Open Access Case Study

Adie's Pupil (About a Case)

M. Bouchaar, S. Bajjouk, S. Haddougui, B. Houda, F. El Asri, K. Reda, A. Oubaaz

Asian Journal of Research and Reports in Ophthalmology, Page 29-32

Adie syndrome is a relatively common neurological disorder of unknown etiology comprising unilateral or bilateral tonically dilated pupils with light-near dissociation and tendon are flexia . Adie syndrome is mostly idiopathic with no identifiable cause but may rarely be caused by local disorders involving the orbit that affect the ciliary ganglion including infections such as syphilis, varicella, autoimmune hepatitis, sarcoidosis. Adie's syndrome is a clinical diagnosis. Low-concentration pilocarpine (one-eighth to one-tenth percent) test may be useful to demonstrate the cholinergic denervation supersensitivity (80% prevalent) in the tonic pupil.  The usual treatment of a standardised Adie syndrome is to prescribe reading glasses to correct for impairment of the eye(s) if it exist. Adie's syndrome is not life-threatening or disabling. As such, there is no mortality rate relating to the condition. We report a case of a young man without a history of medical pathology, who presented with an isolated  pupil of adie for ten months.

Open Access Case Study

Open Access Original Research Article

Micropulse Cyclophotocoagulation Outcomes in Primary Open Angle Glaucoma

D. Dansdill, K. Pikey, R. Krishna

Asian Journal of Research and Reports in Ophthalmology, Page 1-9

Background: Micropulse cyclophotocoagulation (MPCPC) uses a pulsed application of laser energy to produce a more mild and predictable lowering of intraocular pressure (IOP) compared to traditional CPC with fewer adverse events. It is unclear if particular types of glaucoma are better suited for treatment with MPCPC. Primary open angle glaucoma (POAG) is a leading cause of visual disability in the world and is the most common form of glaucoma in the United States.  A retrospective, observational clinical study was done in order to determine the efficacy and safety of MPCPC specifically for patients with POAG in an urban patient population at a tertiary referral academic medical center.

Methods: Patients with primary open angle glaucoma who underwent an MPCPC procedure and had never undergone previous cyclodestructive procedures were considered.  Patients were followed for 6 consecutive months.  IOP, number of topical glaucoma medications, and best corrected visual acuity (BCVA) were recorded prior to the laser procedure, and at follow-up intervals of 1, 3, and 6 months after the procedure. Procedural success was defined as a 20% reduction in IOP, with IOP between 6-21, and no need for subsequent glaucoma filtering surgery. A Wilxocon signed rank test was used to determine statistical significance.

Results: A total of 39 eyes in patients aged 28-82 with POAG that underwent MPCPC were included in the study. Mean baseline IOP was 22.9 mmHg, mean baseline number of drops was 3.1, and mean baseline BCVA in LogMAR notation was 1.0.  The MPCPC procedure produced a statistically significant decrease in IOP of 42.1% (p<0.001), 31.0% (p<0.001), and 34.0% (p<0.001) at 1, 3, and 6 months respectively. The number of required topical glaucoma drops was not significantly reduced at any of the three follow-up time points, but there was a modest trend towards requiring fewer drops. Patients met the criteria for procedural success at a rate of 74.4%.  

Conclusions: Our results are consistent with the hypothesis that the MPCPC is safe and effective in lowering IOP in patients with POAG.  Further research is needed to determine if MPCPC is equally safe and effective in other forms of glaucoma.

Open Access Original Research Article

The Challenge of Predicting OAG Progression from the Initial Visual Field Test

Aristeidis Chandrinos

Asian Journal of Research and Reports in Ophthalmology, Page 10-28

Purpose: The aim of this study was the development of a critical code in order to combine statistics with a workable diagnostic system for open angle glaucoma that could predict improvement or deterioration of the tested visual field of a glaucoma suspect, most likely after the first or second visit for the visual field test.

Methods: The study plan was to apply a set of different filters in order to select the most efficient one that could remove the most of the noise of the test printout, of which probably the greater part of this removed noise could be the component of the learning effect, as it was expected to be at the first or second session. The common mean and median filters were initially used and later on an adapted or Hybrid filter was designed in MatLab© environment and in a similar philosophy to Gardiner’s Predictor filter. Taking into account the details of the study data, an Adaptive or Hybrid filter following the deployment of the optic nerve fibre layers of the retina was tested and selecting different weight depending on the locations of possible glaucoma defects.

Results:  Initially, the used mean and median filters, used to remove noise of visual field provided ambitious results. The first filter blurred the edges and the overall appearance looked fuzzy or blurry. The second one calculated the values of the neighbourhood and set these in ascending array. Then selected the median of these values to replace the original one. The result in general looks misleading.  Next, applying the Hybrid Adapted filter, the end results illustrated elimination of measured noise in the visual field tests and likely the first visit outcome could predict the third or the fifth visit one.

Conclusion: This is a promising approach to identify and eliminate measurement noise in the visual field tests and to predict, after filtering the first examination outcome, the likely visual field outcome of the third or the fifth visit. The challenge of predicting the progression of open angle glaucoma from the initial visit nowadays is even more than any other the “Holy Grail” of Perimetry.

Open Access Original Research Article

Demographic, Clinical, Therapeutic and Evolutionary Features of Cataract in North-African Diabetic Population

. Elkhoyaali

Asian Journal of Research and Reports in Ophthalmology, Page 37-44

Background: Cataract is the leading cause of reversible blindness in the world and its treatment is the most common surgery in ophthalmology. Compared to the non-diabetic populations, cataract occurs earlier and more frequently in patients suffering from diabetes mellitus necessitating urgent operation to avoid a multitude of problems including the correction of the visual impairment as well as the accessibility of fundus examination to look after diabetic retinopathy and treat this latter by photocoagulation.

Aim: This study aims to highlight the difference of socio-demographic, clinical, therapeutic, and evolutionary features between a population of diabetic and non-diabetic patients using SPSS version 11.5 software to analyze the data.

MethodsThroughout our work, we compared the socio-demographic, clinical, therapeutic, and evolutionary characteristics between diabetic and non-diabetic populations who had received cataract surgery. It’s a retrospective study of 2,000 patients, including 672 diabetics and 1328 non-diabetics in our ophthalmology department between January and December 2019.

Results: The average age in the diabetic group is lower than non-diabetic patients (62.5 versus 66.8 years) with a masculine predominance (61.7%). Preoperative visual acuity varies from light perception to 3/10 with a predominance of total white (28.2%). We usually performed cataract surgery by phacoemulsification (94.3%) under local anesthesia (99.7%). Intraoperative complications are infrequent and comparable between the two groups (p = 0.37), but postoperative complications, dominated by secondary cataract and macular edema, are more frequent in diabetics (p = 3.10-7).

Conclusion: Mean postoperative visual acuity was lower in diabetics (8.08 versus 7.36/ p = 0) especially in subjects suffering from diabetic retinopathy.