phacoemulsification. This study comprised 127 eyes of 87 patients who presented with cataract and axial eye length ? 26 mm. Before phacoemulsification and IOL implantation; axial length measurement using immersion ultrasound A-scan technique, and autokeratometry with or without computerized corneal topography for K readings were done. The IOL power was calculated using four formulas, namely the SRK-T, Hoffer-Q, Holladay-2, and Haigis formulas. Four months after surgery, refraction was done. Differences between actual postoperative refraction and assumed target refraction using the different formulas were analyzed. P < 0.05 was considered statistically significant. In all 127 eyes, the mean axial length was 31.71 mm [range, 26.06-37.11 mm] and the mean K was 44.68 D [range, 40.05-55.14D]. The mean preoperative spherical equivalent [SE] was ?17.52D [range, ?12.25 to ?30.50D]. After surgery, the mean spherical equivalent was ?0.8 +/- 0.83D [range, +1.25 to ?3.75D]. The mean postoperative refractive SE when implanting a plus power IOLs was ?0.3 +/- 0.51D [P < 0.001] while the mean postoperative refractive SE when implanting a minus power IOLs was +1.21 +/- 0.11D denoting a highly significant tendency toward hyperopia [P < 0.001]. Concerning the minus power group, most postoperative refractive error was within +1.0 to +2.0D in the actual implanted IOL and in all other formula calculated IOL power. However, Haigis formula showed the least deviation while SRK-T and other formulas showed a greater tendency toward hyperopia. In eyes with high axial myopia, the performance of SRK-T, Hoffer-Q, Holladay-2 and Haigis formulas are comparable in low plus-powered IOL implantation. Haigis formula is the best formula when minus power IOL is implanted

Correlation of central corneal thickness and optic nerve head topography in patients with primary open-angle glaucoma

To evaluate whether changes in optic nerve head topography and visual field in patients with primary open-angle [POAG] are related to central corneal thickness [CCT]. Eighty eyes of 50 patients with POAG underwent ophthalmic examination; optic nerve head imaging with the Heidelberg Retina Tomography II [HRT II], ultrasound corneal pachymetry, and visual field evaluation with the Humphrey visual field analyser [program 24-2]. Correlation between CCT, age, gender, family history of glaucoma, visual acuity, intraocular pressure [IOP], optic disc surface area, vertical and horizontal cup: disc ratios, neuroretinal rim area, mean deviation of visual field, and number of glaucoma medications was analyzed. Patients were divided into a thin CCT group <540 micro m or a thick CCT group >540 micro m. Pearson correlation was used for correlation coefficient and a P value of <0.05 was considered statistically significant. Thin CCT was significantly correlated with vertical and horizontal cup: disc ratios, neuroretinal rim area loss, and smaller optic disc surface area [r=0.043, r=0.021, r=0.036, and 0.031 respectively]. Thin CCT was also significantly associated with worsened mean deviation of visual field, and increased number of glaucoma medications [r=0.065 and r=0.423]. Patients with positive family history correlated with with greater vertical cup: disc ratio, and more glaucoma medications but this was not statistically significant. In patients with POAG those with thinner CCT are likely to develop greater glaucomatous optic nerve and visual field damages than those with a thicker CCT

Graves opthalmopathy and psychoendocrinopathies

To assess the psychiatric and endocrinological changes in patients with Graves ophthalmopathy [GO]. A prospective, controlled, University Hospital based study. The current study comprised 60 patients diagnosed with GO at Mansoura Ophthalmic Center. Thirty five patients of them with moderate to severe GO formed the study group and twenty five patients with negligible to very mild GO formed the control group in the euthyroid state. The study group was further subdivided based on their predominant clinical signs into a proptosis subgroup and a muscle restriction subgroup. Psychiatric changes were assessed with the Middlesex Hospital Questionnaire [MHQ]. Biochemical analyses included serum-free thyroxine and thyroid-stimulating hormone [TSH] concentrations, TSH receptor antibody [TRAb] activity and antrthyroglobulin particle agglutination [TGPA] and antithyroid microsomal particle agglutination [MCPA]. The proptosis group reported significantly higher scores on anxiety, depression, and phobia than the muscle restriction group [P<0.0001]. The proptosis and muscle restriction subgroups reported significantly higher scores on all subscales compared to the control group [P<0.05]. The scale scores of depression and phobia showed a positive correlation with scores of anxiety [P<0.0001]. The serum TRAb activity showed a significant correlation with anxiety, phobia and hysteria [P<0.0001]. The psychiatric aspect of GO should be evaluated during routine follow-up and should be considered when making management decisions. Thyroid specific antibodies may be useful in confirming the diagnosis of GO

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

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]. Prospective observational clinical trial. 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 12 months [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. 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 +/- 1.1 mm Hg [P<0.001]. Central corneal thickness was changed from 425.6 +/- 19.86 to 429 +/- 18.1 micro m 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]. Timolol 0.1% gel was effective for reduction and improvement of myopic regression especially the spherical errors after myopic LASIK