ABSTRACT
AIM:To evaluate the site, size,histology,and recurrence of the tumor.METHODS: We prospectively evaluated 53 patients with histological diagnosis of retinoblastoma involving the eye, orbit, intra cranial cavity and other tissues, at Department of Ophthalmology, Chandka Medical College Hospital, Larkana. To assess the extent of the tumor investigations, including X-ray-orbits, ocular B-scan, CT-scan/MRI-Oorbits-brain, whole body bone scanning, X-ray chest PA view, ultrasound abdomen, lumbar punc-ture, complete blood cell count, blood chemistry as-sessment, including renal and hepatic function para-meters, were performed. The selection of mode of treatment like surgical procedures, local radiotherapy and systemic chemotherapy used depend on the site, size, recurrence and metastasis of the tumor. The patients with local and systemic metastases were referred to the oncologist at the Larkana Institute of the nuclear medicine and radiotherapy for local radiation and systemic chemotherapy. Follow up examinations were carried out at 1, 3 , 6 and 12 months after the operation, and then annually for a further 5 years or longer. The tumor's site, size, histological type, and recurrence were evaluated.RESULTS: Of these 53 patients the age range was from 8 months to 8 years. 25 (47%) were male and 28 (53%) were female. The laterality of the tumor was in left eye 25 (47%) cases, right eye 19 (36%) cases, and both eyes 9 (17%) cases. The presentation of the patient at 1st visit was strabismus 3 (6%) cases, pseudohypopyon 4 (8%) cases, orbital pseudo orbital inflammation 6 cases (11%), mass with metastases 7 (13%) cases, fungating mass 8 (15%) cases, leu-kocoria 12(23%) cases and orbital invasion 13(25%) cases. The surgical procedures performed were enucleation alone in 19 (36%) cases, enucleation with modified exentration followed by local radiotherapy and systemic chemotherapy in 19 (36%) cases and enucleation with total exentration followed by local radiotherapy and systemic chemotherapy in 15 (28%) cases. The histological types of the tumor were well- differentiated retinoblastoma with abundant rosettes in 25 (47%) cases and highly undifferentiated retino- blastoma 28 (53%) cases . After primary surgery, the recu-rrences and metastases of the tumors were noticed in 37 (70%) cases due to optic nerve involvement beyond the point of surgical transaction, orbital invasion and sy-stemic metastasis.CONCLUSION: Any child with red eye or white pupillary reflex should be suspected of having retinoblastoma, until proved otherwise, and should be promptly referred to an ophthalmologist, because early presentation of patient in the initial stage of the tumor will result in decreased risk of tumor extension, recurrence and mortality.
ABSTRACT
AIM: To determine the predisposing factors, clinical and microbial characteristics of bacterial corneal ulcer.METHODS: Three hundred patients (300 eyes) of clinically suspected microbial corneal ulcer were included in the study. Data was collected through history and slit lamp examination. Using standard techniques, corneal scraping was performed. A portion of each scraping was examined by direct microscopy for the presence of bacteria, fungi and acanthamoeba by using 100g/L potassium hydroxideand also by Gramand staining. Another portion was inoculated directly on the surface of solid media such as blood agar, Mac-Conkey agar, chocolate agar and Sabouraud's agar. A bacterial corneal ulcer was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping examination and cured with antibacterial therapy. RESULTS: Of the 300 patients, sixty were lost in follow up, they were excluded from study. Of the remaining 240, bacterial corneal ulcer was identified in 156 (65.0%) patients. The age of patients ranged from 14 to 74 (mean age of 48) years. Majority of them were male (102). Corneal localization of the ulcers was distributed as central in 96 (61.5%) patients and peripheral in 60 (38.5%) patients. Ulcer depth in 82 (52.6%) patients was less than 1/3 of corneal thickness. In 64 (41.0%) patients, anterior chamber inflammation was 1+ to 2+ Tyndall effect with 1+ to 2+ cells present. Bacteria were isolated in 125 (80.0%) patients from the corneal smears. Sixty-nine percent of isolated bacteria were Grams' positive, and 39% were Grams' negative. Gram negative bacteria were associated with severe anterior chamber inflammation (P=0.003) and depth more than 2/3 of cornea (P=0.001). The most frequent organism isolated was Staphylococcus aureus. Forty percent of patients had good visual outcome with visual acuity same or better than the level at admission. Among the others 60% patients, final outcome was poor.CONCLUSION: Bacterial corneal ulcer is aserious ocular infectious disease that remains a therapeutic challenge and vision threatening ocular condition. Rapid isolation of bacteria and treatment with intensive ocular antibiotics represent decisive steps in the management of such pathologies.