Open Access Case Report

Evidence of Post Trabeculectomy Optic Nerve Reperfusion by OCT Angiography

Jigyasa Sahu

Ophthalmology Research: An International Journal, Page 35-39
DOI: 10.9734/or/2020/v12i430154

Aim: To describe a case of glaucoma which showed increase in optical coherence tomography (OCT) angiographic vessel densities after intraocular pressure reduction suggesting reperfusion of optic nerve.

Presentation of Case: A 55 year old female with primary open angle glaucoma was taken up for trabeculectomy in view of inadequate control of intraocular pressure (IOP) despite maximal medical therapy. In addition to routine glaucoma assessment by visual fields and nerve fiber layer assessment by OCT, OCT angiographic evaluation of peripapillary vessel density was done preoperatively. Three months after trabeculectomy, her intraocular pressure decreased from 35mmHg to 14mmHg. Compared with the preoperative baseline value, the vessel density increased significantly in all quadrants after three months from surgery as demonstrated by OCT angiography.

Discussion: This case report suggests that decreased optic nerve head perfusion due to high IOP can be reversed by reduction of IOP.

Conclusion: Vascular parameters like angiographic vessel density can show reversible changes as decreased blood flow reinstates and thus can be better prognostic indicators than structural parameters like OCT retinal nerve fiber layer (RNFL) in glaucoma patients.

Open Access Original Research Article

The Mediator Effect of Visual Impairment in the Relationship between Poor Oral Health and Depression

Obinna F. Akano, Michael A. Joseph, Elizabeth Helzner, Aimee Afable

Ophthalmology Research: An International Journal, Page 1-16
DOI: 10.9734/or/2020/v12i430151

Purpose: Visual impairment (VI) with a global estimate of 161 million has been associated with a lot of health concerns and physical conditions. This study investigates the mediator effect of visual impairment on the relationship between poor oral health and depression.

Methods: This was a cross-sectional study involving secondary analysis using data from the 2010 Behavioral Risk Factor Surveillance System (BRFSS). Self-reported visual impairment was categorized as no and yes (a little difficulty, moderate difficulty, extreme difficulty and unable to do because of eyesight). The responses to oral health were dichotomized to 0-5 teeth removed and 6+ teeth removed (poor oral health). For depression, we used physician-diagnosed depression (yes or no) and self-rated depression (validated Patient Health Questionnaire-8) (PHQ-8). We examined the association between visual impairment and depression using multivariable logistic regression accounting for the survey’s complex design.

Results: After adjusting for socio-demographic variables, health behavior, BMI and diabetes; the model produced a significant relationship between poor oral health and depression. Controlling for visual impairment resulted in the attenuation of the effect poor oral health has on depression. Furthermore, after improving eyesight, a previously significant relationship between poor oral and depression became non-significant.

Conclusion: Controlling for visual impairment, by treating or preventing visual impairment, in patients with poor oral health, merely indicates a reduction in the outcome of depression.

Open Access Original Research Article

Outcomes of Intravitreal Bevacizumab in Patients with Diabetic Macular Edema at a Tertiary Hospital in Northern Tanzania

Shariza Kanji, Kazim Dhalla, William Makupa

Ophthalmology Research: An International Journal, Page 27-34
DOI: 10.9734/or/2020/v12i430153

Background: Diabetic macular edema is a type of diabetic maculopathy affecting the central vision, ranging from mild blur to blindness. Laser photocoagulation has been the mainstay of treatment for the past three decades but it has a limited role in improving the central vision. Recent introduction of anti-vascular endothelial growth factors appears to be promising in restoring vision. However, due to its short half life multiple injections are required to control edema and maintain vision.
Objectives: To determine the visual and anatomical outcomes of intravitreal bevacizumab in patients with diabetic macular edema.

Methods: A hospital based retrospective cross-sectional study was done at Kilimanjaro Christian Medical Center eye department from 2011- 2015. During this time, patients with  diabetic macular edema who were given intravitreal bevacizumab and satisfied the inclusion criteria were included in the study. Visual acuity, central macular thickness and macular volume were recorded at baseline, six, twelve, eighteen, twenty four and thirty weeks respectively. Optical coherence tomography was used to record central macular thickness and macular volume. Univariate and multivariate binary regression analysis were done and the p-value, odds ratio and 95% confidence interval were calculated.

Results: The prevalence of Diabetic macular edema was 15.4%. Mean baseline visual acuity improved from  0.9 ± 0.57 log MAR (6/48) to 0.6±0.49 log MAR (6/24) (95% CI 0.207 - 0.389) at 30 weeks. The mean baseline central macular thickness decreased from 426.97 ± 148.358 μm to 280.98 ± 95.89  μm at 30 weeks (95% 151.531 - 187.044, P < .001). The mean baseline macular volume decreased significantly from 10.59 ± 2.55 mm3 to 8.38 ± 1.498 mm3 (95% CI 1.860 - 2.886) at 30 weeks. In multivariate analysis, patients with no hypertension were more likely to have a better visual outcome of 6/18 or better (95% CI 1.064 - 4.420, P < .033).

Conclusion: This study shows a high burden of diabetic macular edema in our setting. Intravitreal bevacizumab injection results in better visual and anatomical outcomes.

Open Access Original Research Article

Efficacy and Side Effects of Intracameral Moxifloxacin as Prophylaxis after Cataract Surgery

Bhanu Prakash Chaudhary, Baldev Prasad Tripathi

Ophthalmology Research: An International Journal, Page 40-46
DOI: 10.9734/or/2020/v12i430155

Purpose: To determine the efficacy of intracameral moxifloxacin at the end of cataract surgery.

Methods: Retrospective record based study. Study was based on a consecutive case series of patients who had cataract surgery during 2009 through 2019 in the Department of Ophthalmology at Maharishi Vashishth State Medical College, Basti (India). Intracameral preservative free moxifloxacin injection was given at the conclusion of surgery to most patients. Standardized operating room and sterilization protocols were used. All The medical records were reviewed for the 8 weeks after surgery. Post-operative endophthalmitis rate was computed using the number of cases of postoperative endophthalmitis as the numerator and the number of cataract surgeries as the denominator.

Results: Of the 10,108 surgeries performed during study period, 2012 (19.9%) involved intracameral moxifloxacin injection. No adverse drug reactions were reported from administration of intracameral antibiotics during the study period. The post-operative endophthalmitis rate in patient who had not received intracameral antibiotic injection was 0.06%. There was no endophthalmitis case reported in patients who had received intracameral moxifloxacin injection as prophylaxis.

Conclusion: The results of this study support the use if intracameral moxifloxacin as a routine prophylaxis for endophthalmitis after cataract surgery. Especially in rural setting as the patients postoperative instruction compliance is poor and many patients are lost to follow-ups sue to different reasons.

Open Access Review Article

Corneal Endothelium an Important Layer for Corneal Transparency and Its Assessment– a Review

E. Pateras

Ophthalmology Research: An International Journal, Page 17-26
DOI: 10.9734/or/2020/v12i430152

This current study aimed to review the importance and assessment of corneal endothelium in terms of corneal transparency. The study revealed that the normal metabolic activity is necessary to maintain the temperature of the cornea, to renew its cells, to support the exchange processes of nutrients and to maintain its transparency. The endothelium is the inner layer of the cornea. The main function of the endothelium is to remove fluid from the corneal stroma, thus allowing the cornea to remain transparent. Younger patients recover relatively more easily after endothelial injury because they have a larger number of endothelial cells compared to older patients. Knowledge of the number and condition of endothelial cells are crucial for a number of decisions that the ophthalmic surgeon is called upon to make usually before surgery and Endothelial assessment health is a criterion for choosing a surgical method.