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Using WHO questionnaire known as TADDS(Tool for Assessment of Diabetic Retinopathy and Diabetes Management System), a country wide survey was conducted to assess the health care system for diabetes mellitus (DM) and diabetic retinopathy (DR). This would also provide any evidence of the presence and usefulness of links between the two. A total of 190 key informants for DR and DM services from 47 districts were interviewed. The answers were reviewed and any disagreement was resolved through discussion with stakeholders'. The final results were disseminated. The results showed that diabetes is listed as a priority; national plan exists but programme has not been implemented. Health professionals are unaware about Ministry of Health guidelines. There is infrequent networking between DM and DR care providers. Transport and cost are the main barriers for accessing these services. Out of pocket expenses provide 55% of health care financing.
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Diabetes Mellitus , Retinopatia Diabética , Atenção à Saúde , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Retinopatia Diabética/terapia , Humanos , Paquistão , Prevalência , Inquéritos e Questionários , Organização Mundial da SaúdeRESUMO
The corneal functions (transparency, refractivity and mechanical strength) deteriorate in many corneal diseases but can be restored after corneal transplantation (penetrating and lamellar keratoplasties). However, the global shortage of transplantable donor corneas remains significant and patients are subject to life-long risk of immune response and graft rejection. Various studies have shown the differentiation of multipotent mesenchymal stem cells (MSCs) into various corneal cell types. With the unique properties of immunomodulation, anti-angiogenesis and anti-inflammation, they offer the advantages in corneal reconstruction. These effects are widely mediated by MSC differentiation and paracrine signaling via exosomes. Besides the cell-free nature of exosomes in circumventing the problems of cell-fate control and tumorigenesis, the vesicle content can be genetically modified for optimal therapeutic affinity. The pharmacology and toxicology, xeno-free processing with sustained delivery, scale-up production in compliant to Good Manufacturing Practice regulations, and cost-effectiveness are the current foci of research. Routes of administration via injection, topical and/or engineered bioscaffolds are also explored for its applicability in treating corneal diseases.
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Doenças da Córnea/etiologia , Doenças da Córnea/metabolismo , Exossomos/metabolismo , Células-Tronco Mesenquimais/metabolismo , Animais , Diferenciação Celular , Movimento Celular , Terapia Combinada , Córnea/fisiologia , Doenças da Córnea/terapia , Transplante de Córnea , Mobilização de Células-Tronco Hematopoéticas , Humanos , Imunomodulação , Transplante de Células-Tronco Mesenquimais , Células-Tronco Mesenquimais/citologia , Neovascularização Fisiológica , RegeneraçãoRESUMO
Retinal dystrophies are a phenotypically and genetically complex group of conditions. Because of this complexity, it can be challenging in many families to determine the inheritance based on pedigree analysis alone. Clinical examinations were performed and blood samples were collected from a North American (M1186) and a consanguineous Pakistani (PKRD168) pedigree affected with two different retinal dystrophies (RD). Based on the structure of the pedigrees, inheritance patterns in the families were difficult to determine. In one family, linkage analysis was performed with markers on X-chromosome. In the second family, whole-exome sequencing (WES) was performed. Subsequent Sanger sequencing of genes of interest was performed. Linkage and haplotype analysis localized the disease interval to a 70 Mb region on the X chromosome that encompassed RP2 and RPGR in M1186 . The disease haplotype segregated with RD in all individuals except for an unaffected man (IV:3) and his affected son (V:1) in this pedigree. Subsequent analysis identified a novel RPGR mutation (p. Lys857Glu fs221X) in all affected members of M1186 except V:1. This information suggests that there is an unidentified second cause of retinitis pigmentosa (RP) within the family. A novel two-base-pair deletion (p. Tyr565Ter fsX) in CHM (choroideremia) was found to segregate with RD in PKRD168. This paper highlights the challenges of interpreting family history in families with RD and reports on the identification of novel mutations in two RD families.
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Proteínas Adaptadoras de Transdução de Sinal/genética , Proteínas do Olho/genética , Degeneração Retiniana/genética , Deleção de Sequência , Códon sem Sentido , Consanguinidade , Feminino , Genes Ligados ao Cromossomo X , Ligação Genética , Haplótipos/genética , Humanos , Masculino , América do Norte , Paquistão , Linhagem , Sequenciamento do ExomaRESUMO
AIMS: This study describes different types of orbital osteoma based on clinical per-operative morphology and radiological findings to facilitate communication between ophthalmologists and surgical management for a better patient outcome. MATERIALS AND METHODS: The study was conducted in the Orbit and Oculoplastics Department of Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from July 1, 2001 to June 30, 2014. A retrospective analysis of 520 diagnosed orbital tumours who presented to us was carried out and the prevalence of orbital osteoma was determined. The sampling technique was non-randomized sampling. Based on the clinical morphology observed during surgical intervention as well as the radiological findings of the orbital osteoma, a simple yet useful description of orbital osteoma was introduced. RESULTS: The retrospective analysis of 520 diagnosed orbital tumours revealed a prevalence of 2.3% (n = 12) of orbital osteoma. Based on our observation of the 12 (n = 12) cases of orbital osteoma, we have classified orbital osteoma into a combination of seven types: "sessile" or broad-based osteoma; "pedunculated" or mushroom osteoma with a thin cylindrical stalk of origin; "dumb-bell"-shaped osteoma with the simultaneous presence in orbital and adjoining sinus/nasal cavity; "wrapped" osteoma, covered by a thin cartilaginous layer; "naked" osteoma, without any such covering; "homogenous" or uniformly dense osteoma; and "heterogeneous", soft-dense osteoma with varying areas of density. CONCLUSION: This study attempts to introduce a simple description of different types of orbital osteoma based on clinical per-operative morphology and radiological findings for the first time to facilitate the surgical removal of orbital osteoma.
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Neoplasias Orbitárias/classificação , Osteoma/classificação , Humanos , Neoplasias Orbitárias/epidemiologia , Neoplasias Orbitárias/patologia , Osteoma/epidemiologia , Osteoma/patologia , Paquistão/epidemiologia , Prevalência , Estudos Retrospectivos , Tomografia Computadorizada por Raios XRESUMO
Diabetic corneal neuropathy (DCN) is a common diabetic ocular complication with limited treatment options. In this study, we investigated the effects of topical and oral fenofibrate, a peroxisome proliferator-activated receptor-α agonist, on the amelioration of DCN using diabetic mice (n = 120). Ocular surface assessments, corneal nerve and cell imaging analysis, tear proteomics and its associated biological pathways, immuno-histochemistry and western blot on PPARα expression, were studied before and 12 weeks after treatment. At 12 weeks, PPARα expression markedly restored after topical and oral fenofibrate. Topical fenofibrate significantly improved corneal nerve fibre density (CNFD) and tortuosity coefficient. Likewise, oral fenofibrate significantly improved CNFD. Both topical and oral forms significantly improved corneal sensitivity. Additionally, topical and oral fenofibrate significantly alleviated diabetic keratopathy, with fenofibrate eye drops demonstrating earlier therapeutic effects. Both topical and oral fenofibrate significantly increased corneal ß-III tubulin expression. Topical fenofibrate reduced neuroinflammation by significantly increasing the levels of nerve growth factor and substance P. It also significantly increased ß-III-tubulin and reduced CDC42 mRNA expression in trigeminal ganglions. Proteomic analysis showed that neurotrophin signalling and anti-inflammation reactions were significantly up-regulated after fenofibrate treatment, whether applied topically or orally. This study concluded that both topical and oral fenofibrate ameliorate DCN, while topical fenofibrate significantly reduces neuroinflammation.
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Córnea , Diabetes Mellitus Experimental , Neuropatias Diabéticas , Fenofibrato , PPAR alfa , Animais , PPAR alfa/agonistas , PPAR alfa/metabolismo , Camundongos , Fenofibrato/farmacologia , Fenofibrato/administração & dosagem , Diabetes Mellitus Experimental/tratamento farmacológico , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/metabolismo , Neuropatias Diabéticas/tratamento farmacológico , Neuropatias Diabéticas/metabolismo , Córnea/metabolismo , Córnea/efeitos dos fármacos , Córnea/inervação , Córnea/patologia , Masculino , Administração Oral , Administração Tópica , Doenças da Córnea/tratamento farmacológico , Doenças da Córnea/etiologia , Doenças da Córnea/metabolismo , Doenças da Córnea/patologia , Camundongos Endogâmicos C57BL , Proteômica/métodosRESUMO
BACKGROUND: Scientific data regarding effects of platelet transfusion on platelet count in dengue-related thrombocytopenia is scanty. METHODS: A single center, randomized non-blinded trial was conducted on adult patients with dengue fever and platelet counts less than 30,000/µl. Patients were randomized to treatment and control group. Treatment group received single donor platelets. Patients with post-transfusion platelet increment (PPI) ≥10,000/µl and/or corrected count increment (CCI) ≥5,000/µl 1 h post-transfusion were considered responders. Primary outcome was platelet count increments at 24 and 72 h. RESULTS: 87 patients were enrolled, and 43 (48.2%) received platelet transfusion. Mean PPI and CCI at 1 h post-transfusion in the treatment group were 18,800/µl and 7,000/µl respectively. 22 (53.6%) patients in the treatment group were non-responders. Mean platelet increments at 24 and 72 h were higher in the treatment group as compared to the control group. Responders showed significantly higher increments when compared to non-responders and the control group at 24 h (p = 0.004 and p ≤ 0.001, respectively) and 72 h (p = 0.001 and p ≤ 0.001, respectively). Significant differences were found between non-responders and the control group at 24 h (p ≤ 0.001), but not at 72 h (p = 0.104). Patients with lower baseline platelet count were more likely to be non-responders. Platelet transfusion neither prevented development of severe bleeding nor shortened time to cessation of bleeding. Three severe transfusion reactions and two deaths occurred in treatment group. CONCLUSION: In this trial, almost half the patients showed no response to a high-dose platelet transfusion. Platelet transfusion did not prevent development of severe bleeding or shorten time to cessation of bleeding and was associated with significant side effects. Therefore, platelet transfusion should not be routinely done in the management of dengue fever.
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Keratoconus is the most common primary corneal ectasia characterized by progressive focal thinning. Patients experience increased irregular astigmatism, decreased visual acuity and corneal sensitivity. Corneal collagen crosslinking (CXL), a minimally invasive procedure, is effective in halting disease progression. Historically, keratoconus research was confined to ex vivo settings. In vivo confocal microscopy (IVCM) has been used to examine the corneal microstructure clinically. In this review, we discuss keratoconus cellular changes evaluated by IVCM before and after CXL. Cellular changes before CXL include decreased keratocyte and nerve densities, disorganized subbasal nerves with thickening, increased nerve tortuosity and shortened nerve fibre length. Repopulation of keratocytes occurs up to 1 year post procedure. IVCM also correlates corneal nerve status to functional corneal sensitivity. Immediately after CXL, there is reduced nerve density and keratocyte absence due to mechanical removal of the epithelium and CXL effect. Nerve regeneration begins after 1 month, with nerve fibre densities recovering to pre-operative levels between 6 months to 1 year and remains stable up to 5 years. Nerves remain tortuous and nerve densities are reduced. Corneal sensitivity is reduced immediately postoperatively but recovers with nerve regeneration. Our article provides comprehensive review on the use of IVCM imaging in keratoconus patients.
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OBJECTIVE: To determine the one-year visual and refractive outcomes of deep anterior lamellar keratoplasty (DALK) in patients with advanced keratoconus (KC) using inexpensive readily available instruments. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, from November 2016 to March 2021. METHODOLOGY: The authors evaluated different types of big bubble (BB) formation and the conversion rate of intended DALK (n=120) to the penetrating keratoplasty (PK) in patients with grade 4 KC. For analysis, only those patients were included in whom DALK was completed. Main outcome measures at 1-year follow-up were best-corrected visual acuity (BCVA), maximum keratometry (Kmax) reading, spherical equivalent (SE), and topographic astigmatism (TA). All the postoperative complications were recorded. RESULTS: Type 1 BB was formed in 68% (n=82) of the patients. An incomplete type 1 BB and type 2 BB were observed in twenty and eighteen patients, respectively. DALK was completed successfully in 102 patients. Whereas, the conversion rate to PK was 15% (n=18). The mean preoperative BCVA improved from 1.11±0.23 logMAR to 0.46±0.20 logMAR, at 1-year follow-up. The mean Kmax, SE, and TA readings reduced from a preoperative value of 62.1±4.60 D, -11.6±2.62 D, and 4.63±1.82 D, respectively, to 49.1±3.10 D, -5.65±0.84 D, and 2.78±1.35 D, respectively, at 1-year follow-up. Stromal rejection was recorded in two patients, but it responded well to topical therapy. CONCLUSION: Inexpensive readily available instruments can be used to perform DALK in patients with advanced KC with favourable visual and refractive outcomes. KEY WORDS: Big bubble, Deep anterior lamellar keratoplasty, Keratoconus, Perforation, Penetrating keratoplasty.
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Astigmatismo , Transplante de Córnea , Ceratocone , Astigmatismo/cirurgia , Humanos , Ceratocone/cirurgia , Refração Ocular , Resultado do Tratamento , Acuidade VisualRESUMO
OBJECTIVE: To evaluate the utility of teleconsultation in the provision of eye care services during the COVID-19 lockdown. Disparities in the consultation burden of sub-specialities and socio-demographic differences in teleconsultation utilization were also assessed. METHODS: Al-Shifa Trust Eye Hospital Rawalpindi began audio and video teleconsultation using broadband telecommunication services during the lockdown. Patients' and consultations' data gathered during the first three weeks after the commencement of this programme were compared with data from the four weeks prior to lockdown. The weekly consultation ratio and overall consultation burden of sub-specialities were measured. Chi-Square tests of association determined the relationship between different variables (socioeconomic status and consultation characteristics) and consultation modality (on-site vs online). RESULTS: In total, 17507 on-site consultations (4377/week) were conducted compared to 1431 teleconsultations (477/week), which maintained 10.89% of the weekly pre-lockdown eye care services. The post-lockdown teleconsultation programme saw a relatively higher percentage of service utility among female (47.09% vs 44.71%), younger-age (31.33±19.45 vs 41.25±23.32 years) and higher-socioeconomic-status (32.21% vs 0.30%) patients compared to pre-lockdown on-site consultations. The most common indication for teleconsultation was red-eye (16.70%). While cornea and glaucoma clinics maintained most of the pre-lockdown services (30.42% and 29% respectively), the highest dropout was seen in optometric and vitreoretinal services supporting only 5.54% and 8.28% of pre-lockdown services, respectively. CONCLUSION: Digital initiatives could partially maintain eye care services during the lockdown. Focused strategies to improve teleconsultation utilization are required during the pandemic and beyond.
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COVID-19/epidemiologia , Oftalmopatias/diagnóstico , Oftalmopatias/terapia , Consulta Remota/métodos , Adolescente , Adulto , Idoso , COVID-19/prevenção & controle , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Pandemias , Quarentena , Consulta Remota/estatística & dados numéricos , SARS-CoV-2/isolamento & purificaçãoRESUMO
Diabetic keratopathy (DK) is a common, but underdiagnosed, ocular complication of diabetes mellitus (DM) that has a significant economic burden. It is characterised by progressive damage of corneal nerves, due to DM-induced chronic hyperglycaemia and its associated metabolic changes. With advances in corneal nerve imaging and quantitative analytic tools, studies have shown that the severity of diabetic corneal neuropathy correlates with the status of diabetic peripheral neuropathy. The corneal nerve plexus is, therefore, considered as an important surrogate marker of diabetic peripheral neuropathy and helps in the evaluation of interventional efficacy in the management of DM. The clinical manifestations of DK depend on the disease severity and vary from decreased corneal sensitivity to sight-threatening corneal infections and neurotrophic ulcers. The severity of diabetic corneal neuropathy and resultant DK determines its management plan, and a step-wise approach is generally suggested. Future work would focus on the exploration of biomarkers for diabetic corneal neuropathy, the development of new treatment for corneal nerve protection, and the improvement in the clinical assessment, as well as current imaging technique and analysis, to help clinicians detect diabetic corneal neuropathy earlier and monitor the sub-clinical progression more reliably.
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The introduction of femtosecond laser-assisted cataract surgery is an alternative approach to conventional cataract surgery. Our study aimed to determine the effectiveness of femtosecond laser-assisted capsulotomy in the presence of different ophthalmic viscoelastic devices (OVDs) in the anterior chamber. Fresh porcine eyes (n = 96) underwent LDV Z8-assisted anterior capsulotomy, either in the presence of an OVD (Viscoat, Provisc, Healon, Healon GV or HPMC) or without, using 90% and 150% energies respectively. Following that, the capsule circularity, tag's arc-length, tag-length, tag-area and rupture strength (mN) of the residual capsular bag were evaluated. We found that increasing energy from 90 to 150% across the OVD sub-groups improved the studied capsulotomy parameters. Amongst the 90% energy sub-groups, the circularity and tag-parameters were worse with Viscoat and Healon GV, which have higher refractive index and viscosity compared to the aqueous humour. Using 150% energy, Healon GV showed a significantly worse total arc-length (p = 0.01), total tag-length (p = 0.03) and total tag-area (p = 0.05) compared to the control group. We concluded that; an OVD with a refractive index similar to aqueous humour and lower viscosity, such as Healon or Provisc, as well as a higher energy setting, are recommended, to enhance the efficacy of laser capsulotomy.
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Ceratectomia Subepitelial Assistida por Laser/métodos , Implante de Lente Intraocular/métodos , Animais , Câmara Anterior , Extração de Catarata/métodos , Ácido Hialurônico/metabolismo , Terapia a Laser/métodos , Lasers , Dispositivos Ópticos , Facoemulsificação , Suínos , ViscosidadeRESUMO
OBJECTIVE: To describe different types of primary extraocular muscle (EOM) tumours based on the results of imaging studies, peroperative clinical picture and their histopathological diagnosis. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Al-Shifa Trust Eye Hospital, Rawalpindi, from July 2001 to January 2017. METHODOLOGY: A retrospective analysis of 640 diagnosed orbital tumours was carried out using non-randomised sampling technique, and the prevalence of primary EOM tumours was determined. Based on the results of imaging studies, the clinical picture observed during surgery (orbitotomy) and the histopathological diagnosis, primary EOM tumours were divided into different types, accordingly. RESULTS: Nineteen (n=19) primary EOM tumours (frequency of 2.96%) had 12 types of histopathological diagnoses, and were categorised into inflammatory tumours (n=8, 42%), vascular tumours (n=4, 21%), lymphoproliferative tumours (n=3, 16%), neurogenic tumours (n=2, 10.5%) and myogenic tumours (n=2, 10.5%). The recti were involved more frequently than obliques (n=15, 78.94% and n=4, 21.06%, respectively). All the patients presented with proptosis of varying degree with some degree of globe rotation and had surgical excision/appropriate management. Visual acuity was not affected in any of the patients. Four (n=4, 21.05%) tumours were malignant (NHL, ASPS, myeloid sarcoma and rhabdomyosarcoma) and these patients underwent chemotherapy and/or radiotherapy. CONCLUSION: Biopsy-proven primary EOM tumours were devisable into five broad categories. Patients with primary EOM tumours presented with proptosis and impaired ocular motiliy. The primary EOM tumours involved both the recti and the obliques and were excised surgically with favourable outcomes in most cases.
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Neoplasias Musculares/patologia , Músculos Oculomotores/patologia , Neoplasias Orbitárias/patologia , Adolescente , Adulto , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/epidemiologia , Neoplasias Musculares/cirurgia , Músculos Oculomotores/cirurgia , Neoplasias Orbitárias/classificação , Neoplasias Orbitárias/epidemiologia , Neoplasias Orbitárias/cirurgia , Paquistão/epidemiologia , Prevalência , Rabdomiossarcoma/epidemiologia , Rabdomiossarcoma/patologia , Rabdomiossarcoma/cirurgia , Sarcoma Alveolar de Partes Moles/epidemiologia , Sarcoma Alveolar de Partes Moles/patologia , Sarcoma Alveolar de Partes Moles/cirurgiaRESUMO
PURPOSE: To present the clinical, radiological, histopathological, immunohistochemical features and the follow-up of orbital primitive neuroectodermal tumors (PNETs) in pediatric patients along with a review of the literature. METHODS: A retrospective analysis of all diagnosed cases of orbital PNET was done. Patients' ophthalmic findings, imaging, immunohistochemistry, metastatic work-up, treatment, globe salvation, and survival were documented and a mini literature review of orbital PNET was performed. RESULTS: Four diagnosed cases of orbital PNET presented with proptosis and visual impairment were treated during the study period. The radiological imaging showed primary orbital involvement. There were three males and one female with a mean age of 63.75 months (range: 3 to 244 months). Histopathology of all studied patients showed round malignant cells with hyperchromatic nuclei, increased nuclear cytoplasmic ratio, and positive test results for CD99 and FLI-1. The studied patients underwent orbital surgery for excision of tumors followed by chemotherapy. One of the patients also had external radiation in addition to chemotherapy after a second recurrence. The follow-up period of these patients varied from 1 to 5 years. Only one child who had recurrence twice was followed up to 5 years, but was lost to follow-up after that. CONCLUSIONS: The authors believe that most orbital peripheral PNET tumors present as well-defined masses on both imaging and perioperatively and are easily removed surgically. The apparently disguised "benign profile" of orbital PNET may prove deceptive and the shorter duration of symptoms remains a strong reminder of the malignant nature of the lesion. [J Pediatr Ophthalmol Strabismus. 2018;55(2):93-99.].
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Antígeno 12E7/metabolismo , Tumores Neuroectodérmicos Primitivos/diagnóstico , Neoplasias Orbitárias/diagnóstico , Proteína Proto-Oncogênica c-fli-1/metabolismo , Adolescente , Biomarcadores Tumorais/análise , Criança , Pré-Escolar , Terapia Combinada , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Masculino , Tumores Neuroectodérmicos Primitivos/metabolismo , Tumores Neuroectodérmicos Primitivos/terapia , Neoplasias Orbitárias/metabolismo , Neoplasias Orbitárias/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto JovemRESUMO
OBJECTIVE: To evaluate the state of refraction in children with bilateral congenital nasolacrimal duct obstruction (CNLDO). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from April 2014 to April 2016. METHODOLOGY: Children with bilateral CNLDO were studied. Patients' refractive status were evaluated by performing cycloplegic refraction, followed by appropriate management plan. The refractive errors of both eyes were noted and compared for any significant anisometropia. RESULTS: One hundred and seventeen (n=117) children with median age (IQR) of 32 (12) months having bilateral CNLDO were enrolled. Children with bilateral CNLDO had insignificant interocular difference in terms of spherical equivalent (SE) and cylindrical refractive errors (p>0.05). The rate of the anisometropia (>1 D difference between the two eyes) was 5.98% (n=7) in children with bilateral CNLDO. CONCLUSION: Performing cycloplegic refraction routinely in patients with bilateral CNLDO is not as urgent as compared to ones with unilateral CNLDO. Further, avoidance of early surgical intervention in children with bilateral CNLDO will spare the parents from the emotional trauma and positively influence the health economics worldwide.
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Obstrução dos Ductos Lacrimais/congênito , Obstrução dos Ductos Lacrimais/fisiopatologia , Ducto Nasolacrimal/anormalidades , Ducto Nasolacrimal/fisiopatologia , Refração Ocular/fisiologia , Ambliopia/epidemiologia , Anisometropia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Erros de Refração , Testes VisuaisRESUMO
PURPOSE: To determine the role of a single cycle of topical azithromycin in preventing long-term trachoma complications in children from an area with endemic trachoma. DESIGN: A longitudinal cohort study. METHODS: Two hundred thirty-eight (n = 238) children with active trachoma were enrolled in the current study. They were aged 1 to 10 years, with trachomatous inflammation based on the simplified World Health Organization grading system. These children were identified out of a survey of 8600 children from 7 villages in Punjab, Pakistan, where trachoma was endemic. The studied patients with active trachoma were treated with a single regimen of azithromycin 1.5% eye drops, given twice daily for 3 days, and were followed up for 3 years. The long-term effects of this therapy were documented for the first time in an endemic area. RESULTS: Two hundred fourteen children (90%) were present at 1-year follow-up with 10% dropout, and 178 (75%) were present at 3-year follow-up with 25% dropout. Of these, 23% and 11% had active trachoma at 1 and 3 years, respectively. Active trachoma was minimized from 100% at baseline to 11% at the end of 3 years. The reinfection rate was 4%. None of the patients developed trachoma-related ocular complications during the study period. CONCLUSIONS: A single cycle of topical azithromycin can be used as an effective and safe option for treating active trachoma in children in endemic areas. This study also documented that a single cycle of topical azithromycin prevents trachoma-related ocular complications in an endemic area.
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Antibacterianos/administração & dosagem , Azitromicina/administração & dosagem , Soluções Oftálmicas/uso terapêutico , Tracoma/tratamento farmacológico , Administração Tópica , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Estudos Longitudinais , Masculino , Paquistão , Recidiva , Tracoma/complicaçõesRESUMO
A 5-year-old boy presented with a large 5 cm × 5 cm cyst covering the left eye completely since birth. The cyst was excised in toto and was sent for histopathological examination. During the surgery, the inferior oblique (IO) muscle was seen originating from medial orbital wall, 10-12 mm behind the medial orbital margin, just posterior to the lacrimal bone and moving laterally, downward, and posteriorly from its origin making a more acute angle - around 20° to its site of origin. The insertion of the IO to sclera was at its normal site. The abnormal origin of IO was confirmed later by magnetic resonance imaging. The ocular movements of the left eye were tested 2 weeks after the surgery and were found to be normal in all directions. However, the child was hypertrophic and amblyopic. The histopathological findings showed the orbital cyst to contain dermal elements, respiratory, and intestinal epithelium.
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Coristoma/diagnóstico , Cisto Dermoide/patologia , Músculos Oculomotores , Doenças Orbitárias/diagnóstico , Neoplasias Orbitárias/patologia , Pré-Escolar , Coristoma/cirurgia , Cisto Dermoide/cirurgia , Movimentos Oculares/fisiologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças Orbitárias/cirurgia , Neoplasias Orbitárias/cirurgia , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To report a case of conjuctival leiomyoma. CASE REPORT: An 18-year-old female patient presented with a conjunctival growth in the left eye for a 2-year-period with no change in size. She merely presented for cosmetic reasons. Visual acuity was 20/20 in each eye. The lesion had prominent vessels and was not adherent to the sclera. The growth resembled a benign lesion of the conjunctiva. The tough and vascular tissue was excised and sent for histopathology. The defect was covered by an end to end conjunctival suturing. Histopathology showed the lesion to be conjunctival leiomyoma. Trichome was used to highlight the spindle shaped cells and immuno-histochemistry using anti-smooth muscle actin antibody and Vimentin was applied to confirm the diagnosis. CONCLUSION: This case adds to the total number of cases of conjuctival leiomyoma reported in the literature to date. An ophthalmologist needs to think beyond a common mass when encountering a conjunctival growth extending onto the cornea.
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PURPOSE: To evaluate and compare the refractive state in children diagnosed as having unilateral or bilateral congenital nasolacrimal duct obstruction (CNLDO). This study also compares how the laterality of CNLDO affects the refractive state of the patients. METHODS: This descriptive cross-sectional study includes consecutive children with unilateral and bilateral CNLDO over a period of 1 year. Cycloplegic refraction was performed on each child who presented with CNLDO followed by appropriate plans for treatment. The refractive errors of patients with unilateral and bilateral CNLDO were compared. RESULTS: One hundred sixty-one patients with unilateral CNLDO (mean age: 29 ± 19.93 months) and 46 with bilateral CNLDO (mean age: 30 ± 16.21 months) were enrolled from August 2013 to July 2014. The rate of the anisometropia (≥ 1 diopters [D] difference between the two eyes) was 13.7% (n = 22) and 8.6% (n = 4) in patients with unilateral and bilateral CNLDO, respectively. Interocular difference was significant in terms of spherical equivalent (P < .01) but not cylindrical refractive error in patients with unilateral CNLDO. Patients with bilateral CNLDO had insignificant interocular differences in terms of spherical equivalent and cylindrical refractive errors (P > .05). CONCLUSIONS: Unilateral CNLDO is associated with statistically significant anisometropia compared to bilateral CNLDO, which predisposes children with unilateral CNLDO to amblyopia. It is vital to perform cycloplegic refraction routinely and counsel parents regarding regular follow-ups. [J Pediatr Ophthalmol Strabismus. 2016;53(3):168-172.].