Frequency and Risk Factors of Diabetic Retinopathy among Patients with Type 2 Diabetes Mellitus: A Single-Center Study from Bangladesh.

Diabetic retinopathy (DR) is the most frequent microvascular complication of diabetes mellitus (DM). DR remains a leading cause of blindness, currently accounting for 4.8% of the world's 37 million blindness cases. DR is one of the critical preventable causes of blindness. In Bangladesh, the number of studies reporting the prevalence and risk factors of DR in type 2 DM (T2DM) is limited. We conducted this cross-sectional study in a tertiary hospital in Bangladesh from March 2017 to August 2019 among 200 patients with T2DM for the presence and severity of DR by using color fundus photography in a dilated pupil. The diagnosis and grading of DR were made using the Early Treatment of Diabetic Retinopathy Study (ETDRS) Chart. Out of 200 subjects with T2DM, 35.5% had DR; the frequencies of NPDR and PDR were 19.0% and 16.5%, respectively. The mean age, diabetes duration, FPG, HbA1c, TG, TC, LDL-C, and serum creatinine were statistically higher, and eGFR was lower in the study subjects with DR than those without DR; BMI and HDL-C were indifferent in the two groups. The frequencies of males, subjects having monthly income of 10,000 Bangladeshi Taka (BDT) or more, smokers, hypertensives, and subjects having uncontrolled diabetes (HbA1c ≥7%), were higher in the DR group than the no DR group. Higher age (≥50 years), higher monthly income (≥10,000 BDT), urban residence, smoking, uncontrolled diabetes, and high LDL-C (≥100mg/dL) were found to be independent risk factors of DR in the study subjects. A large-scale nationwide study is needed to find out the actual prevalence of DR in Bangladesh.

Susac Syndrome: A Rare Case Report.

Susac syndrome is a rare autoimmune disease, which is characterized by microangiopathic changes that affects the brain, retina and cochlea. A 60-years-old female Muslim housewife, hypertensive, non-diabetic patient was admitted into Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh on 18 December 2017 presented with the complains of gross dimness of vision of left eye for 10 years, vitiligo over the whole body for 5years,hearing loss with tinnitus in both ear for one year. Fluoresce in fundus angiography of Left eye shows Central retinal artery occlusion & was treated by Pan retinal photocoagulation in left eye, Magnetic resonance image of brain shows hyper intense lesions in periventricular white matter & corpus callosum, pure tone audiometry shows bilateral sensorineural type of hearing loss. Early diagnosis and early initiation of treatment is important in reducing the permanent disability.

Sympathetic Ophthalmitis: A Rare Case Report.

Sympathetic ophthalmitis (SO) is defined as bilateral granulomatous panuveitis occurring after penetrating ocular trauma or intraocular surgery. It is now rare due to micro-surgical repair of ocular injury and use of steroid. An 18 years old boy admitted into Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh, Bangladesh on 2nd March 2018. He got penetrating corneal injury in R/E with sharp pointed object 01 month back. It was conservatively managed but his right eye became phthisical. After 04 weeks his left eye was affected in which VA became 3/60, features of panuveitis developed. It was managed with high dose steroid and immunomodulatory drug (Azathioprine). Ultimately his vision of left eye is fully preserved (6/6). So, after a trauma or surgery to one eye, another eye should be meticulously examined and followed up. Early diagnosis and prompt treatment of Sympathetic Ophthalmitis may prevent from blindness.

Outcome of Transcanalicular Endolaser and External Dacryocystorhinostomy in Chronic Dacryocystitis.

Nasolacrimal duct obstruction due to chronic dacryocystitis is the most common cause of epiphora. Dacryocystorhinostomy (DCR) is the treatment of choice for chronic dacryocystitis. This can be carried out by external, endoscopic and endolaser surgical approach. Though external DCR is still a gold standard and most popular method, the latest procedure of less traumatic DCR is transcanalicular approach. The study was done to evaluate the outcome of Transcanalicular Endolaser DCR regarding epiphora and surgery related complications by measuring anatomical success rate (patency assessed by irrigation), functional success rate (symptom free) and complication rate and to compare with External DCR (Ext-DCR). This prospective interventional study was conducted from October 2011 to September 2012 in Ophthalmology department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Total 62 patients included in the study as per inclusion and exclusion criteria of them 31 for TCEL-DCR and 31 for Ext-DCR. But during follow-up one patient was dropped from each group and finally outcome of 30 patients analyzed in each group. Mean age of the patients TCEL-DCR was 38.3±11.54 and of Ext-DCR was 38.4±14.01. In both groups females were the most sufferer (female: male = 1.5: 1). Functional and anatomical success rate of TCEL-DCR showed 93.3% and 83.3% after 3 months; 83.3% and 76.7% after 6 months respectively. Statistically non-significant difference was observed about success rate in comparison between groups. Per-operative complications were pain excessive bleeding. In TCEL-DCR pain complained 13.3% and excessive bleeding occurred in 3.3%. Where as in Ext-DCR pain complained 16.7% and excessive bleeding occurred in 20%; difference was statistically significant (p=0.001). Post-operative complications were bleeding and scar formation. Bleeding occurred in TCEL-DCR 6.67% and in Ext-DCR 10%. So, TCEL-DCR could be an alternative option for the treatment of chronic dacryocystitis especially for those patients who are conscious about scar formation and afraid about Ext-DCR technique.

Associations and Risk Factors of Diabetic Maculopathy.

Diabetic maculopathy is characterised by increased capillary leakage in the main retinal vessels and by alterations in the microcirculation of the macula. Maculopathy occurs frequently in type 1 and type 2 diabetic patients. Prevalence is higher in type 2 than in type 1 diabetic patients. Factors associated with the development of maculopathy are mostly unknown. As maculopathy is the main cause of vision deprivation in diabetic patients it is essential to know the associations and risk factors of diabetic maculopathy so that appropriate measures can be taken to prevent as well as treat diabetic maculopathy. We started the research work to find out the relation between diabetic maculopathy and various associated factors and risk factors for patients with diabetic retinopathy with maculopathy. This cross-sectional observational study done at the Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka & National Institute of Ophthalmology & Hospital (NIO & H), Sher-e-Bangla Nagar, Dhaka, Bangladesh from January 2006 to June 2006. In this study out of 50 patients, diabetes was controlled in 20(40%) patients and uncontrolled in 30(60%). A significant percentage of patients (40%) had elevated blood pressure. Diabetic autonomic neuropathy was observed in 24% cases and polyneuropathy was observed in 36% cases. It is evident that diabetic maculopathy has association with dyslipidaemia, abnormal renal function due to nephropathy. This study lighted on the association of diabetic maculopathy with diabetic nephropathy, cardiac abnormalities and diabetic neuropathy.

Epidemiological Aspect and common Bacterial and Fungal isolates from Suppurative Corneal Ulcer in Mymensingh Region.

This prospective study was done to find out the epidemiological factors of suppurative corneal ulcer and the common causative bacterial and fungal isolates from the, patients with suppurative corneal ulcer in secondary and tertiary level hospital at Mymensingh region. A total 100 samples of corneal scrapings were collected purposively from clinically diagnosed suppurative corneal ulcer patients from March 18, 2012 to March 17, 2013. Out of the total 100 samples, bacterial species were 29(29%) cases and the fungal spacies were 71(71%) identified by the culture in blood agar, chocolate agar and sabouraud's agar media and also by microscopic examination. The bacterial species were streptococcus pneumonae 12 cases (12%), Staphylococcus aureus 9 cases (9%), pseudomonas in 6 cases (6%), and Streptococcus pyoganes 2 cases (2%). Fungal species were aspergillus fumigatus 61 cases (61%), aspergillus niger 10 cases (10%). Out of the study populations, most of the populations were from the age group of 41 to 60 years (39 %), followed 21 to 40 years (34%) age group. Considering the sex, male were 67%, female were 33%. The majority of patients came from the rural area of Mymensingh region; occupationally they were farmers (44%). Ocular trauma due to agricultural materials was the most common associated factor (71%). The etiological and epidemiological pattern of suppurative corneal ulcer varies significantly with geographical region, patient population and health of the cornea. The present study was carried out to explore the epidemiological pattern, causative bacterial and fungal specie by laboratory procedure from corneal scraping and to invent a prospective guide line for the management of corneal ulcer in the community.

Nasal glioma in a six month old girl.

Congenital midline frontonasal swellings are rare condition and nasal glioma accounts for 5% of these abnormality. Nasal gliomas are benign tumours results from embryonic developmental error. Although it is a rare tumour but clinically it has some differential diagnoses. Most common are dermoid tumour, nasal glioma and nasal encephalocele. About 15-20% cases nasal glioma have a fibrous stalk that connecting to the central nervous system. Multidisciplinary approach is needed for proper diagnosis and to prevent life threatening intracranial complication. We present a case of nasal glioma in a 6 months old girl presented with a congenital swelling on the left lateral side of the nose with complaints of watering from the eye of same side.

Thelazia callipaeda infestation in Bangladesh: a case report.

A 5 years old girl was admitted to Ophthalmology department of Mymensingh Medical College Hospital, Mymensingh with excessive watering, redness and movement of something in her right eye for last 2 months. She had unaided visual acuity- 6/6, matted eye lashes and mucoid discharge in right eye. Follicles were present on the fornices and lower palpebral conjunctiva of the same eye. On eversion of the right upper lid there were silicon tube like coiled moving structures seen at the lateral part of the upper fornics. Six nematodes were seen in the upper fornics around the duct of lacrimal glands. After removing the nematodes, one specimen was sent to parasitology department of Bangladesh Agriculture University for species identification. They reported that sending specimen is an adult "Thelazia Callipaeda". By the present study, the presence of human ocular T. callipaeda infestation is second reported case in Bangladesh. Ophthalmologists should be aware about parasitic infestation of conjunctiva.

Morning glory syndrome.

A 20 years young boy came from Sherpur was admitted in the Department of Ophthalmology, Mymensingh Medical College Hospital, Mymensingh on 10th December 2011 with the complaints of dimness of vision of right eye since childhood. His best corrected visual acuity right eye was 6/60 and left eye was 6/6. He has no strabismus or nystagmus. Fundus examination showed right eye - large disc with funnel shaped excavation surrounded by chorioretinal disturbance, white tuft of glial tissue on central part of disc, blood vessels emerge from rim of excavation in radial pattern. By clinical examination the patient was diagnosed as morning glory syndrome.

Pattern of ocular trauma.

This prospective observational study was conducted in the department of Ophthalmology Mymensingh Medical College Hospital during the period of November, 2009 to October, 2010. Two hundred & fifty (250) patients of both sexes and all ages with ocular trauma were selected randomly for this study. A detailed history of patients, duration of trauma, relation of trauma with work, visual status prior to injury, any surgery prior to injury & patients were alcoholic or not were taken. Male patients were 190(76%) and female patients were 60(24%). Majority of patients were 11-20 years group (39.2%). Most of patients (40%) attended into hospital within 60 hours of ocular trauma. Accidental occupational trauma were more common (51.2%) and assault injury were less common (12.8%). Greater number of ocular trauma was caused by sharp objects (59.2%) and less number of ocular trauma was caused by chemical injuries (2.4%). Open globe injuries were more common (62%) than closed globe injury (38%). Visual acuity on admission between 6/60 to PL comprises highest number (64%) and also on discharge between 6/60 to PL comprises highest number of cases (50%). Most of the patients came from poor socioeconomic group (60%).

Refractive status of medical students of mymensingh medical college.

This study is done to find out the refractive status of medical students of Mymensingh Medical College (MMC), Mymensingh, Bangladesh. They are of the age of 17-19 years. This is a nonrandom purposive cross sectional study done at late part of the November 2008. Visual acuity estimation, automated refraction, streak retinoscopy, fundoscopy using +78D volk lens were done according to the need of the cases. Out of 175 students 53.14% are emmetropic and 46.86% are ametropic, ametropia is nearly equal in both sexes (male 51.22%, female 48.78%). About all students are of highest academic attainment (GPA 5). About one quarter of the ametropic students (21.61%) are not using spectacles. Simple myopia (81.70%) and myopic astigmatism (18.30%) are the types of ametropia. Out of 67 simple myopic students 56 are of bilateral involvement and 11 are of unilateral involvement. There is similarity in the distribution of sex & refractive status in between general population & medical students of Bangladesh. Myopia and myopic astigmatism are prevalent among medical students.

Pattern of ocular trauma admitted in a tertiary hospital.

Ocular trauma is an important cause of ocular morbidity. This prospective study was conducted to identify primarily the population at risk, sources of eye injuries and the common barriers for their early management. Cases were selected randomly during the period Aug/2006 to March/2008 among the patients admitted in the department of ophthalmology, Mymensingh Medical College Hospital, with the history of ocular injury. A total of 100 eyes in 97 patients were included in the study. Age ranges were 1.5 years to 75 years. Male were 78.35% (n=76) & female were 21.65% (n=21). 56.00% (n=56) injuries were accidental occupational injuries. Common sources of eye injury included sharp objects used in occupational activities 43% (n=43), blunt objects 23% (n=23), Chemicals 7% (n=7), Projectile objects 8%, (n=8), Bird-beak 5% (n=5), agricultural trauma 3% (n=3) and miscellaneous 11% (n=11). Young adult males engaged in industrial, mechanical, agricultural or domestic works are at particular risk for ophthalmic trauma. Poverty, ignorance, indigenous treatment, remote communications and lack of supervised and collaborative management seems to be the possible barriers for the early management of ocular injuries. Preventive measures are recommended to adopt not only in the workplaces but also in domestic, recreational, sports and transport settings.

Histomorphological study of lymphoid follicle of vermiform appendix.

The study was done to find out the number of lymphoid follicle of vermiform appendix in Bangladeshi people and to increase the knowledge regarding variational anatomy in our population. Total 40 fresh appendixes were collected for histological study of different age and sex during postmortem examination in the autopsy laboratory of Forensic department of Mymensingh Medical College. This cross sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the number of lymphoid follicle of vermiform appendix in relation to age and sex, findings were classified in four groups, up to 20 years, 21 to 35 years, 36 to 55 years and 56 to 70 years. In the present study the number of lymphoid follicle were highest in group A, mean were (5.40+/-1.30) and lowest in group D where mean were (1.05+/-0.35). In male mean were 3.16 and in female mean were 2.86. Diameter of the lymphoid follicle in group A was highest (40.14+/-2.66) and lowest in group D (0.24+/-1.35). Number of germinal centre are highest in group B (2.20 +/- 0.45) and lowest in group D (0.00 +/- 0.00).

Optic nerve avulsion following accidental penetrating orbital injury.

Traumatic enucleation with optic nerve avulsion following accidental penetrating orbital injury is a rare phenomenon. A 35 years old young active man was suddenly traumatized in his left orbit after falling down on a boat following collision of two running boats having no search light in a dark night. The patient was examined few hours after the event. The patient presented with severe pain around left periorbital region. He never lost consciousness. On examination right eye revealed no abnormality. There was left periorbital swelling with blood clots. Left eyeball was hanging from the orbit with 20mm portion of optic nerve. Left eyeball was suspended with the attachment of superior oblique, superior rectus, inferior rectus, lateral rectus muscle. Medial rectus was lacerated and could not be traced out. One V shaped lacerated injury over the root of left side of nose was noted. One arm of the injury caused full thickness laceration of upper lid and other arm entered within orbit with medial bony orbital wall in nasal side and periorbita with other structures in temporal side upto apex of the orbit. Another lacerated full thickness lower lid injury was also noted. This case was managed surgically by removal of the left eyeball with orbital implant. Conjunctival injury, upper and lower lid injuries were repaired after proper surgical toileting. Ocular prosthesis was given two weeks later to have a good cosmetic view. Postoperatively the patient was managed with systemic antibiotics, NSAIDS and topical antibiotics. Traumatic enucleation following accidental boat collision was not reported yet. Awareness of the passengers, strict maintenance of the navigation rules may prevent this type of hazards.

Herpes zoster ophthalmicus in an otherwise healthy 7 years child.

A 07 years otherwise healthy child, non vaccinated for chickenpox and with a history of chickenpox infection at 02 years of age presented with red colored lesions in right upper lid, right side of forehead, vertex and right side of nose and defective vision in right eye in Mymensingh Medical College Hospital, 20 days after the appearance of blister in the same region. On examination granulation tissue was present on the same area. There was no hair and skin over that area. Lesion was strictly limited to right side of midline. Eyelashes of right upper lid were absent and there was defective closure of eyelids. Best corrected visual acuity of right eye was 3/60 and of left eye was 6/6. There was ciliary congestion of right eye with haziness of cornea at interpalpebral region of right eye. Corneal sensitivity was reduced and there was uniform fluorescein staining at central part of cornea. Mild flare and cells were present in anterior chamber. Fundus examination revealed no abnormality. He was treated with systemic acyclovir, antibiotics, topical acyclovir, antibiotic and atropine. Corneal ulcer and skin lesions were healed, but the patient developed cicatricial ectropion of right upper lid and best corrected visual acuity of right eye was reduced to 6/60 due to corneal opacity. So early diagnosis and treatment of herpes zoster ophthalmicus is mandatory to prevent sight threatening complications.