Journal of National Institute of Ophthalmology

A Comparative Evaluation of Corneal Endothelium between Diabetic & Non-Diabetic Patients Undergoing Phacoemulsification in a Tertiary Hospital

2023-06-08T07:43:33+00:00

Objective: To compare changes of corneal endothelium after phacoemulsification in diabetic patient comparison to non-diabetic patient.

Methods: This prospective observational study was conducted over 100 patients in a tertiary hospital from 01st January to 30^th July 2020. Patients were selected purposively based on specific selection criteria. Patients were allocated into two groups: Group-I: cataract patient without diabetes mellitus and Group-II: cataract patient with diabetes mellitus. Selected patients underwent detailed ophthalmic and systemic examination as well as relevant laboratory investigation. Phacoemulsification was done in every patient by a single experienced surgeon under local anesthesia. Patients were evaluated pre-operatively, 7^th POD and after one month post-operatively. In each visit, visual acuity, endothelial cell count, endothelial hexagonality, cell variability and central corneal thickness were recorded. All the relevant data were recorded in a pre-designed data collection sheet.

Results: The mean age of patients in group I and II were 54.40+3.22(SD) and 54.86+3.07(SD) years respectively. In group I, 29 (58%) were male and 21(42%) were female whereas in group II, 33 (66%) were male and 17(34%) were female. In Group-I, visual acuity in preoperative period, 7th POD and after one month were 0.734, 0.232 and 0.148 respectively and in Group-II, preoperatively, 7^th POD and after one month were - 0.730, 0.260 and 0.148 respectively. In group I, Endothelial cell count per square millimeter in preoperative, 7^th POD and after one month were- 2681.76, 2543.62 and 2518.68 respectively and in Group-II, preoperative, 7^th POD and after one month were - 2596.62, 2378.84 and 2270.46 respectively. Hexagonality of endothelial cell count in group-I, pre-operative, 7^th POD and after one month value were 64.34, 61.08 and 59.12; in group-II, pre-operative, 7^th POD and after one month value were 63.80, 56.04 and 53.10 respectively. Cell size variability in group-I, pre-operative, 7^th POD and after one month value were 30.76, 33.96 and 35.42; in group-II, pre-operative, 7^th POD and after one month value were 29.58, 33.90 and 35.98 respectively. Central corneal thickness in group-I, pre-operative, 7th POD and after one month value were 534.04, 589.12 and 560.68; in group-II, pre-operative, 7th POD and after one month value were 530.12, 630.24 and 569.94 respectively.

Conclusion: By analyzing the results and findings, it may be concluded that corneal endothelium was greatly changed after phacoemulsification in diabetic patient in compare to non-diabetic patient.

J. Natl. Inst. Ophthalmol. 2022; 5(2):9-15

Consequences of Sclera-fixated Intraocular Lens (SFIOL) Implantation after 1 Year Follow Up

2023-06-08T07:43:34+00:00

Purpose: To evaluate the consequences of sclera-fixated intraocular lens (SFIOL) after one year of implantation surgery.

Methods: This observational study was conducted among 50 patients at the National Institute of Ophthalmology and Hospital (NIOH), Dhaka, from June 2021 to December 2021. The study population was taken among patients whose SFIOL surgeries were performed in the Department of vitreo retina. The sampling method was purposive sampling. Variables were age, gender, best corrected visual acuity (BCVA), lens status, etiological factor, history of pars plana vitrectomy, and post-operative complications. All examinations were done accordingly, and collected data were correctly recorded. Ethical principles were followed.

Results: The mean age was 54±18.3 years where 72% of cases were male. Aphakia was present in 64% of patients, 14% of patients had pseudophakia, and 22% were phakic. Among the patients, 78% had a history of complications due to cataract surgery and 18% suffered from trauma. Both anterior and pars plana vitrectomy were done to 46% of patients, and 54% had been treated only with anterior vitrectomy. In this study, mean BCVA was 1.4±0.5 during admission, 0.8±0.3 during discharge, 0.5±0.3 after one month and 0.3±0.2 after one year. After one year, BCVA significantly decreased from admission (p=0.001). Post-operative complications were found in 6% of cases.

Conclusion: After SFIOL implantation, significant visual improvement appeared. It's a sight-saving process that gives patients better visual acuity.

J. Natl. Inst. Ophthalmol. 2022; 5(2):16-20

Association of Serum IgE with Keratoconus

2023-06-08T07:55:00+00:00

Purpose: Keratoconus is an ectatic corneal disease characterized by regional thinning and protrusion that leads to irregular astigmatism and, ultimately, substantial vision impairment. The aim of this study was to see if there was a link between serum IgE levels and keratoconus.

Methods: At the Combined Military Hospital Dhaka, a prospective observational study was conducted in the general Eye OPD and Cornea clinic. The study involved 60 participants who were divided into 2 groups. Thirty people with keratoconus were assigned to Group A, while 30 healthy people were assigned to Group B. All 60 patients had their serum IgE levels checked.

Results: The mean age of the study subjects in Group A and group B were 19.60±5.28 (SD), and 20.23±5.62 (SD) respectively; 13 were male and 17 were female in Group-A, and 10 were male and 20 were female in Group-B. Serum IgE was 243.183±143.059 (SD) in group-A and 86.067±77.065 (SD) in group-B. There was a significant rise in serum IgE in Group-A (p value <0.0001).

Conclusion: Elevated serum IgE levels are strongly associated with keratoconus. Measuring serum IgE could be an important parameter in the management of Keratoconus.

J. Natl. Inst. Ophthalmol. 2022; 5(2):21-24

Changes in Visual Acuity and Keratometry Readings following Pterygium Excision: A Study in A Public Medical College Hospital

2023-06-08T07:43:36+00:00

Introduction: Pterygium is a degenerative, triangular wing shaped, fibro vascular connective tissue of bulbar conjunctiva towards and onto the cornea, leading to significant astigmatism. It is a common ophthalmic condition of tropical and sub-tropical country like Bangladesh where there is dry sunny hot dusty climate.

Purpose: To find out the change in visual acuity and keratomety before and after pterygium excision and effect of different grades of pterygium on the final outcome.

Methods: This prospective study was carried out from March 2021 to December 2021 at Ophthalmolgy Department, Sher-E-Bangla Medical College & Hospital, Barishal. Total 68 patients with different grades of pterygium were operated for pterygium excision with conjunctival autograft and were studied and analyzed. All the eyes underwent detailed ocular examination like visual acuity measured by Snellen’s chart; refractive astigmatism measured by automated keratometry and slit lamp biomicroscopy and fundus examination.

Results: Pterygium is more common in males (61.76%) than females (38.23%) where 45.59% cases were in age group of 31-40 years followed by 33.82% in 41-50 years and rare (2.94%) in more than 60 years; so, 86.76% cases are in the age group of 31-60 years. Preoperatively mean±SD of K1 (Horizontal meridian) was 42.428±1.853 D and 3 month after the surgery it was 42.061±0.563 D. On the other hand mean±SD of K2 (vertical) readings before surgical excision were 44.185± 0.871 D and postoperatively after 3 months it was 42.691±0.384 D. Pre and post-operative BCVA in Grade I pterygium cases were 6/6-6/9 both pre & post -operatively. In patients of Grade II preoperative VA was 6/18-6/36 which was postoperatively 6/12-6/18; in Grade III pre and postoperative VA was 6/24-6/36 and 6/12-6/18 respectively. While in Grade IV pterygium VA were 6/36-6/60 preoperatively and 6/18-6/24 postoperatively.

Conclusion: We conclude that, the greater the grade of pterygium the lesser is the outcome of visual acuity after surgery; the greater was the change in keratometry reading. It was inferred that, timely and appropriate surgery at Grade II & Grade III can result in not only a good visual outcome but also less complications.

J. Natl. Inst. Ophthalmol. 2022; 5(2):25-30

Topographic Pattern of Keratoconus patient at First Presentation in Tertiary Eye Hospital of Bangladesh

2023-06-08T07:43:38+00:00

Objective: To evaluate the topographic pattern of keratoconus patient at first presentation in a tertiary eye hospital of Bangladesh.

Methods: This was a cross sectional study conducted over 200 eyes of 100 keratoconus patients attending at National Institute of Ophthalmology & Hospital, Dhaka, for a period of 6 months. Selected patients underwent detail history, ocular and systemic examination as well as related investigations which includes corneal topography, keratometry and auto refractometry.

Results: Mean age of the patients was 21.24 ± 6.25(SD) years and among the patients male predominance was observed, male to female ratio was 2.1:1. The mean unaided visual acuity of better eye was 0.86 ± 0.38(SD) Log MAR and mean unaided visual acuity of worse eye was 1.16 ± 0.44 Log MAR. Among 200 eyes there were 36 mild (18.0%), 100 moderate (50.0%) and 64 severe (32.0%) keratoconus eyes. Majority of the eyes (81.0%) showed three common topographic pattern, these are asymmetric bowtie with skewed axis (32.0%), asymmetric bowtie with inferior steepening (30.0%) and inferior steepening (19.0%). In mild keratoconus patients topography showed largely one pattern, inferior steepening (30.6% of mild keratoconus). In case of moderate keratoconus patients topography shows mainly three patterns, asymmetrical bowtie with skewed axis (19.0%), asymmetric bowtie with inferior steepening (16.5%) and inferior steepening (10.5%). In severe keratoconus patients topography shows mainly three patterns, asymmetrical bowtie with inferior steepening (10.5%), asymmetric bowtie with skewed axis (9.5%) and irregular pattern (8.5%). There was no round, superior steepening, symmetric bowtie or asymmetric bowtie with superior steepening pattern in severe keratoconus.

Conclusion: The pattern of topography varies among the different stages of keratoconus patients. From the topography pattern we can diagnose the keratoconus early and also get the information of severity of the disease and treat accordingly.

J. Natl. Inst. Ophthalmol. 2022; 5(2):31-36

Efficacy of Topical Difluprednate in Control of Inflammation after Phacoemulsification

2023-06-08T07:43:39+00:00

Objective: To study the efficacy of topical Difluprednate 0.05% ophthalmic emulsions in control of post-operative inflammation following phacoemulsification.

Methods: This randomized control study included hundred diagnosed cases of age-related cataract who visited at the National institute of Ophthalmology and Hospital in Bangladesh over one year period. The patients were divided into two groups –Difluprednate group and Prednisolone group. The post-operative grades of inflammation following phacoemulsification were assessed by slit-lamp examination.

Results: In the present study, majority of the patients were in age group of 55 to 65 years. Male: female ratio in Dfluprednate group was 29:21 and in Prednisolone group was 35:15. Anterior chamber flare and cells was seen in 52% of patients in Prednisolone group and in 56% of patients in the Difluprednate group by day 07, which regressed to mild (1-3) in both the groups by day 28. On day 42, the cells and flair were reduced to 4% in Difluprednate group and 8% at Prednisolon group. When the total scoring of all these parameters were compared, in Prednisolone group 34% of the patients persisted with mild (Grade1-3) inflammation on Day 28 as compared with 26% of the patients in Difluprednate group.

Conclusion: Both Difluprednate Ophthalmic Emulsion 0.05% eye drops and Prednisolone Acetate 1% eye drops were equally effective in reducing the inflammation following uncomplicated phacoemulsification. With proven efficacy of Difluprednate, we now have a new standard for potency in a topical corticosteroid, with excellent anti-inflammatory properties and an ideal formulation for our patients.

J. Natl. Inst. Ophthalmol. 2022; 5(2):37-41

Chloroquine Induced Retinal Toxicity- A Case Report

2023-06-08T07:43:40+00:00

Chloroquine (CQ) and hydroxychloroquine (HCQ) is used increasingly in the management of variety of autoimmune disorders with well-established role in dermatology, rheumatology, and oncology. Retinopathy in the form of maculopathy occurs due to long term use of CQ or HCQ in large dose, have been associated with irreversible visual loss. A middle aged diabetic patient had been complaining of profound dimness of vision following uncomplicated cataract surgery on both eyes. She had a very good vision (6/6) in both eyes which reduced to 6/60 and 5/60 in right and left eye respectively. Colour fundus photography (CFP), Visual field analysis (VFA), Optical coherence tomography (OCT) and Fundus fluorescein angiography (FFA) revealed the changes consistent with “bulls’ eye maculopathy”. Treatment was unsatisfactory with antioxidant and neuro vitamin.

J. Natl. Inst. Ophthalmol. 2022; 5(2):42-44

Orbital lymphatic-venous malformation: A Review on the Management Strategies

2023-06-08T07:43:42+00:00

Still, there is no ideal guideline for managing orbital lymphatic-venous malformations. Significant advances have been made in the treatment of lymphatic-venous malformation. Here, we attempt to review the current and recent evidence on management strategies, including sclerotherapy agents, systemic medications, and techniques. The orbital lymphatic-venous malformation is notorious for being very difficult to treat due to risks of morbidity, loss of vision and periocular disfigurement. Management depends on lymphangioma size, cyst type, and location. One option is carefully watching patients without doing any treatment (Observation). The option of surgery has typically been delayed until necessary because of the high recurrence rate, a high risk of morbidity because of injury to the globe, extraocular muscles, vessels, and optic nerve, and it is difficult to remove the entire lesion. Sclerotherapy is famous for reducing the size of orbital lymphangioma. Systemic medication can reduce the size and improve the clinical symptoms where the lesions are difficult to access surgically or with injections. These treatment modalities aim to reduce the size of the lesions, and cosmetic disfigurement and free from pain caused by these lesions, also avoid vision_threatening complications.

J. Natl. Inst. Ophthalmol. 2022; 5(2):45-51

Journal of National Institute of Ophthalmology – thinking towards the advancement in ophthalmic practice

2023-06-08T07:43:32+00:00

Abstract not available

J. Natl. Inst. Ophthalmol. 2022; 5(2):8