Spectacle Decentration to Augment Over-minus Therapy in Cases with Intermittent Exotropia.

Purpose: To evaluate the adding effect of inward decentration of concave spectacle lenses (adding a prismatic effect) on angle control in cases with distance intermittent exotropia (IXT) receiving over-minus therapy.Methods: Patients with myopia with IXT angles ≤25 and a Newcastle score (NCS) ≥5 were included. Patients were randomised into two groups. Group 1 received over-minus therapy. Group 2 received over-minus therapy with inward decentration of spectacle glasses to add a base out prism effect equal to one-third of the distance angle of deviation. Success was measured as the percentage of orthotropic cases or those with orthophoria or IXT with improved NCS ≤ 3 and tolerant to treatment. Patients were evaluated 3 months after initial treatment, 3 months after partial weaning and 18 months after complete weaning.Results: Sixty-four patients were included, with 32 in each group. The success rates of group 1 were 65.6%, 37.5%, and 31.3%, in group 2, the rates were 75%, 65.6%, and 65.6% for orthotropic cases or those with orthophoria or IXT with improved NCS ≤ 3, respectively. Moreover, NCS significantly improved in group 2 till last visit.Conclusion: Adding decentration to over-minus therapy can result in better control of small angle IXT and could be considered as a non-invasive and reversible therapy.

Evaluating optic nerve diameter as a possible biomarker for disability in patients with multiple sclerosis.

BACKGROUND AND PURPOSE: The development of new biomarkers for multiple sclerosis (MS) is of paramount importance to improve our ability to predict disease progression and disability. The aim of this study was to evaluate the potential role of the optic nerve diameter (OND) measured by ultrasonography as a biomarker of early disability in patients with relapsing-remitting multiple sclerosis (RRMS). METHODS: Forty-nine RRMS patients, 23 with a history of optic neuritis (MS-ON) and 26 without a history of optic neuritis (MS N-ON), and 50 age- and sex-matched healthy control subjects were included in the study. The OND and optic nerve sheath diameter (ONSD) were measured by transorbital sonography (TOS), and the retinal nerve fibre layer (RNFL) and ganglion cell complex (GCC) thicknesses were measured by optical coherence tomography (OCT) using the Optovue RTVue™ system (Optovue, Inc., Fremont, CA, USA). RESULTS: There was no significant difference between the patient (whether ON or N-ON eyes) and control groups in either the OND (p=0.979) or the ONSD (p=0.911). However, patients with an expanded disability status scale (EDSS) score >2 had a significantly lower OND and RNFL thicknesses (p=0.014, p=0.010 respectively) than patients with an EDSS score ≤2. Statistical logistic regression revealed that OND was an independent predictor of EDSS>2 (p=0.044, OR =0.000, 95% CI=0.000-0.589). CONCLUSION: The OND, as measured by ultrasonography, could be potentially used as a biomarker for the detection of early disability in RRMS patients.

Outer Retinal Healing After Internal Limiting Membrane Peeling in Diabetic Macular Oedema with Vitreomacular Interface Abnormality Using Three Different Dyes.

Purpose: To evaluate the difference in ellipsoid zone and external limiting membrane (EZ/ELM) restoration after vitrectomy with internal limiting membrane (ILM) peeling in diabetic macular oedema with vitreomacular interface abnormalities (VMA DME) patients using 3 different dyes.Methods: Patients with type 2 diabetes mellitus and VMA DME indicated for ILM peelings were included. Disruption of the EZ/ELM was graded and compared among groups (preoperative and 6 months postoperative). Patients were divided into 3 groups according to the dye used: group A: indocyanine green (ICG); group B: trypan blue (TB); and group C: brilliant blue G(BBG).Results: Twenty-six eyes were included in group A, 29 eyes were included in group B, and 28 eyes were included in group C. Improvement in EZ/ELM integrity was observed in 34.6% of group A, 27.6% of group B, and 32.1 % of group C (p = .84). Deterioration of EZ/ELM integrity was observed in 19.2% of group A, 6.9% of group B and 0% of group C (p = .03).Conclusion: ICG resulted in a greater percentage of deteriorated EZ/ELM integrity at 6 months after surgery in cases with pre-treatment ELM interruption. Therefore, ICG should be used with caution in cases with ELM disruption, yet, further studies are recommended.

Is Inverse Prism Therapy Comparable to Conventional Prism Therapy for Improving Newcastle Scores in Patients with Basic Intermittent Exotropia?

Purpose: To determine the effect of prism orientation on the Newcastle Control Score (NCS) in patients with basic intermittent exotropia (IXT).Methods: Patients with IXT with a distant angle of deviation (DAD) ≤50∆ and NCS≥5 were recruited and randomly divided into two groups. The inverse prism (IP) group received a base-out Fresnel prism addition to achieving full refractive correction, and the conventional prism (CP) group received base-in Fresnel prism addition. The prism addition was equivalent to one-third of the mean DAD. Patients were evaluated 3 months after initial treatment, 3 months after partial weaning and 6 months after complete weaning. NCS and DAD values were compared. Tolerance was defined as the ability to wear the prescription 80% of waking hours.Results: Fifty patients were enrolled in each group. The IP group had 6 intolerant patients, and the CP group had 3 intolerant patients. NCS improved in both groups (from 6.2 ± 0.7 to 3.4 ± 2.5 in the IP group and from 6.4 ± 0.7 to 3.7 ± -2.2 in the CP group). However, the final NCS difference was nonsignificant (Mann-Whitney, p = .6). The DAD changes were not significantly different between the 2 groups (t-test = 0.04). The average DAD decreased from 31.9 ± 6.9∆ to 10.11 ± 11∆ in the IP group and from 30.7 ± 8.5∆ to 15.5 ± 13.5∆ in the CP group. Four patients in the CP group exhibited an increase in DAD.Conclusion: The two types of prism therapy showed comparable improvements in NCS.

Erratum to "Prevalence of Selected Eye Diseases Using Data Harvested from Ophthalmic Checkup Examination of a Cohort of Two Thousand Middle Eastern and North African Subjects".

[This corrects the article DOI: 10.1155/2018/8049475.].

Prevalence of Selected Eye Diseases Using Data Harvested from Ophthalmic Checkup Examination of a Cohort of Two Thousand Middle Eastern and North African Subjects.

PURPOSE: To highlight the prevalence of selected ophthalmic diseases accidentally discovered at first-time screening of a large sample of patients from the Middle East and North Africa visiting a large referral university hospital checkup unit based in Cairo. MATERIAL AND METHODS: A cross-sectional study of two thousand and thirteen subjects coming for routine ophthalmic medical checkups from different Middle East countries (mainly Egypt, Sudan, and Yemen). Patients were evaluated for prevalence of diabetic retinopathy, glaucoma, ocular hypertension, cataract, and amblyopia. Patients' demographic data and medical history were collected. Complete ophthalmic examination was performed. Investigations were done when needed to confirm suspected conditions. RESULTS: The study included 1149 males and 864 females. 652 Sudanese patients, 568 Yemeni patients, 713 Egyptian patients, and 63 patients from different Gulf and North African countries like Saudi Arabia, Qatar, Libya, and Jordan. Sudanese patients showed a higher percentage of glaucoma (13.3%) and ocular hypertension (8.3%). Yemeni patients showed the highest prevalence of amblyopia (6.7%), diabetic retinopathy (8.6%), and cataract (4.2%). The group of relatively higher economic classification seemed to show fewer prevalences of these ophthalmic conditions. Yemeni patients tended to have a high percentage of persistent myelinated nerve fibers. CONCLUSION: Different ophthalmic conditions were discovered for the first time at the general checkup clinic. Certain conditions were more common than others in certain countries. The lack of regular checkups and the unavailability of medical services due to low to moderate socioeconomic status as well as political turbulence may account for the delay in initial diagnosis of many treatable conditions.

Predicting transepithelial phototherapeutic keratectomy outcomes using Fourier domain optical coherence tomography.

PURPOSE: The aim of this study was to use Fourier domain optical coherence tomography to predict transepithelial phototherapeutic keratectomy outcomes. METHODS: This is a prospective case series. Subjects with anterior stromal corneal opacities underwent an excimer laser phototherapeutic keratectomy (PTK) combined with a photorefractive keratectomy using the VISX S4 excimer laser (AMO, Inc, Santa Ana, CA). Preoperative and postoperative Fourier domain optical coherence tomography images were used to develop a simulation algorithm to predict treatment outcomes. Main outcome measures included preoperative and postoperative uncorrected distance visual acuities and corrected distance visual acuity. RESULTS: Nine eyes of 8 patients were treated. The nominal ablation depth was 75 to 177 µm centrally and 62 to 185 µm peripherally. Measured PTK ablation depths were 20% higher centrally and 26% higher peripherally, compared with those for laser settings. Postoperatively, the mean uncorrected distance visual acuity was 20/41 (range, 20/25-20/80) compared with 20/103 (range, 20/60-20/400) preoperatively. The mean corrected distance visual acuity was 20/29 (range, 20/15-20/60) compared with 20/45 (range, 20/30-20/80) preoperatively. The MRSE was +1.38 ± 2.37 diopters (D) compared with -2.59 ± 2.83 D (mean ± SD). The mean astigmatism magnitude was 1.14 ± 0.83 D compared with 1.40 ± 1.18 D preoperatively. Postoperative MRSE correlated strongly with ablation settings, central and peripheral epithelial thickness (r = 0.99, P < 0.00001). Central islands remained difficult to predict and limited visual outcomes in some cases. CONCLUSIONS: Optical coherence tomography measurements of opacity depth and 3-dimensional ablation simulation provide valuable guidance in PTK planning. Post-PTK refraction may be predicted with a regression formula that uses epithelial thickness measurements obtained by optical coherence tomography. The laser ablation rates described in this study apply only to the VISX laser.

Repeatability of pachymetric mapping using fourier domain optical coherence tomography in corneas with opacities.

PURPOSE: To evaluate the repeatability of Fourier domain optical coherence tomography (OCT) pachymetric mapping in patients with corneal opacities and to assess the reliability of Fourier domain OCT with 830 nm wavelength as a pachymetric measurement tool in opaque corneas. METHODS: A Fourier domain OCT system was used to map the corneal thickness of patients with corneal scars or dystrophy. A retrospective study of a consecutive series was conducted. The repeatability was measured using pooled standard deviation of repeated measurements. A slit-scanning tomography device provided pachymetric mapping for comparison. RESULTS: Seventeen eyes of 12 patients with corneal scars (7 trauma and 3 post infection) or dystrophy (2 Reis-Bucklers and 5 granular dystrophy) were included. The posterior corneal boundary was detectable in all cases. The average corneal thickness measured by OCT was 536 ± 89 µm in central 2 mm area, 553 ± 76 µm in pericentral 2- to 5-mm area, and 508 ± 93 µm for the minimum corneal thickness. The slit-scanning tomography central corneal thickness, 433 ± 111 µm, was significantly lower than OCT readings (mean difference -91.1 ± 33.3 µm, P = 0.002). Repeatability of the OCT measurements was 2.1 µm centrally and 1.2 µm pericentrally. CONCLUSION: Pachymetric mapping with Fourier domain OCT was highly repeatable. Fourier domain OCT is a reliable pachymetric tool in opaque corneas. In comparison, corneal thickness measured by the slit-scanning tomography is significantly thinner than those measured by the Fourier domain OCT in the presence of corneal opacities.