Optical coherence tomography: clinical applications in medical practice

Optical Coherence Tomography [OCT] is a success story of scientific and technological co-operation between a physicist and a clinician. The concept of cross-sectional imaging revolutionalized the applicability of OCT in the medical profession. OCT is a non-contact, topographic, biomicroscopic device that provides high resolution, cross-sectional digital images of live biological tissues in vivo and in real time. OCT is based on the property of tissues to reflect and backscatter light involving low-coherence interferometry. The spatial resolution of as little as 3 microns or even less has allowed us to study tissues almost at a cellular level. Overall, OCT is an invaluable adjunct in the diagnosis and follow up of many diseases of both anterior and posterior segments of the eye, primarily or secondary to systemic diseases. The digitalization and advanced software has made it possible to store and retrieve huge patient data for patient services, clinical applications and academic research. OCT has revolutionized the sensitivity and specificity of diagnosis, follow up and response to treatment in almost all fields of clinical practice involving primary ocular pathologies and secondary ocular manifestations in systemic diseases like diabetes mellitus, hypertension, vascular and neurological diseases, thus benefitting non-ophthalmologists as well. Systemically, OCT is proving to be a helpful tool in substantiating early diagnosis in diseases like multiple sclerosis and drug induced retinopathies by detecting early changes in morphology of the retinal nerve fiber layer

Visual outcome following extracapsular cataract extraction in mature cataracts with pseudoexfoliation syndrome: a retrospective study

To report the best corrected visual acuity, at the end of one year, in 33 patients [35 eyes], who underwent extracapsular cataract extraction [ECCE] with posterior chamber intraocular lens implantation [PC-IOL] for mature and hypermature cataracts, with pseudoexfoliation [PEX]. Retrospective, non-comparative, single-institutional [Sultan Qaboos University Hospital] study. Thirty-three patients with mature and hypermature cataracts, with PEX operated upon between January 2007 and December 2008, by one surgeon [AM]. Retrospective study of thirty-three patients [35 eyes] with mature and hypermature cataracts, with ocular PEX, evaluating the visual outcome at the end of 12 months following ECCE with PC-IOL. Thirty eyes [85.71%] showed improvement in the best corrected visual acuity [BCVA] ranging from 0.2 to 1.0 Snellen lines. Four eyes [11.43%] had unchanged BCVA from the baseline. There were no intraoperative complications in any patient. One eye [2.86%] that did not improve developed retinal detachment at three months follow-up, and was referred to the Vireoretinal Unit and follow-up has been lost. Extracapsular cataract extraction is a safe and effective technique in eyes with mature and hypermature cataracts with PEX

Cerebro-rhino orbital mucormycosis: an update

Mucormycosis is an uncommon fungal infection which can lead to fulminant necrotizing infection under optimal host condition. Fungi have the ability to invade blood vessels and can affect different parts of the body. The most common, though the most aggressive, form is cerebro-rhino-orbital mucormycosis that occurs in debilitated patients, in conjunction with sinus or para-sinus involvement. Due to increased number of newly diagnosed cases of mucormycosis world-wide resulting from uncontrolled metabolic conditions, this paper intends to widen the reader's scope and knowledge about the nature of the disease and its multicomplexity that require a collaborative effort for careful management. Patients who are at risks both at the onset of the disease and during its management have been identified in the paper

Ocular adnexal reactive lymphoid hyperplasia in children

To describe the clinical and histopathological features of ocular reactive lymphoid hyperplasia in children, and review the literature regarding this entity. In this retrospective, interventional case series, a chart review was performed of three patients diagnosed with reactive lymphoid hyperplasia. Details of clinical presentation, ocular and systemic examination findings, management and subsequent course were noted. Three children, aged 9-14 years presented with ocular adnexal masses [two unilateral and one bilateral] with 7-12 months duration. Ocular examination revealed discrete nasal conjunctival masses in two patients, and bilateral eyelid fullness and conjunctival chemosis in the third patient. Systemic evaluation and laboratory tests were normal in all patients. Orbital imaging showed lacrimal gland enlargement in one patient. Histopathological evaluation with immunohistochemical markers established the diagnosis of reactive lymphoid hyperplasia. Two patients underwent surgical excision with complete resolution. All patients have remained stable and at their last follow-up have showed no evidence of recurrence, transformation, or systemic involvement. Reactive lymphoid hyperplasia, though uncommon in children, can have a favorable outcome with timely intervention

Oral propranolol for the treatment of periorbital infantile hemangioma: a preliminary report from Oman

To investigate the efficacy and safety of oral propranolol in the management of periorbital infantile hemangioma in four subjects. Consecutive patients who presented with periorbital capillary hemangioma with vision-threatening lesions were prospectively enrolled in this study between January 2009 and October 2010. All subjects underwent treatment with 2 mg/kg/day oral propranolol. All subjects underwent ocular, systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated. Four subjects, between 3 months and 19 months of age, with periorbital hemangioma were enrolled in this study. Two subjects had been previously treated with oral corticosteroids with unsatisfactory response. All subjects had severe ptosis, with the potential for deprivation amblyopia. Three subjects had orbital involvement. After hospital admission, oral propranolol was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent therapy was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of periorbital and orbital hemangioma. There were no side effects from therapy. Oral propranolol for periorbital hemangioma was effective in all the four subjects. Oral propranolol may be appropriate for patients who are nonresponsive to intralesional or systemic steroids. In patients with significant orbital involvement and lesions causing vision-threatening complications, oral propranolol can be the primary therapy

Satisfaction and perceived quality of an electronic medical record system in a tertiary hospital in Oman

To evaluate the knowledge, attitude and practice [KAP] of physicians towards the Electronic Medical Record [EMR] system. A cross-sectional survey including physicians from various clinical specialties was conducted. An existing questionnaire was adapted to assess the KAP of physicians towards the EMR system. Information was analyzed using Statistical Package for Social Sciences [SPSS] software. Out of 200 distributed questionnaires, 141 [70.5%] responses were received. Overall, only 22 physicians [15.6%] rated the current EMR system as an effective tool. A substantial proportion [29.4%] of respondents considered EMR not worth the time and effort required to use it. The majority [67.4%] reported increasing difficulty with the performance of work after applying the EMR system. The overall quality of work was perceived not to have changed [41.2% of the respondents] or declined [27.4% of the respondents]. The low satisfaction and underperformance was found to be associated with younger age [p=0.032], junior designation [p=0.041], and low familiarity with computers [p=0.047]. We report low satisfaction and perceived quality of work among physicians in our institution with the current EMR system. Inappropriate and inadequate usage of the system was found to be the main cause of the underlying poor satisfaction

Successful surgical management of optic disc pit maculopathy without internal membrane peeling

Optic disc pit is an excavation of the optic nerve head usually seen in association with other abnormalities of the optic nerve, peripapillary retina, or posterior vitreous detachment. In 50% the cases, it might be associated with serous macular detachment. The prevailing theory that explains this disorder is that subretinal fluid which is derived from liquefied vitreous passes through the optic disc pit and elevates the macula. In this study, we report a case of serous macular detachment complicating optic disc pit in a young male patient treated surgically without internal limiting membrane peeling and showed dramatic improvement of vision after 1 year

Sebaceous gland carcinoma of the eyelid

Sebaceous gland carcinoma, commonly arises in the periocular area, is an uncommon condition. It represents 1-5.5% of eyelid malignancies and is considered to be the third most common eyelid malignancy after basal cell and squamous cell carcinomas, although few reports placed this tumor as second most common after basal cell carcinoma. It usually affects elderly women and characterized by high rate of local recurrence, regional, and distant metastases. A delay in diagnosis, which can be attributed primarily to ability of this tumor to masquerade as more benign conditions, often leads to inappropriate management with increased morbidity and mortality rates. In this study, the authors discuss key elements of the primary disease and therapeutic options available to treat such devastating problem

Total levator aponeurosis resection for primary congenital ptosis with very poor levator function

This study was designed to evaluate the effectiveness of total levator aponeurosis resection in patients with very poor levator function secondary to primary congenital ptosis. A retrospective, noncomparative single-institutional study was designed. Seven patients with very poor levator function secondary to primary congenital ptosis operated between May 2008 and May 2010 by one surgeon [AM]. A retrospective study of seven patients with congenital ptosis evaluating eyelid elevation following total levator aponeurosis resection. End result is improvement of the eyelid elevation. Total levator aponeurosis resection is easy and effective tool in elevating the eyelid in patients with very poor levator function secondary to primary congenital ptosis

Functional endoscopic sinus surgery: indications and complications in the ophthalmic field

Functional Endoscopic Sinus Surgery [FESS] is a highly sophisticated type of surgery, which has revolutionized the surgical management of chronic sinus diseases. In the ophthalmic field, FESS plays a crucial role in the management of a few conditions, but not without risks. Ophthalmic complications associated with FESS are well documented. They mainly occur due to the shared common anatomic areas between ophthalmology and otolarynogology. Ophthalmic complications can vary in severity from very trivial cases such as localized hematoma collection, which is not very problematic to very devastating cases, such as optic nerve damage, which can lead to complete blindness. In order to minimize such compilations, safety measures need to be considered prior to the surgery, these include; precise knowledge of detailed anatomy, the operating surgeon's ability to interpret precisely the para nasal sinus CT scan and experienced procedural surgical skills

Bilateral coexistence of keratoconus and macular corneal dystrophy

Bilateral coexistence of keratoconus and macular corneal dystrophy is a very rare clinical entity. Further elaboration on the possible genetic, histopathologic, pathophysiologic and biochemical correlation is required to study the nature of the condition. The authors hereby report a 21-year-old female who presented with the typical signs and topographic evidence of keratoconus in association with macular corneal dystrophy. Histopathologic evaluation from the excised corneal button after corneal transplant confirmed the diagnosis. To our knowledge, there is only one previous report in the literature linking the association of keratoconus and macular corneal dystrophy in the same eye bilaterally

Bacterial keratitis: perspective on epidemiology, clinico-pathogenesis, diagnosis and treatment

Bacterial keratitis is an acute or chronic, transient or recurrent infection of the cornea with varying predilection for anatomical and topographical parts of the cornea like marginal or central. It is a potentially sight-threatening corneal infection in humans that is generally found in eyes with predisposing elements, the most common of which is contact lens wear. The epidemiological data reveals the universal occurrence of this disease. With advances in the understanding of its pathogenesis, laboratory investigations like immunohistochemistry, fluorescent microscopy, enzyme immunoassays and molecular biology, and the availability of fourth generation antibiotics, the overall visual outcome in bacterial keratitis has improved with time. Particular attention should be given to this condition as it can progress very rapidly with complete corneal destruction occurring within 24-48 hours. Early diagnosis, which is primarily clinical and substantiated largely by microbiological data, and prompt treatment are needed to minimise the possibility of permanent visual loss and reduce structural damage to the cornea

Cyanoacrylate induced pseudo-tarsorrhaphy of the eye

Cyanoacrylate, also known as superglue, is a polymer which forms a strong bond at room temperature with a variety of materials including metal, glass, plastic, rubber, skin, mucous membranes and other epithelial tissues as well. We hereby present a 22-year-old female who had an accidental instillation of the glue in her eye, with an uneventful outcome