Long term follow-up study of a trachoma vaccine trial in villages of Northern India.

A field trial of two high titer bivalent trachoma vaccines was done in a rural area of Northern India in children under the age of 6 years. Three months later 310 of the original 451 children in the study received a booster vaccination of either of the two vaccines or a placebo. Both the sucrose gradient purified and the Genetron purified vaccine protected against trachoma infection for one year. Significant protection for two years was found only with the gradient vaccine. A 12-year follow-up study located and examined 201 subjects that had received booster vaccine. It was found that 31, 27, and 28% of the individuals in each of the three groups (two vaccine and placebo) had evidence of mostly minimally active trachoma. Additionally, from 6 to 10% of the subjects in each group had signs of mild to moderate potentially blinding sequelae. The results showed no protection by either vaccine, and there was no evidence of adverse effects from the vaccines.

Prostaglandins in human tears.

We detected small quantities of prostaglandin F in tear fluid of patients with clinically normal conjunctivae. The prostaglandin F levels were significantly increased in tear fluid or patients with acute vernal conjunctivitis and chronic trachoma. We could not determine the source of prostaglandin in tears.

Ocular horn.

The case of a horn-like hyperplasia of the caruncle of the left eye in a 3-month-old child is reported. An atavistic origin of this growth as a vestigial upper incisor is suggested from the anatomical location of the horn.

Eclipse retinopathy.

Ten patients (13 eyes) suffered from varying degrees of eclipse retinopathy during a solar eclipse on 16 February 1980. There was no correlation between severity of the fundus lesions and the visual acuity. In 8 of the 10 eyes available for follow-up 6/6 or better visual acuity was seen. Early fluorescein studies revealed microleaks in 3 eyes (2 patients) and masking of choroidal fluorescence in 1 eye; however, 1 to 3 weeks later these eyes showed only faint window defects. It is postulated that in mild to moderate lesions there is a transient retinal capillary spasm, producing oedema in anterior retinal layers. Fluorescein angiography in such patients reveals no abnormality or only masking of choroidal fluorescence. However, severe cases develop micropunctures in the tight junctions of the pigment epithelium, leading to microleaks, which are sealed within a short period.

Ocular fireworks injuries in children.

Fourteen children and six adults presented in 1987 with firework-induced ocular injuries following celebrations of the Prophet Muhammad's birthday in Tripoli, Libya. The children's injuries were, typically, much more severe than those of the adults. Indigenous modifications to the fireworks, which are intended for children's use, render the devices into very dangerous missiles that, in the cases presented, resulted in the loss of one eye and serious damage to another. Educating children of the proper use of legal fireworks, and parents discouraging their children from modifying fireworks should help reduce the incidence of these severe ocular injuries.

Osteosarcoma of the orbit.

A rare case of osteosarcoma of the orbit in a 10-year-old female child is reported.

Prognosis in traumatic cataract surgery.

Surgical results in 30 cases of traumatic cataracts using mainly aspiration and extraction techniques are reported. A corrected visual acuity of 6/12 or better was achieved in 64.3% of cases. Three eyes had light perception only. Early surgery using aspiration technique followed by contact lens correction is recommended for traumatic cataracts.

Congenital cataract: management and results.

The visual outcome in cases of congenital cataract, managed both surgically and conservatively, is outlined. Final vision was better in cases with partial cataract, about 40% of whom attained 6/24 or better vision. With total cataracts, none could achieve this level of vision, with the majority (84%) attaining only 6/60 or less acuity. Visual results were also better in patients without nystagmus, 34% of whom attained 6/24 or better vision, while in cases with nystagmus, only 15% could come up to this level. Cataracts necessitating early surgery had a worse prognosis than cataracts necessitating late surgery. Visual results were best in cases with bilateral cataracts, partial cataracts, absence of associated ocular anomalies, the absence of nystagmus and in patients requiring later surgery. The important causes of nonimprovement of vision were amblyopia and after-cataract. Retinal detachment, retinopathy, and degenerative myopia were some of the less frequent causes of poor vision, while mental retardation was another important factor. Full cooperation from the parents is absolutely essential in the proper visual rehabilitation of the handicapped child.

Congenital cataract: etiology and morphology.

In a study of congenital cataract in northern India, 76 patients (146 eyes) were evaluated for morphological patterns and etiology. Partial cataracts were found to be three times more common than total cataracts, the lamellar types being the most common among the partial cataracts. Hereditary cataracts had a 19.7% incidence. The majority (46.05%) of cases of congenital cataract were of idiopathic origin. A few cases were associated with metabolic disorders (Marfan's and Marchand's). Strabismus and nystagmus were the most common associated ocular abnormalities (28.94% and 15.79%), and mental retardation was the most commonly associated systemic abnormality. Rubella cataract was seen far less frequently than expected.

Ocular fireworks injuries. Clinical features and visual outcome.

In a prospective analysis of ocular fireworks injuries over three consecutive years (1997 to 1999) during the Indian festival of Diwali, 42 patients presented with various types of fireworks-related ocular injuries. Twenty two (52%) patients had to be admitted for the management of their ocular injuries.

Suprasellar malignant mixed germ cell tumour presenting as craniopharyngioma.

A 15 year old boy presented with diminution in vision of both eyes, diabetes insipidus and hypopituitarism. MRI was suggestive of a large suprasellar and retrosellar craniopharyngioma with stretching of the optic chiasma. Histopathological findings on the first surgical specimen were interpreted as a craniopharyngioma. He was reoperated on account of clinical deterioration and increase in tumour size. Histological examination this time revealed derivatives of all three germ cell lineages along with areas of embryonal carcinoma, and yolk sac tumour besides squamous cysts, establishing the diagnosis of malignant mixed germ cell tumour. Serum and CSF were strongly positive for alpha foetoproteins.

Damage to the anterior visual pathway and brain parenchyma following external pituitary irradiation.

Three cases of damage to the optic nerves and chiasma following pituitary irradiation with Co60 teletherapy are described. All of them presented with progressive visual impairment months following irradiation and simulated recurrence of the tumour. CT scan was also not helpful in differentiating radionecrosis from tumour recurrence. On exploration the optic nerves and chiasma appeared discoloured and scarred. One case, who also had diffuse radionecrosis of brain parenchyma, died. No satisfactory therapy is currently available for this grave complication but proper safeguards can prevent it.