Closed-Chamber Anterior Capsulorhexis Under Air Tamponade In White Cataract.

PURPOSE: To evaluate the efficacy and safety of a closed-chamber air bubble capsulotomy technique to prevent the Argentinean flag sign (AFS) in patients with white and intumescent cataracts. SETTING: Sohag University, Faculty of Medicine, Ophthalmology Department, Sohag, Egypt. DESIGN: Prospective interventional noncomparative case series. METHODS: Eighty-two eyes of 80 patients with white and intumescent cataracts were included. Eyes with any ocular pathology other than cataract or eyes subjected to previous intraocular surgery were excluded. Needle capsulorhexis was performed under a large air bubble tamponade without capsular staining. Efficacy of the technique was assessed intraoperatively by successful completion of capsulorhexis. Safety of the technique was assessed by the occurrence of intraoperative or postoperative complications. RESULTS: Complete capsulorhexis by the closed-chamber air bubble technique was successful in 75 eyes (91.5%), while capsulorhexis extension occurred in seven eyes. In four eyes with extension, the procedure was shifted to the standard technique of CCC (circular curvilinear capsulorhexis), using a viscoelastic device. A shift to extracapsular cataract extraction (ECCE) surgery occurred in the remaining three eyes, as the extension was so far-gone. No intraoperative or postoperative complications were observed. CONCLUSION: The closed anterior chamber air bubble technique for capsulorhexis is a novel, safe, and effective technique to prevent AFS in white and intumescent cataracts. It is also time-saving and cost-effective, with less likelihood of capsulorhexis extension. The technique is considered a valuable addition to previously described techniques.

Outcomes of Corneal Tattooing by Rotring Painting Ink in Disfiguring Corneal Opacities.

AIM: To evaluate corneal tattooing with Rotring painting ink (Rotring Ink, Hamburg, Germany) as an available and affordable surgical technique to improve cosmetic appearance in the eyes with disfiguring corneal opacities. METHODS: Fifty-three blind eyes with corneal disfiguring opacities underwent corneal tattooing using Rotring painting ink (Rotring Ink, Hamburg, Germany) by multiple transepithelial intrastromal injections under topical anesthesia. Complete ophthalmic examination and ocular ultrasonography were performed, and photographs of the patients' eyes were taken. Follow-up period was at least 12 months. RESULTS: On the first postoperative day, all patients presented with mild conjunctival injection and foreign body sensation. After the end of the follow-up period, 51 patients (96%) were satisfied of cosmetic appearance while only 2 patients (4%) post-op cosmetic results were less than their expectations; however, they were better in appearance. No major complications like corneal erosions; corneal ulcers or corneal melting was noted in any case. CONCLUSIONS: Corneal tattooing with Rotring painting ink in blind disfigured eyes achieves favourable cosmetic results and is associated with high patient satisfaction. With better case selection, a high post-op satisfaction was achieved. Corneal tattooing acts as an alternative to more sophisticated and expensive cosmetic reconstructive surgery. This trial is registered with ISRCTN46626979.

Combined oral propranolol with intralesional injection of triamcinolone acetonide in treatment of infantile periocular hemangiomas.

AIM: To evaluate the clinical effectiveness of combined oral propranolol with intralesional injection of triamcinolone acetonide in the treatment of infantile periorbital capillary hemangioma. PATIENTS AND METHODS: This prospective interventional study included children diagnosed with periocular infantile hemangiomas in the proliferative phase with vision-threatening lesions. The children presented to the oculoplastic unit in Sohag University Hospital in the period between January 2016 and February 2017 and were treated with a combined intralesional injection of triamcinolone acetonide with oral propranolol, with a follow-up period of 6 months. Treatment response was evaluated according to the size of the tumor (horizontal diameter); additionally, complications of both treatment methods were recorded. RESULTS: This study included 33 infants: 21 females (64%) and 12 males (36%). The mean age at the time of injection was 4.9±2.6 months. The study included three modes of treatment response: regression of the tumor, 28 patients (85%); stabilization, three patients (9%); and failure, two patients (6%), which necessitated repeated intralesional injection of triamcinolone but with minimal response. Regarding complications, only one patient reported with subconjunctival hemorrhage during intralesional injection of steroids; there were no recorded cases of hypotension, bradycardia, or hypoglycemia during the course of oral propranolol treatment. After the end of the follow-up period, there were no reported cases of recurrent increase in the size of the regressed group of infantile hemangiomas with stable tumor size. CONCLUSION: Combined oral propranolol with intralesional injection of triamcinolone acetonide is the effective method of treatment for infantile periorbital capillary hemangioma with minimal adverse effects.

The efficacy of Alahmady ring implantation in the management of neovascular glaucoma.

PURPOSE: To evaluate the efficacy and safety of Alahmady ring implantation in the management of neovascular glaucoma. METHODS: A total of 15 eyes of 15 patients with intractable neovascular glaucoma with intraocular pressure (IOP) ≥28 mmHg not responding to medical treatment were retrospectively analyzed. All patients had poor visual acuity and underwent Alahmady ring implantation. The ring was designed from fenestrated silicon tube used in lacrimal surgeries and was implanted subsclerally after passing it through the anterior chamber. Patients were followed up for at least 24 months. Success in this study was defined based on IOP ≥8 mmHg and <21 mmHg, with not more than 1 glaucoma drug, and improvement of patient symptoms and signs with maximum use of beta blocker as antiglaucoma drug. RESULTS: A total of 15 eyes of 15 patients (9 males [60%] and 6 females [40%]) were analyzed in this study. The mean IOP before surgery was 38.6 mmHg (standard deviation [SD]: 6.98) and it was 14.05 mmHg (SD =7.57) after surgery. The follow-up range was 24-36 months. Success of silicon drainage device was defined as an IOP <21 mmHg on the last follow-up visit. Medications included only beta-blockers and topical steroids for those who were without severe complications or for those who were not in a condition to undergo a further glaucoma surgery. CONCLUSION: Alahmady ring implantation proves to be a good surgical option for neovascular glaucoma; however, a longer follow-up period is recommended.

Clinical and electromyographic assessment of facial nerve function after temporomandibular joint surgery.

The aim of this study was to evaluate the factors that may cause alterations in facial nerve function during temporomandibular joint (TMJ) surgeries. Forty-six patients were included (66 joints) between the years 2000 and 2007. Study patients were those undergoing various surgical procedures for the treatment of TMJ disorders. Patients who had made an incomplete recovery from a facial nerve injury resulting from a previous operation and patients who presented with facial palsy after a previous TMJ surgery were excluded. The facial nerve function of all patients was evaluated at different time intervals using a facial nerve grading system, motor unit action potentials of the frontalis and orbicularis oculi muscles, and a facial nerve latency test. Various degrees of facial nerve affliction were initially noticed in 71% of the study cases (47 of 66 joints). Statistical analyses (χ(2) goodness-of-fit) revealed that several factors could lead to facial nerve injury following TMJ surgery, including the design of the skin incision, prior surgeries, type of surgery, and duration of surgery. Facial nerve injury during TMJ surgery is multifactorial. Electromyographic studies are non-invasive and valuable diagnostic and prognostic tools for assessing facial nerve function.

Interchangeability between Pentacam and IOLMaster in phakic intraocular lens calculation.

PURPOSE: To evaluate the agreement and interchangeability between IOLMaster and Pentacam in phakic intraocular lens (IOL) calculations. METHODS: This was a prospective study involving measurement of the anterior segment parameters anterior chamber depth (ACD), white to white (WTW) line, and average anterior corneal curvature (K-reading) on 108 healthy eyes of 56 consecutive patients. Interdevice agreement and interchangeability in phakic IOL calculations was evaluated. RESULTS: Pentacam measured significantly longer ACD measurements (3.54 ± 0.35 mm) than the IOLMaster (3.40 ± 0.37 mm) (p<0.0001); on the other hand, it measured significantly shorter WTW line measurements (11.61 ± 0.44 mm) than the IOLMaster (11.66 ± 0.42 mm) (p = 0.016). No difference was found regarding the average K-readings. For biometry and phakic IOL power calculation, there was no clinically significant difference between the devices, but for phakic IOL diameter calculation the difference was clinically significant. CONCLUSIONS: There is a good agreement in ACD and K-readings between Pentacam and IOLMaster, making them interchangeable in biometry and phakic IOL power calculation, but they are not interchangeable regarding WTW line measurement; the difference will affect the phakic IOL diameter, which would affect lens safety.