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   Table of Contents - Current issue
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January-June 2017
Volume 9 | Issue 1
Page Nos. 1-33

Online since Tuesday, September 19, 2017

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REVIEW ARTICLE  

Advances in clinical concept of retinopathy of prematurity treatment p. 1
Amir Ahmadzadeh-Amiri, Ahmad Ahmadzadeh-Amiri
DOI:10.4103/sjopthal.sjopthal_8_17  
Retinopathy of prematurity (ROP) continues a major cause of premature infants' blindness and rises the incidence with improved survival of very premature infants. Timely screening for ROP risk and treatment is important to retain visual rehabilitation. Recent advance in genetic studies shows a Wnt pathway ROP linking genes predispose to the evolution of severe ROP. A newly screening method is recommended based on weight gain postnatally in combination with insulin-like growth factor levels for prediction of ROP risk. Anti-vascular endothelial growth factor treatment options for severe cases of ROP have been showed safe in preterm infants. However, several studies suggest that early laser therapy for Type 1 but not Type 2 high-risk ROP makes better visual results. This review gives an outline of the recent advances on ROP with treatment options and screening methods.
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ORIGINAL ARTICLES Top

Efficacy of home-based vision therapy for convergence insufficiency in secondary schools' students p. 5
Layali Ibrahim Hassan, Samira Mohamed Ibrahim, Mustafa Abdu
DOI:10.4103/sjopthal.sjopthal_11_17  
Background: Convergence insufficiency (CI) is one of the most common causes of ocular discomfort among students that it may have a negative effect on the student's school performance. Although various treatments are prescribed for patients with CI, there is a lack of studies regarding the most effective treatment. Aim: The aim of this study is to determine the efficacy of four home-based vision therapy (VT) techniques in the treatment of symptomatic CI. Materials and Methods: A Convergence Insufficiency Treatment Trial was conducted in Central Khartoum North (Central Bahri) in Sudan. A total of 273 students with mean age of 15.5 ± 2.5 years with symptomatic CI were assigned to one of the four TV groups: Pencil push-Up (n = 66), Cat card (n = 65), Brock string (n = 66), Dot card (n = 66) against placebo control group (n = 66). Data were collected using three outcome measurements: Convergence Insufficiency Symptom Survey score, Near Point of Convergence (NPC), and Positive Fusional Vergence (PFV) at near. Data were collected at baseline, after 3 weeks and at the end 6 weeks of treatment. The participants were advised to do this exercise at home 10 min per day, for 5 days a week for 6 weeks. Results: After 6 weeks of treatment, Dot card therapy group showed the best result in eliminating CI symptoms score by the mean value of 13.59 points (P < 0.001). Pencil push-up therapy group showed the best result in improving NPC by the mean value of 5.60 cm (P < 0.001). However, Cat card therapy group showed the best result in improving PFV by mean value of 7.32 PD (P < 0.001). Conclusions: All four home-based VT techniques were significantly reduced symptoms and improved NPC and PFV. The home-based VT techniques are effective option for treating symptomatic CI. There is no unified treatment suitable for all patients with CI. Therapist should deal with each patient separately.
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To study the effects of central corneal thickness, axial length, and anterior chamber depth on intraocular pressure p. 10
Muhammad Ijaz Ahmad, Manzoor Ahmad Qureshi, Yousef Homood Aldebasi
DOI:10.4103/sjopthal.sjopthal_17_17  
Purpose: The aim of the research project is to study the effects of central corneal thickness (CCT), axial length (AL), and anterior chamber (ACD) depth on intraocular pressure (IOP). Study Period: It was a cross-sectional study and was conducted from February 2015 to June 2015. Methodology: A total of 100 participants of varying age groups were selected from Qassim University clinics who had clinically normal corneas and then were divided into different groups based on their ages. All the participants had no evidence of any ocular disease and both eyes were examined in each participant. Anterior chamber depth (ACD) and CCT were measured with Pentacam (OCULUS). IOP was measured with air puff tonometer. AL was measured by A-scan ultrasonography. Results: Two hundred eyes of one hundred participants were examined. The ages of the participants ranged between 18 and 30 years. Mean age was 23.94 years with ± 2.994 standard deviations The number of emmetropes, myopes, and hypermetropes was 50, 19, and 31, respectively. The mean corneal thickness in the right eye was 541.64 μm (±34.80) and in the left eye, it was 543.46 μm (±33.65). IOP was found to increase with increased CCT and it was statistically significant (P < 0.001). There was a positive correlation between refractive errors, CCT, and IOP. On the other hand, very weak correlation was observed between IOP and AL and ACD. Conclusion: It can be concluded that people with increased CCT and steep cornea need to be monitored closely for their IOP because of strong positive correlation between increased corneal thickness and IOP and high IOP should not be considered as the only factor for diagnosis and it should be related with optic disc evaluation and visual field examination to avoid the over treatment.
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Comparative evaluation of trabeculectomy with releasable suture versus subconjunctival mitomycin C in post keratoplasty glaucoma p. 16
Anuradha Raj, Renu Dhasmana, Harsh Bahadur
DOI:10.4103/sjopthal.sjopthal_4_17  
Aim: The aim of the study was to compare the efficacy of trabeculectomy with releasable suture (RS) and trabeculectomy with mitomycin C (MMC) in post keratoplasty glaucoma (PKG). Methods: This observational study was conducted for the patients who developed refractory PKG. Patients who underwent trabeculectomy with RS and with MMC 0.2mg/ml for 2 minutes under the sclera flap were randomly divided into two groups as group I and II respectively. Postoperative follow up of all patients was complete till 6 months for intraocular pressure (IOP) and complications if any. The criteria for surgical success and failure were defined as complete success if final IOP <21 mm Hg achieved without anti-glaucoma medication (AGM), qualified success as achieving the same IOP criteria with AGM and failure as IOP > 21 mm Hg with more than one medications. Results: A total of 52 eyes of 52 patients were included with 26 eyes in each group. Most frequent indication for PK was corneal opacity 25(48.07%). The preoperative mean IOP was 42.11 ± 5.90mmHg and 46.38 ± 8.51mmHg on three AGM in group I and group II respectively. The mean IOP was lowered after both the procedures significantly at all the postoperative follow ups (P=0.000). In group I, the IOP stabilized to 13.12 ± 5.23mmHg by two weeks and remained same till three months with further mild rise in IOP to 17.13 ± 4.28mmHg at six months. In group II, the IOP decreased to 11.27 ± 4.35mmHg on Ist POD and it stabilized at around 22mmHg at two weeks and remained same till six months of follow up. Conclusion: IOP control in trabeculectomy with RS was very good till three months as compared to trabeculectomy augmented by MMC with comparable results at six months of follow up.
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Congenital and acquired colour vision deficiency among population in North Kordofan State of Sudan p. 22
Saif Hassan Alrasheed, Mohamed EL Hassan Ali EL Awad, Ahmed Alsedeeiq Abdulbagi, Mustafa Abdu
DOI:10.4103/sjopthal.sjopthal_5_17  
Background: Congenital colour vision deficiency (CVD) is an x-linked chromosome disorders which, predominantly occurring in males. This disorder results from abnormalities in one or all three-cone type's photoreceptors. It is mainly affect long wavelength photopigments (red) and middle wavelength photopigments (green). However, the acquired CVD is due to ocular or general pathology as well as due to prolonged use of some medications, which is mostly affect short wavelength photopigments (blue). Objective: This study aimed to evaluate the prevalence of hereditary and acquired CVDs among Sudanese population in North Kordofan State. Materials and Methods: This is a population-based crossed-sectional study of 1100 subjects, their age ranged from 10 to 80 years, the mean age of subjects was 40.4 ± 16.6 (standard deviation) were selected from three districts and 110 subjects were selected from each set. Investigations included visual acuity using Snellen tumbling E-chart, refraction using retinoscopy, colour vision using Ishihara and City University colour vision tests, external eye using torch and magnifier and evaluation of internal eye and ocular media using direct ophthalmoscope. Results: A total of 1216 subjects were invited to participate in the study and 1100 were examined resulting in a participation rate of 91%. The findings revealed that 61 (5.5%) had CVD, 49 (9.0%) were males and 12 (2.2%) were females. The prevalence of congenital (red-green) CVD was 39 (3.5%) which was high in males 37 (6.8%) than females 2 (0.4%). The prevalence of congenital CVD was found associated with males (P < 0.001), but was not significantly correlated with females (P = 0.165). The prevalence of acquired CVD was 22 (2.0%) which was slightly higher among males 12 (2.2%) compared to 10 (1.8%) in females. The distribution of protanopia, deuteranopia and tritanopia among males was 12 (2.2%), 25 (4.6%) and 12 (2.2%), respectively, which was high compared to 1 (0.2%), protanopia, 1 (0.2%), deuteranopia, and 10 (1.8%), tritanopia in females. The main leading cause of acquired CVD was cataract change 8 (13.1%) followed by myopic degeneration 6 (9.8%). Conclusion: Congenital and acquired CVD affect the colour perception of individual. Thus, the early assessment and diagnosis of CVD is necessary to avoid disappointment and psychological trauma during study and career choices.
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CASE REPORTS Top

A rare case of Duane's retraction syndrome: Type 3 with exotropia and nystagmus p. 28
Anubhav Chauhan
DOI:10.4103/1858-540X.215106  
Duane's retraction syndrome (DRS) is a well-known congenital ocular motility disorder. It has been described as the consequence of a congenital anomaly of the 6th cranial nerve nuclei with aberrant innervations by supply from the 3rd cranial nerve. The syndrome includes abduction deficiency, adduction deficiency, or a combination of the two. Compensatory head adaptation helps maintain binocular vision. The purpose of this study is to report a rare case of DRS with a probable inverse DRS (occurrence of both the forms together is a rare phenomenon) presenting to a secondary care institute in this hilly terrain and highlight the ocular findings.
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Keratin cyst: An unusual cause of eyelid mass p. 31
Abhishek Das, Akshay Bhandari, Surekha Bangal
DOI:10.4103/sjopthal.sjopthal_16_17  
Keratin cyst is a keratin-containing cyst lined by epidermis also known as epidermal cyst. Epidermal cysts are slow growing, benign tumors that result from the proliferation of surface epidermal cells within the dermis. They are usually located over scalp, face, neck, chest, back, and extremities. It differs from dermoid cyst where they lack dermal appendages. It occurs 1 in 2000 adults.[5] An 80-year-old female presented with chief complaints of painless swelling on the left upper eyelid for 8 years. From the past 8 years, the patient was aware of the swelling, but it has increased in size in the past 1 year. The swelling was nontender and local temperature was not raised. There were no pulsations or bruits over the swelling. Surgical excision was done. Histopathological examination revealed single, globular, and soft to cystic mass with cheesy material inside. Section showed cyst walled lined by cornified, distinct granular layers and contained lamellar keratin. Keratin cyst is a rare cause of eyelid mass because eyelid is not the usual location of the cyst. Surgical excision of the cyst with intact capsule is the treatment of choice as there is a least chance of recurrence.
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