Anisometropia and refractive status in children with bilateral congenital nasolacrimal duct obstruction

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

Serum IgE levels: an effective diagnostic tool for evaluation and monitoring of orbital fungal granuloma

To determine the changes in IgE levels in diagnosis and postoperative monitoring of orbital fungal granuloma. Descriptive analytical study. Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from July 2012 to June 2013. Cases with clinically high index of suspicion for orbital fungal granuloma and 50 healthy volunteers were inducted as control subjects. Patients with recurrent cases of orbital fungal granuloma, previous orbital surgery, and those with very low clinical suspicion of fungal granuloma were excluded. Total serum IgE level [IU/ml], eosinophil counts and skin prick test were performed in all subjects. Independent t-test was used for comparison of healthy volunteers and patients with biopsy proven orbital fungal granuloma. Repeated measures ANOVA was used for comparing the preoperative and postoperative total serum IgE level of patients with biopsy proven fungal granuloma. The mean total serum IgE level for the healthy volunteers was 208.82 +/- 41.43 IU/ml. The mean pre-operative IgE value of histologically confirmed cases of fungal granuloma was 1613.72 +/- 282.83 IU/ml. The total serum IgE level gradually declined after surgery and anti-fungal treatment. The mean serum IgE level 3, 6 and 9 months postoperatively were 1039.48 +/- 308.40, 568.77 +/- 162.01 and 224.92 +/- 51.55 IU/ml respectively. These tests showed that the drop in IgE level in cases of fungal granuloma with treatment was statistically significant [p < 0.001]. Total serum IgE level can be used as a reliable diagnostic and postoperative monitoring tool in orbital fungal granuloma

Management of ocular complications in Terson's syndrome

To evaluate and manage the patients presenting with vitreous hemorrhage and intracranial hemorrhage simultaneously. Prospective observational study. A total of 6 patients presenting with vitreous hemorrhage were included in this case series. Study was conducted at Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular examination including visual acuity, slit lamp examination and dilated fundus examination was done. Ultrasound B scans and CT brain was done in all patients. According to the clinical findings a management plan was formulated. Findings were recorded on a proforma for analysis. A total of 12 eyes of 6 patients [all males, age range 25-60 years were included in the study. Vision improved in two cases by conservative management and in one case by 23G pars plana vitrectomy. Vision remained the same on in one case, deteriorated in one and one patient was lost to follow up. Ocular complications in Terson's syndrome can have good outcome if treated conservatively and/or surgically

Visual outcomes of Harada disease

To evaluate visual outcome of patients diagnosed with Harada Disease. A prospective observational study A total of 4 patients presenting with exudative retinal detachment were included in this case series. Study was conducted in Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular exam including visual acuity, slit lamp examination and dilated fundus examination was done. Fundus photos and Optical Coherence Tomography pre and post treatment was done in almost all patients. Patient A, 37/F, presented with VA CF OD and CF in OS and B/L exudative retinal detachment. After 4 weeks of treatment B/L retina was flat and BCVA was improved to 6/6 in Right eye and 6/9 in Left eye. Patient B, 35/F, presented with VA CF in both eyes and exudative retinal detachment. After 4 weeks of treatment B/L retina was flat and BCVA of both eyes was 6/6P.Patient C, 38/F, presented with BCVA 6/60 in both eyes and exudative retinal detachment. After 8 weeks of treatment B/L retina was flat and BCVA was 6/6 in both eyes. Patient D 20/F presented with VA CF in both eyes and B/L exudative retinal detachment. At 2nd follow-up visit [Post treatment 14 days] B.C.V.A. was 6/6P OD and 6/9 in OS. Patient is still under treatment and follow-ups. The visual prognosis is good for patients with Harada disease and the disease may manifest itself with minimum neurological features

Diagnostic role of polymerase chain reaction in active uveitis

To evaluate the role of polymerase chain reaction [PCR] for detection of Mycobacterium tuberculosis in the vitreous humor samples obtained from eyes with active uveitis. A total of 15 patients were included in the study with the signs of anterior, intermediate or posterior uveitis. Study was conducted in Department of Ophthalmology Lahore General Hospital, Lahore. Detailed ocular examination including visual acuity using Snellen's chart, slit lamp examination and detailed dilated fundus examination was done. All patients were advised complete blood count with ESR, Mantoux test and chest x-ray. Vitreous fluid samples were taken and sent for polymerase chain reaction for Mycobacterium tuberculosis [MTB] DNA. Vitreous samples from 15 [15-45 +/- 5yrs] patients, 9 male and 6 female, with signs of anterior, intermediate or posterior uveitis on slit lamp examination were taken and sent for Mycobacterium tuberculosis DNA on PCR. In 4 out of 15 samples [26.6%] Mycobacterium tuberculosis DNA on PCR was detected. Out of the 15 patients, 6 were females [15-45 years] with 1 [16.6%] positive PCR and 9 [15-40years] males with 3 [33.3%] positive PCR for Mycobacterium tuberculosis DNA. 2 of the male patients were positive for Toxoplasma and one of them was also positive for Cytomegalo virus on TORCH test. PCR can be effectively used for the diagnosis of intraocular tuberculosis in the presence of clinically identified cases of uveitis

Prevalence of ocular Leishmaniasis in district Chakwal

Cutaneous Leishmaniasis is endemic in Pakistan. The current study was undertaken in District Chakwal to measure the prevalence of ocular lesions in cutaneous leishmaniasis. A 60 years male presented to the Oculoplastic Clinic at Al- Shifa Trust Eye Hospital Rawalpindi, Pakistan, with an isolated chronic non-healing ulcerative lesion of left upper eye lid. Clinically suspected to be squamous cell carcinoma, it underwent total excision followed by Cutler-Beard reconstruction. The histopathology was cutaneous leishmaniasis. A team was dispatched to the health center, Choa Saiden Shah of the area to which the patient belonged [120 km southeast of Islamabad]. The area was found to be endemic for leishmaniasis. A total of 925 patients with known cutaneous leishmaniasis were registered for treatment at the health center and examined for ocular involvement. The prevalence of ocular lesions was found to be about 1%. Most of the lesions involved the skin of the upper eyelid. All the non-ocular patients were undergoing treatment with intralesional injection of Glucantime, while patients with exclusive ocular involvement were treated with intramuscular injections. Ocular involvement in Leishmaniasis is relatively rare, but it should be kept in mind in the differential diagnosis of ulcerative lesions of the eyelid especially in an endemic area

Choroidal melanoma in a young patient - a case report and mini review of literature

Background: Choroidal melanoma is the most common primary intraocular malignant neoplasm in adults[1]. However, there are various benign and malignant lesions that mimic ophthalmoscopic features of choroidal melanoma[2]. Moreover, atypical presentation and unusual age distribution of choroidal melanoma in some cases make the diagnostic elucidation even more difficult and in such cases, supplementary tests especially ultrasonographic methods gain prime importance

Case Description: The authors report a case of primary choroidal melanoma in a 27 years old young male patient who presented to department of Orbit and Oculoplastic at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan in 2013 being the first case to be reported at this age at Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan in more than fifteen years. Keeping in view the uncommon age distribution, supplementary tests and the clinical follow-up was essential for the correct diagnosis of the lesion

Conclusion: The present case report draws attention to the fact that age can be a misleading factor and choroidal melanomas should not be over looked in young individuals