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   Table of Contents - Current issue
May-August 2018
Volume 2 | Issue 2
Page Nos. 41-136

Online since Friday, September 21, 2018

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A study of correlation of fine-needle aspiration cytology with postoperative histopathological examination in patients with either solitary thyroid nodule or multiple nodules Highly accessed article p. 41
Mohammed A Sirry, Elsayed M Abdelwahab, Heba T Abdelaziz, Maher F Badr
Background Fine-needle aspiration cytology (FNAC) of the thyroid gland is now a well-established, first-line diagnostic test for the evaluation of thyroid nodules with the main purpose of confirming benign lesions and thereby, reducing unnecessary surgery. Different imaging techniques are now used for diagnosis of thyroid nodules like radionucleotide scanning and ultrasonography. However, FNAC is still regarded as the single most accurate and cost-effective procedure, particularly if ultrasound is used as a guide for better sample collection, especially for cystic lesions. Aim The aim of the work is to evaluate the correlation of preoperative FNAC with postoperative histopathological examination in patients with either solitary thyroid nodule and multiple nodules. Patients and methods This prospective study was done between April 2016 and November 2017 on 100 patients presented to the General Surgical Department with either solitary or multiple thyroid nodule. This was done to assess the correlation between preoperative FNAC and postoperative histopathological examination. Results Statistical analysis of our study showed sensitivity, specificity, accuracy, false-positive fraction, false-negative fraction, positive predictive value, and negative predictive value of FNAC to be 92, 81, 84, 36, 3.3, 63, and 96%, respectively. Conclusion The FNAC is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings in our setting as well. The correlation of cytological and histopathological diagnoses is an important quality assurance method, as it allows cytopathologists to calculate their false-positive and false-negative results.
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Estimation of bladder wall thickness at different areas with ultrasound and its relation to cystocele p. 47
Basem I Foda, Adel Saad, Eman M El-Dydamony
Objective The aim was to verify our hypothesis that decreasing bladder wall thickness will facilitate ballooning of the bladder wall at this thin part that will be involved in a process of cystocele other than the last traditional reported factors. Patients and methods This prospective study included 80 female patients between 20 and 45 years of age who were divided into two groups. Group I: 40 women were normal (control group); 20 of them were married and 20 were virgins and Group II: Comprising 40 patients have clinical manifestations of cystocele. All underwent complete history taking, physical examination, translabial, and transabdominal ultrasound examination with measurement of anterior and posterior detrusor wall thickness (DWT); also multichannel urodynamic testing was done to diagnose if there is associated obstruction or not. Results In group I, the mean DWT in 20 virgin women was 3.28±0.79 at the anterior bladder wall and 2.72±0.77 at the posterior bladder wall by transabdominal ultrasound, whereas by translabial ultrasound it measured 3.34±0.83 at the anterior bladder wall and 2.62±0.94 at the posterior bladder wall. In 20 married women of the control group without cystocele the mean DWT was 2.85±0.72 and 2.70±0.75 at the anterior and the posterior bladder wall, respectively, by transabdominal ultrasound. Also, the mean DWT was 2.90±0.69 and 2.75±0.74 at the anterior and the posterior bladder wall, respectively, by translabial ultrasound. In group II the anterior and the posterior wall measured 2.95±0.95 and 2.25±0.73, respectively, by transabdominal ultrasound, while it measured 4.35±1.40 and 2.40±0.77, respectively, by translabial ultrasound. With obvious obstruction in group II, Pdet.Qmax. was 29.18±7.54 whereas it was 18.10±13.40 in group I. An increased level of Qmax was noticed in group I with a mean value of 25.73±8.56 whereas it was of a less value in group II (15.83±6.21). Conclusion Our findings verify our hypothesis that decreasing bladder wall thickness will facilitate ballooning of the bladder wall at this thin part. Moreover, an increase in intravesical pressure during micturition will form a pseudo-diverticulum of the bladder wall, which in turn had lost the scaffolding of the fascia and/or vaginal wall.
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Role of computed tomography in diagnosis, follow-up, and minimally invasive treatment of acute pancreatitis p. 52
Hazem A.M Bader, Asmaa S Abd El Azeem
Background Acute pancreatitis is an inflammatory disease of the pancreas with variable involvement of other regional tissues or remote organ systems. It has a mild, self-limiting course in 80% of patients who recover without complications. The remaining patients have a severe disease with local and systemic complications, and this disease carries a mortality risk of 10–24%. Objective To examine the role of computed tomography (CT) in diagnosis, follow-up, and guided therapy in acute pancreatitis. Patients and methods The study was performed on 100 patients with acute pancreatitis from January 2014 to October 2016. There were 80 males and 20 females. Inclusion criteria Previously known acute pancreatitis attacks, clinically suspected acute pancreatitis, laboratory results suggesting acute pancreatitis, and patients with trauma with suspected pancreatic injury sequelae were the inclusion criteria. All patients were subjected to history taking; laboratory assessment, including serum amylase, lipase, creatinine levels, complete blood count, lipid profile (mainly triglyceride), and blood glucose; as well as CT scan to assess the pancreatic parenchyma, peripancreatic region, extrapancreatic ascites, pleural effusion, lung bases, and intestinal loops. Results The study included 100 patients whose age ranged from 9 to 83 years old, with a mean of 41.89 years. Overall, 80 (80%) patient were males and 20 (20%) patient were females. The CT showed sensitivity of 99.1% and specificity of 100% with positive predictive value of 100% and negative predictive value of 97% in the diagnosis of acute pancreatitis. Conclusion Acute pancreatitis can be severe and life-threatening. Imaging is central in the identification of complications, and radiological scoring systems can predict prognosis. With the current move toward minimally invasive treatment, the role of image-guided therapy is increasing and the need for surgical intervention is decreasing. CT is playing a golden role in diagnosis, follow-up, and guided therapy of acute pancreatitis.
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Follow-up of hepatitis b virus vaccine response in healthy individuals p. 58
Nessren M.B El-Deen Mohamed, Hanna Abuo-El-Yazed Abuo-El-Hassan, Hend M.B El-Deen Mohamed
Background The long-term protective effect of hepatitis B virus (HBV) vaccine and the need for booster dose vaccination remain unclear. Detection of nonresponders to HBV vaccine and search for factors that lead to nonresponse will help in prevention of HBV infection, hepatocellular carcinoma related to hepatitis B infection and hepatitis D virus infection. Aim The aim of this study was to assess the benefit of follow-up of hepatitis B vaccine response and evaluate the persistence of seroprotection after HBV vaccination to determine the necessity of a booster dose in healthy individuals after 5 and 10 years of vaccination. Patients and methods Serum samples were tested for quantitative detection of hepatitis B surface antibodies (HBsAb) using ELISA for 30 individuals who received HBV vaccine of less than or equal to 5 years (group I) and 30 individuals who received HBV vaccine for more than or equal to 10 years (group II), and if the results were negative or less than 10 IU/ml, evaluations of hepatitis B surface antigen and hepatitis B core antibodies (total) were done. Results HBsAb was positive among 66.7% of each group, and the median HBsAb level was 59.73 and 51.21 in groups I and II, respectively. Conclusion Approximately 33% of the studied groups were nonresponders of HBV vaccine regardless of postvaccination years (5–10). Hepatitis B infection and occult hepatitis B infection results were negative in all of nonresponders. Recommendations Follow-up of HBsAb levels in vaccinated individuals after having completed three doses of hepatitis B vaccination on a large scale is important to detect nonresponses and revaccinate them.
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Evaluation of serum YKL-40 and cardiovascular risk in chronic kidney disease p. 64
Fatma M El Senosy, Mona M Morsy, Nagwa A Mohamed, ALRomisa S Albanna
Background Chronic kidney disease (CKD) is a worldwide health problem. Patients with end-stage renal disease have high prevalence of atherosclerosis and consequently development of cardiovascular disease resulting in elevated mortality rates. YKL-40 has been shown to play a role in the pathogenesis of endothelial dysfunction, atherosclerosis, and abnormal angiogenesis. It is closely related to the early and late phases in the development of atherosclerosis. Aim To study serum YKL-40 levels in patients with CKD and to assess its correlation with high-sensitive C-reactive protein (Hs-CRP) and carotid intima-media thickness (CIMT) as a predictor for early atherosclerosis. Patients and methods A cross-sectional study included 40 CKD patients. Group I was classified into: Ia which 20 patients on regular hemodialysis and Ib which included 20 predialysis patients’ CKD (stages 4–5), compared with 40 healthy controls of the same age and sex (group II). Routine laboratory investigations were done and serum Hs-CRP and YKL-40 level were measured in both groups and healthy controls. CIMT was measured by B-mode ultrasound. Results There were a highly significant increase of serum YKL-40 and Hs-CRP levels and intima-media thickness of carotid artery in group I when compared with the control group and a highly significant increase in group Ia in comparison to group Ib. There were highly significance positive correlations between YKL-40 level and Hs-CRP, CIMT in groups Ia and Ib. Conclusion The study concluded that the serum level of YKL-40 is significantly elevated in patients with chronic renal failure both hemodialysis and predialysis and there was significant positive correlation between YKL-40 and CIMT as well as Hs-CRP in all patients with chronic renal failure. We suggest that YKL-40 had a role as an inflammatory marker and for early detection of atherosclerosis.
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Urodynamic changes in females with refractory lower urinary tract symptoms p. 75
Salah E Shebl, Rasha A Hassan, Refaat M Awad
Objectives The study aims to evaluate the urodynamic changes in female patients with refractory lower urinary tract symptoms (LUTSs) and to find the urodynamic changes associated with it. We also aim to diagnose the cause of refractory LUTS as it affects the quality of life. Patients and methods The current study included 80 female patients with refractory LUTS who underwent urodynamic evaluation (uroflowmetry, filling and voiding cystometry). Patient with previous anti-incontinence surgery, pregnancy, bladder tumor, bladder stone, haematuria, patients with ureteric stent, partial cystectomy, and cystocele were excluded from this study. Results The maximum flow rate (Qmax) was low in 41.9% of the patients who were complaining of storage symptoms (urgency, frequency, and nocturia). Increased sensation was reported in 67.5% of the patients. There is a strong positive correlation of increased sensation to urgency, frequency, nocturia, and nocturnal enuresis. Low maximum cystometric capacity (MCC) was reported in 52.5% of the patients. There was a strong positive correlation of decreased MCC to urgency, frequency, nocturia, and nocturnal enuresis. Detrusor overactivity (DO) was found in 57.5% of the patients. There was a statistically significant increase in DO among patients who complained of nocturia. Positive Valsalva stress test was seen in 28.6% of the patients with stress urinary incontinence. Respectively, storage symptoms were reported in 95%, voiding symptoms were reported in 5%, and bladder-outlet obstruction was reported in 10% of the patients. Conclusion Higher incidence of early sensation, low MCC, and DO is seen in patients with overactive bladder. There is a strong positive correlation between frequency and low Qmax. The urodynamic studies are complementary to patients’ symptoms, which can be useful to reach a more precise diagnosis and a more appropriate management plan.
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Closed intubation with mitomycin C application for patients older than two years having nasolacrimal duct obstruction p. 80
Hossam Eldin A Ziada
Purpose The aim was to explore the safety and efficacy of silicon intubation with mitomycin C (MMC) in increasing the success rate of closed intubation in patients older than 2 years. Patients and methods This prospective study included thirty eyes of 24 consecutive patients with tearing and discharge owing to primary and acquired partial nasolacrimal duct obstruction. Their ages ranged from 2.5 to 40 years, and the male/female ratio was 10/14. Probing of nasolacrimal duct with silicone intubation (SI) (which is soaked in MMC 0.2 mg/ml for 2 min) was done in all cases, but it was abandoned if the resistance or obstruction was too difficult to overcome or if excessive bleeding or a hard blind bony pouch at the end of the nasolacrimal duct was detected. This occurred in five patients (5/35). In these patients, dacryocystorhinostomy was performed, and they were excluded from our study. Results The procedure was successful in 24 eyes and unsuccessful in six eyes. The success is defined as prevention of recurrence of duct obstruction after removal of silicon tubes 3±1.7 months from intubation. The mean age of the patients with unsuccessful outcomes was 22.4±3.4 years, whereas those with successful outcomes was 8.0±2.8 years, and the difference was statistically significant (P=0.006). Sex (P>0.05) was not statistically different. No serious intraoperative and/or postoperative complications were observed. Conclusion The results of our prospective study showed that SI with MMC in patients with simple epiphora has a success rate of 80%. This success rate was achieved by other studies using SI alone but in younger age group. In our study, an older patient group was included with almost the same success rate. We can conclude that MMC application during SI does not appear to have additional benefit over SI alone in young children with simple epiphora, as shown in other studies by different authors, whereas the application of MMC during SI would result in better efficacy compared with SI alone in older age patients.
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Comparison of SRK/T and Haigis formulae in the prediction of refractive outcome after phacoemulsification p. 85
Mona N Mansour, Rehab M Kamel, Hanan S Hegazy
Purpose To compare the accuracy of SRK/T and Haigis formulae used for intraocular lens (IOL) power calculation by a partial coherence interferometer in patients undergoing phacoemulsification surgery. Patients and methods A prospective interventional clinical study included 70 eyes of 60 patients, who underwent uncomplicated phacoemulsification with IOL implantation from October 2015 to December 2017. Preoperative axial length (AL), corneal curvature (keratometry), and preoperative anterior chamber depth (preoperative ACD) were measured using Nidek AL-scan optical biometer and the IOL power was determined using both SRK/T and Haigis formulae. The difference between the predicted value and the postoperative spherical equivalent was calculated for both the formulae by the end of the follow-up (3 months postoperatively). Results The mean errors of the two formulae were SRK/T: −0.225±0.61 D and Haigis: 0.171±0.68 D; the mean absolute errors of the two formulae were 0.534±0.36 and 0.533±0.44 D, respectively. There was no statistically significant difference between the mean error of the two formulas used in the overall performance, but was significant in eyes with an AL of more than 25 mm. The proportion of patients having a prediction error within ±0.50 D of SRK/T formula (54.29%) was comparable to those of Haigis (55.71%) and the prediction errors within ±1.0 D were 87.14 and 85.71%, respectively. There is a weak correlation between the mean AL, keratometry and the Haigis–SRK/T prediction differences (r2=0.273). Conclusion The calculation of IOL power using SRK/T and Haigis formulae resulted in an accurate postoperative refraction. In long AL subcategory, the mean absolute error of Haigis was less compared with the SRK/T formula.
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Impact of combining dexmedetomidine to ondansetron and dexamethasone for prophylaxis against postoperative nausea and vomiting after laparoscopic bariatric surgery p. 90
Mostafa M Sabra
Background Postoperative nausea and vomiting (PONV) are common and highly distressing following laparoscopic bariatric surgery. However, there is inadequate evidence regarding the impact of combining dexmedetomidine to dexamethasone and ondansetron. We aimed to study the impact of combining dexmedetomidine to dexamethasone and ondansetron in the prevention of PONV. Patients and methods Seventy-two adult patients scheduled for laparoscopic bariatric surgery were randomized in this double-blind study to receive either single dose of dexmedetomidine 1 µg/kg; ondansetron 4 mg; dexamethasone 8 mg (group D, n=36) or ondansetron 4 mg and dexamethasone 8 mg (group B, n=36), after induction of anaesthesia. Anaesthesia administration was performed similarly for both groups using a standard protocol. During the first 24 h postoperatively, the primary outcomes were the incidence of PONV. The severity of PONV and use of rescue antiemetic were the secondary outcomes. χ2-Test and Student’s t-test were utilized to evaluate significant differences in categorical and continuous variables. Results The incidence of PONV was significantly reduced in group D (13.9 vs. 52.8%, P<0.001). The severity of PONV was significantly lower in group D (34.22±10.48 vs. 62.50±13.34, P=0.03). Ondansetron consumption was reduced significantly during 24 h in group D (2.33±2.93 vs. 3.58±2.68, P=0.03). Conclusion Addition of dexmedetomidine to ondansetron and dexamethasone was efficacious in decreasing incidence, severity of PONV, and the total analgesic consumption during the first 24 h after laparoscopic bariatric surgery.
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Impact of abnormal circadian blood pressure profile on left atrial function assessed by 2D speckle tracking echocardiography and its effect on the functional capacity of hypertensive patients p. 97
Taghreed A Ahmed, Layla A Mohamed
Background The left atrial (LA) function has an important role in hypertension as it is strongly predictive of adverse cardiac events and death, assessment of the circadian blood pressure (BP) profile is more predictive than assessment of the office BP reading in estimating the cardiovascular risk. The 2D speckle tracking echocardiography (2D-STE) provides more insight into early hypertension-induced LA dysfunction. Aim The aim of this work is to assess the impact of abnormal circadian BP profile on LA function using 2D-STE and its effect on functional capacity in hypertensive patient with preserved ejection fraction assessed by conventional echocardiography. Patients and methods This work included 60 consecutive hypertensive patients with preserved ejection fraction by conventional echocardiography [mean age 48±5 years and body surface area (BSA) 1.9±1.1] they were classified into two groups according to the data derived from 24 h ambulatory BP, group 1: dipper group that included 28 patients (mean age 48±8 years and BSA 1.9±0.1) and group 2: nondipper group that included 32 patients (mean age 50±6 years and BSA 1.9±0.09). All patients were evaluated by comprehensive 2D and Doppler echocardiographic techniques, TDI and 2D-STE, ambulatory BP, and stress. Myocardial perfusion imaging using treadmill exercise test was done to exclude coronary artery disease (CAD) and to assess the functional capacity. Results The results showed a statistically high significant decrease in the average peak left atrial global longitudinal strain in group 2 (the nondipper group) (group 1=26±4 vs. 20.4±3.5 in group 2, P<0.00), and a statistically significant decrease in the functional capacity parameter using treadmill metabolic equivalents (METs) in group 2 (group 1=7.3±1.4 vs. 6.2±0.8 in group 2, P<0.01) in comparison with group 1. Also we found a significant positive correlation between the average peak atrial longitudinal strain and the functional capacity assessed by treadmill stress test (r=0.424, P=0.05). There were no other significant differences between the two groups with respect to other LA parameters by conventional echo Doppler, TDI, and 2D-STE. Conclusion Abnormal circadian BP profile add more deleterious effect on LA function in hypertensive patients as detected by 2D-STE that denotes more decrease in functional capacity and worse cardiac events.
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Detection of early left ventricular and left atrial dysfunction in type I diabetes mellitus using two dimensional speckle tracking echocardiography p. 106
Taghreed A Ahmed, Mona N Hassan, Adel A Mazen, SHreen A Hegazy
Background Occult left ventricular (LV) systolic and diastolic dysfunction is not uncommon among young adults with type I diabetes mellitus (T1DM). Early detection in the subclinical phase may enhance different preventive strategies. The two-dimensional speckle tracking echocardiography (2D-STE) is a novel and promising tool for the detection of early changes in LV and left atrial (LA) myocardial performance. Aim To detect early LV and LA dysfunction in young adults with T1DM by 2D-STE and its correlation with their functional capacity using the treadmill stress test. Patients and methods Thirty patients with T1DM and 15 nondiabetics acting as controls were enrolled. Conventional 2D echo, tissue Doppler imaging (TDI), and 2D-STE were done. Peak LV global longitudinal strain and peak LA global longitudinal strain were obtained. The functional capacity was assessed using the treadmill stress test. Results A statistically significant decrease in the average peak LV global longitudinal strain was found in diabetics compared to nondiabetics (15.8±6.8 and 23.9±2.7, respectively; P<0.001) and in LV TDI strain rate (19.7±5.4 and 23±2.7, respectively; P<0.05) were found. A statistically significant peak atrial longitudinal strain decrease in the average in diabetics compared to nondiabetics (34.40±12.9 and 42.3±3.9, respectively, P<0.05). There were no significant differences between the two groups with respect to the functional capacity of the parameters. Conclusion Since T1DM is associated with early (subclinical) LV and LA dysfunction, 2D-STE becomes an important and sensitive tool for an early detection of subclinical LV and LA myocardial dysfunction.
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The role of serum retinol in nonalcoholic fatty liver disease p. 115
Fatma A.S Mourad, Zeinab H El Sayed, Heba A.M Showman, Mona M.M Abo Ragab, Nagwa Abd El-Ghaffar Mohamed
Background Retinol has been involved in the regulation of lipid metabolism and hepatic steatosis. Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH) have emerged as the most common chronic liver diseases. A minority of affected patients develop subsequently hepatic fibrosis, whereas most of them exhibit simple steatosis. Indeed, the relation between retinol and NAFLD and NASH is still incomplete and unknown. Objective This study aimed to identify the clinical relevance of retinol in patients with NAFLD and NASH. Patients and methods This study enrolled 90 individuals who were selected from the outpatient clinic of Al Zahraa University Hospital, Egypt, which comprised 30 patients with NAFLD, 30 with NASH and 30 healthy persons as a control group. Serum glucose, lipid profiles, markers of liver damage, serum retinol, and abdominal ultrasound were studied. Results Serum retinol concentrations were significantly lower in NAFLD and NASH than in control, where the mean serum retinol concentration in patients with NAFLD was 23.02±2.9 and NASH was 11.7±2.3, and it was significantly lower than those in controls, with 36.1±2.7 (P<0.01). Conclusion Circulating retinol concentrations were lower in patients with NAFLD and were associated with hepatic lipid metabolism and insulin resistance.
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Subconjunctival bevacizumab versus mitomycin c as adjuvant treatment to subscleral trabeculectomy p. 123
Mohamed I El-Kasaby
Aim To compare the clinical outcome of adjuvant subconjunctival bevacizumab (BVZ) injection versus mitomycin C (MMC) during subscleral trabeculectomy. Patients and methods In this study, 20 patients who were divided into two groups: group A included 10 (20 eyes) patients who underwent subscleral trabeculectomy with subconjunctival injection of 1.25 mg/0.1 ml BVZ, and group B included 10 (20 eyes) patients who underwent subscleral trabeculectomy with adjuvant intraoperative use of 0.2 mg/ml MMC for 2 min. This prospective nonrandomized clinical comparative study was conducted in Nour-El-Hayaha Eye Center (Cairo). Patients were diagnosed for primary open angle glaucoma with uncontrolled intraocular tension by maximum tolerable antiglaucoma therapy. The study excluded patients with neovascular glaucoma, congenital and juvenile glaucoma, history of ocular pathology, or surgery as retinal surgeries and uveitis. Results Twenty patients were considered for the study, nine (45%) patients (18 eyes) were males and 11 (55%) patients (22 eyes) were females. The patients’ ages ranged from 35 to 65 years (mean age 55.2±8.3). Mild hyphema, in one eye in group A (8.33%), wound leak in one (8.33%) eye in each group, and shallow anterior chamber in two (16.7%) cases in each group. It was the most common encountered complication in our study. One (8.33%) case of shallow anterior chamber in group A led to choroidal effusion. One (8.33%) case in group B developed late bleb-related endophthalmitis after 3 months, which ended in phthisis bulbi. Conclusion The success of glaucoma filtration surgery is heralded by a wound healing response mainly mediated by fibroblast proliferation, migration, and contraction that leads to postoperative subconjunctival scar. The effect of subconjunctival BVZ and MMC-augmented trabeculectomy in cases of primary open angle glaucoma was beneficial in improving the success rate with better intraocular pressure control and prolonging the trabeculectomy survival with no significant difference between the two groups.
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Transepithelial versus standard corneal collagen cross-linking for treatment of grades 1–3 keratoconus p. 129
Mohamed I El-Kasaby
Purpose The purpose of this article was to assess the safety and efficacy of transepithelial corneal collagen cross-linking (epithelial on) versus standard (epithelial off) technique in halting the progression of keratoconus. Patients and methods A prospective nonrandomized interventional comparative standard technique was conducted, which divided 40 patients into two groups: in group A, 34 eyes of 24 patients were enrolled and treated by transepithelial cross-linking, and in group B, 28 keratoconus eyes of 16 patients were included and treated by the standard technique. In group A, a solution of riboflavin 0.1%, dextran T500, trometamol, and EDTA (trans-Ribo) was instilled. In group B the epithelium was removed and riboflavin 0.1 solution (10 mg of riboflavin-5-phosphate in a 20% dextran T500 10 ml solution Ricrolin was instilled. Ultraviolet A irradiation (Food and Drug Administration approval) Avedro system was used with total energy 7.2, power intensity 30 mW, induction time 10 min, ultraviolet time continuous 4 min, and ultraviolet time pulse 8 min, but in transepithelial cross-linking, the intensity was 45 mW. Preoperative and postoperative assessments were performed at baseline and 3, 6, and 12 months postoperatively. Results Group A showed statistically highly significant differences between mean uncorrected visual acuity (UCVA) and mean UCVA at first, sixth, and 12th months postoperatively. In group B, there were statistically highly significant differences between mean UCVA preoperatively and the mean UCVA at first, sixth, and 12th months postoperatively. In group A, there were statistically significant differences between mean Km (mean k power) preoperatively and mean Km at the first and at 12th months postoperatively, whereas in group B, there were statistically significant differences between mean Km preoperatively and the mean Km at first month and statistically insignificant difference at third, sixth, and 12th months postoperatively. Conclusion Both epithelial-on and epithelial-off techniques appeared to correct best-corrected visual acuity but epithelial-off technique was more effective in reduction of KM, astigmatism, Q-value and anterior elevation. Moreover, epithelial off showed to halt keratoconus progression more than epithelial-on technique.
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