Tumor regression patterns in retinoblastoma

Objective: To observe the types of tumor regression after treatment, and identify the common pattern of regression in our patients

Study Design: Descriptive study

Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from October 2011 to October 2014

Methodology: Children with unilateral and bilateral retinoblastoma were included in the study. Patients were referred to Pakistan Institute of Medical Sciences, Islamabad, for chemotherapy. After every cycle of chemotherapy, dilated fundus examination under anesthesia was performed to record response of the treatment. Regression patterns were recorded on RetCam II

Results: Seventy-four tumors were included in the study. Out of 74 tumors, 3 were ICRB group A tumors, 43 were ICRB group B tumors, 14 tumors belonged to ICRB group C, and remaining 14 were ICRB group D tumors. Type IV regression was seen in 39.1% [n=29] tumors, type II in 29.7% [n=22], type III in 25.6% [n=19], and type I in 5.4% [n=4]. All group A tumors [100%] showed type IV regression. Seventeen [39.5%] group B tumors showed type IV regression. In group C, 5 tumors [35.7%] showed type II regression and 5 tumors [35.7%] showed type IV regression. In group D, 6 tumors [42.9%] regressed to type II non-calcified remnants

Conclusion: The response and success of the focal and systemic treatment, as judged by the appearance of different patterns of tumor regression, varies with the ICRB grouping of the tumor

Comparison of pre-operative central corneal thickness in pediatric cataract cases versus normal

To compare the pre-operative central corneal thickness [CCT] in paediatric cataract patients with reference to normal control group. A case control study. Paediatric Ophthalmology Clinic of Al-Shifa Trust Eye Hospital [ASTEH], Rawalpindi, from November 2009 to May 2010. The study included 116 subjects with equal number of cases and controls. Demographic profile of all the subjects was noted followed by history and detailed ophthalmic examination. CCT was measured using an ultrasonic pachymeter [model Pac Scan 300]. The mean of three measurements from the central cornea were recorded in microns. Results were analyzed using SPSS version 17.0. Mean CCT values of the cases was 566.83 +/- 37.646 microns while the control group had a mean CCT of 535.81 +/- 24.466 microns. Difference between the CCT values of the two groups was highly significant [p < 0.001]. Eyes with congenital cataracts have greater CCT values as compared to normal paediatric population. This factor must be kept in mind while interpreting intra-ocular pressure in such patients

Hypermetropia as a presentation of diffuse choroidal haemangioma in Sturge-Weber syndrome

A 16 years old male patient of Sturge-Weber syndrome was referred to glaucoma clinic for the management of unilateral glaucoma. There was also an ipsilateral hypermetropic shift. On detailed investigations, a diffuse choroidal haemangioma was diagnosed which induced this hypermetropic shift. Anisometropia in Sturge-Weber syndrome can give us clue regarding some underlying pathology, so unilateral myopia or hypermetropia should be thoroughly evaluated in such patients

Clinical presentation and staging of newly diagnosed intraocular retinoblastoma according to international classification of retinoblastoma

To report the clinical presentation and stage of the disease in newly diagnosed retinoblastoma cases at Al-Shifa Trust Eye Hospital Rawalpindi according to International Classification of Retinoblastoma. A hospital based prospective descriptive study. Clinical data of presentation and staging of cases diagnosed with primary retinoblastoma from January 2009 to June 2011 was collected. All patients underwent an examination under anaesthesia including fundus examination by indirect ophthalmoscopy with 360 degrees indentation, ultrasound and RetCam photographs to document the location and size of the tumours, the presence and extent of vitreous and subretinal seedings and subretinal fluid. An oncologist performed the metastatic workup. All the eyes were then classified according to the Reese-Ellsworth classification and International classification of retinoblastoma [IIRC]. Treatment methods included chemoreduction, focal therapy [transpupillary thermotherapy and cryotherapy], enucleation and exenteration in rare cases with extra ocular extension. 72 eyes of 51 patients with primary retinoblastoma were diagnosed during this period. Thirty patients [58.8%] had unilateral retinoblastoma and 21 patients [41.2%] had bilateral retinoblastoma. Thirty four [66.6%] patients presented with leukocoria. The disease in 32 [62.74%] patients was classified in group E. Majority of the patients presented with advanced disease manifesting as leukocoria and were staged in group E

Risk factors for early posterior capsule opacification after cataract surgery

To determine risk factors for early posterior capsule opacification [PCO] following cataract surgery. Case-Control study. Patients developing PCO within and after 12 months of cataract extraction were selected as cases [early PCO] and controls [late PCO] respectively. PCO [central/ peripheral] was diagnosed by clinical examination with slit lamp biomicroscope under pupillary dilation. Operation notes were also reviewed from the hospital record. Risk factors including age of patient, surgical procedure, intraocular lens material, anterior capsulotomy/ capsulorhexis, duration since operated and experience of surgeon were observed. The study population was 146 patients, 73 in each group. There were 84 male and 62 female patients with mean age 59.33years + 15.76 SD. The study revealed significant risk of early PCO in patients who underwent standard ECCE versus Phacoemulsification [p value 0.000], PMMA vs. Acrylic IOLs [p 0.000], and can-opener capsulotomy vs. Continuous curvilinear capsulorhexis [p 0.001]. Experience of surgeon was not related with early onset PCO[p 0.184]. Early PCO has multifactor etiology; related to surgical technique and IOL implant. Meticulous surgical technique, performed under more physiological conditions, with minimum compromise of blood aqueous barrier, thorough removal of lens matter, implantation of an acrylic IOL into capsular bag are various factors that may retard the onset of PCO. These factors are interdependent and cannot slow down the process of PCO formation independently