Retinoblastoma: clinical picture and grouping at the time of first presentation

To study the clinical picture and staging of retinoblastoma at the time of first presentation. This prospective study of consecutive case series was conducted in the department of ophthalmology, Dow University of Health Sciences and Civil Hospital, Karachi, from October 2007 to September 2009. Twenty patients with unilateral or bilateral retinoblastoma were examined during this period. Parents of every patient were interviewed in detail. Patients were examined under general anesthesia to measure corneal diameter, anterior chamber examination with hand held slit lamp. IOP was recorded with Perkin's tonometer; fundoscopy with indentation was performed with indirect ophthalmoscope. International intraocular classification of retinoblastoma [IICR] was used for grouping of retinoblastoma. Ultrasonography and neuroimaging were performed in all cases. Twenty patients were found to have retinoblastoma with a mean age of 3.86 years [SD=2.56] with a minimum of one year and maximum of 12 years. Out of 20 patients there were 12 [60%] male and 08 [40%] female. Thirteen [65%] were from urban and 07 patients [35%] from rural areas. Family history of retinoblastoma was positive in two patients [10%].Bilateral retinoblastoma was present in 10 patients [50%] and unilateral retinoblastoma in other 10 patients [50%].The most common clinical presentation of retinoblastoma was Leukocoria that was seen in 12 patients [60%] followed by anterior segment involvement in three patients [15%], orbital Cellulitis in three patients [15%], strabismus in one patient [5%] and phthisis bulbi in one patient [5%]. Among 10 patients with unilateral retinoblastoma 60% had group E, 20% had group D and another 20% with group C of IICR at the time of presentation. Twenty eyes of 10 patients with bilateral retinoblastoma showed group E in 13 eyes [65%], group D in four eyes [20%], group C in two eyes [10%] and group A in one eye [5%]. Leukocoria is the commonest clinical presentation of retinoblastoma. In developed countries 95% of children with retinoblastoma present with limited stage disease and are cured while in our set-up most patients still present with advanced diseases and cure rates are very low. Educational programs are required to educate general public, parents of retinoblastoma patients. Collaboration with pediatricians to check red reflex on every well baby visit is mandatory for early diagnosis

Presentation of amblyopia at a tertiary care hospital in Karachi

To study the type and density of amblyopia in children visiting pediatric ophthalmology and strabismus unit in the department of ophthalmology at Civil Hospital Karachi. This prospective study was conducted in pediatric ophthalmology and strabismus unit of department of ophthalmology Civil Hospital Karachi, from June 2009 to May 2010. All children under 15 years of age diagnosed with different types of amblyopia underwent standard procedure of orthoptic assessment and were divided into four pediatric age groups. Statistical analysis by simple descriptive analysis was carried out. During the study period, 239 patients were diagnosed with different types of amblyopia including 128 [53.55%] cases with refractive amblyopia, 58 [24.26%] cases with strabismic amblyopia and 53 [22.17%] cases with deprivation amblyopia. Severe amblyopia was seen in 59 [24.68%] cases with refractive errors, 25 [10.46%] cases with strabismus while all 53 [22.17%] cases with deprivation amblyopia had severe density of amblyopia. Amblyopia is a common cause of visual impairment in pediatric age group. Refractive amblyopia is the most frequent type while children with stimulus deprivation have higher chances of having severe density amblyopia. Children with amblyopia should be diagnosed at an early age for successful treatment. An effective screening program for early diagnosis and prompt treatment is recommended to prevent our future generation from visual impairment

Frequency of different types of paediatric ocular trauma attending a tertiary care paediatric ophthalmology department

To assess the etiological factors and circumstances associated with the occurrence of eye injuries in children attending a tertiary care pediatric ophthalmology department. This study was conducted at the Department of Pediatric Ophthalmology, Civil Hospital, Karachi from August 2007 to July 2009. Personal information, clinical findings and management plan was recorded on a prescribed performa. Variables studied included: age, sex, date of injury, place of injury, involved eye, circumstance and mechanism of injury, initial visual acuity and immediate management. A total of 462 patients under the age of 16 years presented with ocular trauma. There were 297[64.3%] males and 165[35.7%] females. Mean age was 7.03 +/- 3.61 years. Most cases 198 [42.9%] belonged to the schoolgoing age group [6 to 11years]. The injuries occurred most frequently at home [215 patients, 46.5%].Blunt trauma occurred in 228[49.4%] cases followed by penetrating in 162[35.1%] cases. Injuries restricted to the eyelid occurred in 61 [13.2%] accidents, closed globe injury occurred in 338 [73.1%] and open globe injury in 63 [13.7%] accidents. Visual acuity was better than 6/12 in 245 [53.0%] children. Two hundred and fifteen children [46.5%] were prescribed only general measures like pressure patching, warm or cold compresses antibiotics or lubricant eye drops. Surgical management was required in 121[26.2%] patients. This study has shown frequencies of different type of ocular trauma which can be minimized by taking preventive measures as adopted in developed countries

Prevalence of diabetic retinopathy and influence factors among newly diagnosed diabetics in rural and urban areas of Pakistan: data analysis from the Pakistan national blindness and visual impairment surgery 2003

To estimate the prevalence of diabetic retinopathy among newly diagnosed adult diabetics from the data set of Pakistan National Blindness survey 2003. We analyzed the data collected from the Pakistan National Blindness Survey, a population based survey with regards to diabetic retinopathy and its risk factors. Descriptive information for each of the variable was derived and distribution was assessed by simple tabulation and cross tabulation. We used Odds Ratio [using Mantel-Haenszel technique] and 95% confidence interval to assess association between the variables. Among the 16507 subjects [95.3% response rate] 660 [4%] were found to be diabetic. Out of these, one hundred one [15.3%] had diabetic retinopathy. We found a low prevalence of diabetic retinopathy [0.6%] among the subjects aged 30 and above. The risk of diabetic retinopathy was higher in urban diabetic subjects [OR 2.7, with 95% CI 1.08-4.1] as compared to rural areas of Sindh. In addition it was higher in hypertensive [OR 2.77 with 95% CI 1.0-4.1] and in obese [OR 2.2 with 95% CI 1.7-4.2] as compared to subjects with normal body mass index [BMI]. The prevalence of blindness in diabetic subjects was 5.9%. There were three hundred forty four [52%] subjects with diabetes with normal vision, 149[22%] subjects were with moderate visual impairment, thirty six [5.9%] subjects were blind and twenty two [3.3%] subjects were with severe visual impairment. About 214 diabetics have hypertension [32.4%], one hundred forty one [21.3%] diabetics are obese. Our study data suggests lower prevalence of Diabetic Retinopathy as compared to other part of the region. There is great need to collect and monitor epidemiological data at district hospital level in order to develop a national annual retinal screening program for diabetic patients in Pakistan