Success Rate of Augmented Trabeculectomy in Primary Congenital Glaucoma.

PURPOSE: To evaluate the outcome of trabeculectomy augmented with mitomycin C in primary congenital glaucoma and to document the complications of the procedure in young children. METHODS: This was a prospective study of children younger than 2 years with primary congenital glaucoma who were treated with primary trabeculectomy with mitomycin C. After surgery, patients were observed for a minimum of 1 year. Trabeculectomy success was defined as an intraocular pressure (IOP) of 21 mm Hg or less without (absolute success) or with (qualified success) topical antiglaucoma medications. Surgical success was assessed at 1, 6, and 12 months after the procedure. RESULTS: Seventy-four eyes of 42 children were included in the current study. The mean age was 11.7 ± 8.5 months. Of the 42 children, 57.2% were male and 42.8% were female. The mean IOP after surgery was significantly lower than the preoperative IOP (P < .0001). Absolute success was observed in 98.6%, 50%, and 27% of eyes at 1, 6, and 12 months, respectively. Qualified success was achieved in 1.4%, 36.5%, and 48.6% of eyes at 1, 6, and 12 months, respectively. Overall success of the procedure was 100% at 1 month but reduced to 86.5% at 6 months and 75.7% at 12 months. In 24.3% of eyes, IOP was not controlled even with adjunctive topical glaucoma medications and was considered a failure. Postoperative complications were shallow anterior chamber (10.8%), collapsed anterior chamber (1.3%), and choroidal detachment (12.0%). Complications were managed conservatively, and 6 eyes needed surgical intervention. CONCLUSIONS: Augmented trabeculectomy is a useful primary procedure in children with primary congenital glaucoma. Topical glaucoma medications supplement the success of the procedure. [J Pediatr Ophthalmol Strabismus. 2022;59(3):180-186.].

Results of a community-based screening programme for diabetic retinopathy and childhood blindness in district Hyderabad, Pakistan.

PURPOSE: To present the results of a community-based screening programme for diabetes, diabetic retinopathy (DR) and childhood blindness (CB) in District Hyderabad, Pakistan. METHODS: Prospective cross-sectional data collection from January 2014 to December 2015 of screening for diabetes, DR and CB in Hyderabad District. Female health workers were trained to identify high-risk (potential) patients for diabetes and childhood eye disorders to undertake preliminary screening and refer patients to basic health units. The patients were further assessed by medical officers with the support of qualified optometrist, after which they were referred to Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, Pakistan for management. RESULTS: A total of 995 244 population was covered in this screening programme during which 2622 children (0-≤15 years) were screened for CB while 16 760 adult patients (>15 years) were screened for diabetes. Random blood glucose level of 3075 patients was >140 mg/dL. Out of these patients, 17% were diagnosed with DR. Refractive error (42%) was the most common cause of childhood visual impairment. CONCLUSION: The diabetic screening programme detected a high prevalence (17%) of retinopathy in patients with diabetes living in Hyderabad District. The most common cause of childhood visual impairment was refractive error (42%), which was successfully managed due to timely diagnosis. A large number of patients benefited from this community-based screening programme.

Corneal approach 20 Guage vitrectomy system for the management of congenital cataract.

OBJECTIVE: To evaluate the efficacy and complications of 20 gauge vitrectomy via corneal approach for the management of congenital cataract. METHOD: We performed anterior capsular vitreorhexis, lens matter aspiration (LMA), primary posterior vitrectorhexis and anterior vitrectomy via corneal approach using 20 gauge vitrectomy system in children younger than two years of age with congenital cataract between January 2014 to December 2014. The intra and postoperative complications were observed. RESULTS: Twenty nine eyes of 21 children were included in this study. Congenital cataract surgery using 20 gauge vitrectomy system via corneal approach did not reveal any intra operative complication. Post operatively all children were able to freely open their operated eyes. Conjunctival congestion at the incision site in four eyes and mild anterior chamber reaction in 8 eyes were seen on 1(st) daywhich resolved at one week follow up. Other major post operative complications such as inflammatory membrane, irregular pupil, posterior/anterior syneache and opacification of visual axis were not seen during follow up period. CONCLUSION: The 20-gauge vitrectomy system via corneal approach is easy to perform, is less time consuming, safe and effective for the management of congenital cataract in younger children.

Changes in Central Corneal Thickness and Endothelial Cell Count Following Pediatric Cataract Surgery.

OBJECTIVE: To evaluate the mean changes in Central Corneal Thickness (CCT) and Endothelial Cell Count (ECC) in eyes after pediatric cataract surgery with foldable intraocular lens using scleral tunnel incision micro-surgical technique. STUDY DESIGN: Qausi experimental study. PLACE AND DURATION OF STUDY: Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, from May 2011 to March 2012. METHODOLOGY: Fifty-two eyes of 37 children with pediatric cataract were included in the study. Extracapsular Cataract Extraction (ECE) with foldable Intra Ocular Lens (IOL) implantation using sclera tunnel incision was performed in all children. Endothelial Cell Count (ECC) and Central Corneal Thickness (CCT) were recorded before surgery and 1 month, 3 months and 6 months after surgery and the effect of currently practiced surgical technique on ECC and CCT was evaluated. RESULTS: The mean age at the time of surgery was 8.8 ±2.7 years (range: 4 to 15 years). The postoperative ECC and CCT were significantly different from the pre-operative values. Mean pre-operative ECC was 3175.3 ±218.4 cell/mm2 and in first postoperative month the mean ECC was 3113.4 ±210.8 cell/mm2(p<0.0001). In the 3rd and 6th month postoperative means ECC were 3052 ±202.5 cell/mm2(p<0.0001) and 3015 ±190.6 cell/mm2(p<0.0001), respectively. The mean cell loss at first postoperative month was 1.95% and at 3rd and 6th postoperative month were 3.9% and 5.05%, respectively. Mean pre-operative CCT was 514 ±49.9 µm and first postoperative mean CCT after 1 month was 524.1 ±25 µm (p = 0.084). After the 3rd and 6th months postoperative, mean CCT were 527.3 ±24.6 µm, and 530 ±24.5 µm, respectively. Third and 6th months postoperative means were significantly higher than baseline CCT, p = 0.024 and 0.007, respectively. CONCLUSION: Endothelial cell loss with closed chamber micro-surgical technique using scleral tunnel incision is within acceptable limits and within the range of normal ECC in children.

Congenital myasthenia gravis.

Congenital myasthenia gravis is caused by genetic mutations affecting neuromuscular transmission, characterized by muscle weakness usually starting in childhood. A two and a half years old male child presented with bilateral ptosis and hoarseness of voice. The symptoms progressed giving the clinical impression of congenital myasthenia gravis. A series of tests were done including Ice Pack Test, acetylcholine receptor antibody test, trial of steroids and finally neostigmine test which confirmed the diagnosis. This case illustrates the challenges in diagnosing congenital myasthenia gravis and highlights the potential benefits of neostigmine test in its diagnosis.

Visual outcome of unilateral traumatic cataract.

OBJECTIVE: To evaluate the visual outcome of a series of patients presenting with unilateral traumatic cataract. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Ophthalmology Department, Liaquat University Hospital, Hyderabad, from July 2007 to June 2010. METHODOLOGY: Analysis included data of 41 patients (31 males and 10 females) with unilateral traumatic cataract. Data regarding demographics, causative agent, clinical course and outcome in terms of best corrected visual acuity (BCVA) was retrieved from the patients' files in hospital record. Data was expressed as frequencies, percentages, mean and standard deviation. RESULTS: There was a male predilection with a male to female ratio of 3.1:1. The age group more frequently affected was 5 - 14 years (58.5%). Commonest causative agent was trauma with wooden stick in 13 eyes (31.7%) followed by thorn in 9 eyes (22%) and stone in 7 eyes (17.1%). Pre-existing posterior capsular defects were observed intraoperatively in 6 eyes. Posterior capsular opacification was evident in 10 eyes (24%). Best corrected visual acuity of 6/18 or more at 6 months was achieved in 29 eyes (70.8%). Duration between injury and cataract surgery did not affect the final visual outcome of traumatic cataract patients. CONCLUSION: Patients with traumatic cataract if managed appropriately can have best possible visual outcome. Young males are commonly affected. Taking protective measures in sports and work as well as patient education can avoid ocular trauma and traumatic cataract formation.

Nasolacrimal duct obstruction in children: outcome of primary intubation.

OBJECTIVE: To evaluate the outcome of nasolacrimal intubation as a primary treatment of congenital nasolacrimal duct obstruction (NLDO) in children up to 4 years of age. METHODS: During the 3 years period from July 2008 to June 2011, in the Paediatric Ophthalmology Department. Alshifa Trust Eye Hospital, Rawalpindi, 65 eyes of 59 children, aged 12 to 48 months with congenital NLDO and no prior Nasolacrimal duct surgery were enrolled. After written informed consent, all nasolacrimal intubations using olive tip silicon tube were performed under general anaesthesia. The planned tube retention was at least 3 months. The study outcome visit was timed 1 month after tube removal and treatment success was analyzed. Intra operative and post operative complications were also noted. Data were analyzed by SPSS 16. Frequencies and percentages were calculated for categorical variables. Mean +/- SD were computed for age and duration of intubation. Chi-square test was used to compare proportion of outcomes in different age groups and duration. RESULTS: The overall success rate of Nasolacrimal intubation as a primary treatment of congenital NLDO was 89% in children between 12 to 48 months age (mean 25.8 +/- 9.8 months). The success was 92% in children under 2 years of age (P < 0.0001) and 90% in children between 2-3 years of age (P < 0.0001). The procedure remained less successful in children between 3-4 years of age (P < 0.2860) as compared to children under 3 years of age. The success rate was consistently high (92.3%) when the tube was left in situ for more than 3-6 months (P < 0.0001). CONCLUSION: Nasolacrimal intubation with Olive tip silicon intubation tube is a successful procedure as a primary treatment of Nasolacrimal duct obstruction in children under 4 years of age.