Journal of National Institute of Ophthalmology

Editorial Vol 5(1)

Md Shahidul Islam — Thu, 08 Dec 2022 00:00:00 +0000

Abstract not available

J. Natl. Inst.Ophthalmol.2022;5(1):8-9

Craniofacial Fibrous Dysplasiaa Rare Case Report in a Tertiary Eye Hospital

Thu, 08 Dec 2022 00:00:00 +0000

Purpose: Fibrous dysplasia (FD) is a rare fibro-osseous lesion of the osseous structures of the body. Craniofacial FD confined to contiguous bones of the craniofacial skeleton. Purpose of the study is to report such a rare case which was diagnosed and managed in the outpatient department in our tertiary eye hospital.

Method: A 12-year-old girl complaint of painless swelling over right side of eyebrow for 4 months.Facial examination revealed well-defined bony swelling rounded in shape with hard consistency, nontender; diameter 10x10 mm; overlying skin free; no regional lymphadenopathy. Visual acuity was 6/6. Anterior and posterior segment revealed normal. Ocular motility was full. No other swelling was present in body and café-au-lait spots were absent. Routine investigations such as hemogram, serum calcium and serum alkaline phosphatase (ALP) were performed. Among them ALP was raised to 300 U/L. CT scan showed a radio dense mass with ground-glass appearance involving right frontal bone whose expansion causing facial asymmetry .An incisional biopsy with histopathological analysis was done. It showed irregular bony trabeculae in chinese script pattern scattered within fibrous stroma. The bone appeared woven rather than lamellar. MRI suggest diffuse thickening of right frontal bone.

Result: Clinical history, radiographic assessment and histological features suggested that it was a case of craniofacial FD involving right side of frontal bone.

Conclusion: Detection of early suspicious sign for diagnosis and early initiation for management is crucial to prevent the long-term complication with avert the process of optic nerve compression.

J. Natl. Inst. Ophthalmol. 2022;5(1):46-50

Comparison of a Preservative-free Non-steroidal Anti-inflammatory Drug and Preservative-free Corticosteroid after Uneventful Cataract Surgery: A Randomized Control Trial

Thu, 08 Dec 2022 00:00:00 +0000

Background: Cataract is considered as a main cause of blindness around the world along with glaucoma and macular degeneration. Now, surgery remains the only effective treatment option of cataracts and cataract surgery is one of the most frequently accomplished surgeries in the field of ophthalmic arena. This study aimed to compare the effects of NSAIDs with those of steroids for the management of inflammation after uneventful cataract surgery.

Methods: This study was a prospective randomized control trial, conducted at the Department of Cataract in National Institute of Ophthalmology and Hospital, Dhaka, from 01 February 2021- 30 January 2022. A total of 194 patients were randomly allocated into two groups by lottery. The patients of NSAID group was prescribed bromfenac sodium hydrate 0.1% to apply two times a day in 1 eye, whereas the steroid group was treated with Dexamethasone 0.1%, 4 times per day for 4 weeks after the surgery.

Results: The mean age of the patients in NSAID and steroid group were 71.10 (± 8.55) years and 72.09 (± 8.64) years respectively. The male female ratio of each group was 33:64. The change in inflammation grade of the anterior from postoperative day 1 to week 8 in the NSAID group was -1.25 ± 1.30 and in the steroid group -1.25 ± 1.32 which shows a significant reduction in both eyes (p <0.001). Comparing the changes from preoperative to week 1 and preoperative to week 8 showed central corneal thickness in the NSAID group was also significantly less than that in the steroid group (8.87 ± 22.46 and 29.48± 46.60 vs. 4.74 ± 31.75 and 8.76 ± 40.95 mm) (p<0.05). Comparing the changes from postoperatively to week 1 and postoperatively to week 8, the NSAID group had lower conjunctival hyperemia -0.09± 0.53 and -0.19 ± 0.54 vs. the steroid group had higher conjunctival hyperemia 0.08 ± 0.64 and -0.20 ± 0.53.

Conclusion: NSAIDs like nepafenac 0.1%, bromfenac 0.09%, and ketorolac 0.5% are proven to be a good alternative to steroids which has a corresponding level of anti-inflammatory activity like Dexamethasone 0.1% for controlling postoperative ocular inflammation among patients going through cataract surgery.

J. Natl. Inst. Ophthalmol. 2022;5(1):10-15

Pattern of Ocular Myasthenia Gravis in a Tertiary Eye Care Hospital, Bangladesh

Thu, 08 Dec 2022 00:00:00 +0000

Purpose: The purpose of this study was to evaluate pattern of ocular myasthenia gravis patients in a tertiary eye care hospital in Bangladesh.

Methodology: This observational study was conducted in National Institute of Ophthalmology and Hospital (NIOH), Dhaka from January 2019 to December 2019. A total of 33 cases were purposively selected among ocular myasthenia gravis patients attending in the Department of neuro ophthalmology of NIOH irrespective of age, gender, residence. Study variables wereage, gender, clinical features, presence of thymoma, clinical, pharmacological and serological test findings. A proforma was prepared to record the data on particulars of the patients.

Results: Among the cases, 45.5% were male and 54.5% were female where the mean age was 38.7 years. All patients presented with ptosis (100.0%) and most of them had fatigability(87.9%), cogan twice sign (81.8%) andorbicularis weakness (81.8%) while 63.6% had diplopia. Diabetes mellitus was observed in 18.2%patients and 15.1% had thyroid associations. Most of them had positive ice test(87.9%), 51.5% had positive serological test and 6.1% had positive neostigmine test. Thymoma was present in 6.1% cases.

Conclusion: Ptosis was the most common clinical presentation for ocular myasthenia. Clinical diagnosis was confirmed by ice pack test and neostigmine test. Ocular myasthenia gravis patients may be have other systemic diseases.

J. Natl. Inst. Ophthalmol. 2022;5(1):16-20

Incidence of the Oculocardiac Reflex using Isoflurane & Halothane during Enucleation Surgery under General Anaesthesia at NIO&H - A Comparative Study

Thu, 08 Dec 2022 00:00:00 +0000

Background: The Oculocardiac reflex (OCR) is a well-known complication of ocular surgery involving direct or indirect manipulation of the eye or ocular adnexa. While most commonly associated with eye muscle surgery, with a reported incidence of 40-93%, it is prevalent during traction on the extraocular or eyelid muscles, compression of the globe, intraocular and retro bulbar injection, iris traction, retinal reattachment surgery and enucleation procedures and may manifest as a wide range of arrhythmias including ventricular bigeminy, bradycardia and asystole. Occurrence of the reflex in eye muscle surgery has been documented to increase with hypoxia and decrease with aging and premedication with anticholinergics, namely glycopyrrolate or atropine.

Objective: The purpose of our study was to determine the degree of change in heart rate (HR) and systolic blood pressure (SBP) during Enucleation surgery in patients anaesthetized with equipotent concentrations of Isoflurane or Halothane breathing via a laryngeal mask airway (LMA).

Methods: The study was designed as a prospective randomizedstudy. Fifty patients, having selected for Enucleation were randomized to Isoflurane (I) or halothane (H) in 66% nitrous oxide at 1.3 minimum alveolar concentration. Patients breathed through a laryngeal mask airway (LMA) and were not pretreated with anticholinergics.

Results: The Oculocardiac reflex (OCR), defined as a 20% decrease in heart rate (HR) from baseline, dysrhythmias or sinoatrial arrest concomitant with ocular muscle traction occurred less frequently with Isoflurane than with halothane (I: 37%, H:78%, P = 0.009). The HR during induction was higher with Isoflurane (I: 110 ± 13 bpm, H: 100 ± 15 bpm, P = 0.002). The lowest HR occurred with halothane (I: 94 ± 22 bpm, H: 72 ± 19 bpm, P = 0.001). The incidence of dysrhythmias was higher in the halothane group (I 4%, H: 42%, P = 0.004). Isoflurane may be a more suitable anaesthetic than halothane for operations involving traction on the ocular muscles with controlled respiration in patients because of reduced incidence of OCR with slightly higher airway irritability.

Conclusion: Some patients experience a sudden slowing of the heart when the surgeon pulls on the eye muscles during Enucleation operations under anaesthesia. We found that Isoflurane was associated with a lower incidence of the OCR but relatively higher airway irritability compared with halothane. The oculocardiac reflex possesses the potential for significant morbidity and mortality. While some have documented factors affecting the OCR during eye muscle surgery, our data could not prove such a relationship during enucleation.

J. Natl. Inst. Ophthalmol. 2022;5(1):21-26

Visual Outcome after Scleral Fixation of Intraocular Lens (SFIOL) Implantation Following Pars Plana Vitrectomy (PPV) and Removal of dropped Intra-Ocular Lens (IOL)

Thu, 08 Dec 2022 00:00:00 +0000

Introduction: Placement of a posterior chamber scleral fixated intraocular lens (SF-IOL) is the only option for patients whose eyes lack zonular or capsular support. Long-term data comparing the various techniques used to place scleral fixation intraocular lens (SF-IOL) will be crucial to identify optimal strategies for scleral fixation intraocular lens (SF-IOL) implantation.

Aim of the study: The aim of the study was to observe the visual outcome after SFIOL implantation following PPV in case of dropped intraocular lens.

Methods: This prospective observational study was conducted at National Institute of Ophthalmology & Hospital, Dhaka, Bangladesh. The study duration was 6 months, from August 2019 to January 2020. The study was conducted with a total of 30 patients with aphakia due to dropped intraocular lenses. The patients were selected non-randomly on a first come first serve basis.

Results: The mean age of the participants was 57.7±7.64 years and the majority (60.0%) were female with 66.67% had left eye involvement. Mean visual acuity at baseline was 1.34 ± 0.26 (SD) in the Log MAR unit, which had significant improvement at each follow-up period. After 3 months visual improvement was 0.34±0.27 in LogMAR unit. A few cases of corneal edema, raised intraocular pressure, lens decentration and some other complications were observed after surgery.

Conclusion: In most cases, a decent optical outcome may be reached by using this surgical approach. To prove that it might be a safe and effective treatment without zonular or capsular support, long-term follow-up, a large sample size, and many surgeons' involvement are required.

J. Natl. Inst. Ophthalmol. 2022;5(1):27-31

A Study on the Advanced Ophthalmic Training Program of Bangladesh

Thu, 08 Dec 2022 00:00:00 +0000

Aims: To describe the present status, strength, and weakness of the advanced ophthalmic training program in Bangladesh.

Methods: A prospective study was carried out among the ophthalmologists those who had completed their long-term advanced ophthalmic training program (fellowship) in five tertiary eye hospitals of Bangladesh. The study period was from 01 January 2020 to 30 June 2020 including first three months data collection period. A semi-structured questionnaire was supplied to the study subjects. The analysis was made based on the answer from the study subjects.

Results: The total responder was 46. The male responder was 58.7%, where the mean age of the study subjects was 33.05 years when they entered the training program. The Vitreo-retina fellows were the highest at 30.4%. Most of the fellows performed as the primary surgeon without supervision rather than surgery with supervision. Satisfied with the mentor was 91% while satisfied with hands-on work was 85% and satisfied with academic activities was 69.6%. About 21.7% of fellows did not involve any research work during the fellowship period. About 67.4% of fellows said that the central scientific session could be rearranged twice a week. However, 37% of fellows did not fulfill their logbook in the fellowship period.

Conclusion: Most of trainees had got the opportunity to do hands on work but the supervision was inadequate. The research activities were not satisfactory in the advanced training period. There was not any unique training/fellowship curriculum among all institutes.

J. Natl. Inst. Ophthalmol. 2022;5(1):32-38

Clinical Profile of Patients with Bilateral Optic Disc Swelling Attending in an Apex Eye Hospital in Bangladesh

Thu, 08 Dec 2022 00:00:00 +0000

Background: Patient with optic disc swelling demands thorough ophthalmic as well as systemic evaluation as it may reflect intraocular as well as systemic diseases. Early diagnosis and proper management of bilateral disc swelling is important, as it can save vision as well as life. This study is aimed to determine the socio-demographic and clinical profile of patients with bilateral optic disc swelling in a tertiary eye hospital of Bangladesh.

Methods: This cross sectional study had been conducted over 102 patients with bilateral disc swelling at the Neuroophthalmology clinic of National institute of ophthalmology and Hospital, Dhaka between April 2019 and March 2020. Patients were selected purposively based on specific selection criteria. Detail history was taken, ocular examinations like visual acuity, color vision, field of vision, pupillary light reaction, fundus examination were done and relevant investigations included color fundus photograph, visual field analysis, Computed tomography scans and Magnetic Resonance Imaging were performed. All the information’s were recorded in a pre-designed data collection sheet.

Results: The mean age of the patients was 30.2±10.8 years where 37.3% patients were from 18-27 year age group. Females (67.7%) were commonly presented with bilateral disc swelling than male (33.3%). Most of the patients commonly presented with the symptoms like headache (71.6%), dimness of vision (62.8%), nausea & vomiting (42.2%), ocular pain (21.6%) etc. Best corrected visual acuity of the study population was within 0-0.3 log MAR unit in the right eye in 55.9% cases and in the left eye in 59.8% cases. Majority of the patients (Right eye: 60.8%, Left eye: 63.7%) could read all plates while color vision assessment. About 20% patient had RAPD. About 17% patients had field defect in their right eyes whereas about 15% had visual filed defect in left eyes. Other than disc swelling, 14 patients had diplopia (13.7%), 12 patients had uveitis (11.8%). Out of 102 patients, 36 patients were clinically diagnosed as IIH (35.3%). Others were diagnosed as ICSOL (24.5%), bilateral optic neuritis (12.7%), VKH (12.7%), grade-IV hypertensive retinopathy (8.8%). The analysis of neuro imaging findings among the patients showed 72 patients (70.6%) had no space occupying lesions, 9 patients (8.8%) had meningioma, 6 patients had CP angle tumor (5.9%), 5 patients had empty sella (4.9%).

Conclusions: Most of the Bangladeshi patients with bilateral disc swelling report to neuro-ophthalmology clinic in NIO&H are female and belong to 18-37 years age group. Among them headache is the most common presenting complaint and IIH is the most common clinical diagnosis.

J. Natl. Inst. Ophthalmol. 2022;5(1):39-45

An Overview of Childhood Ocular, Orbital and Surface Tumor with Clinical Updates

Soma Rani Roy, Fahmida Huque — Thu, 08 Dec 2022 00:00:00 +0000

Childhood tumor is different from but has a wide range varieties in types and presentation due to its origin from different embryogenic layers. Pediatric patients mostly depend on their parent or caregiver for seeking medical attention thus many ocular tumor present with unnecessary delay. Most childhood ocular tumors are benign but there are also life threatening tumors. In this paper a variety of intraocular, orbital and surface tumors are reviewed with their key sign of diagnosis and current treatment modalities. Though most of these tumor present at tertiary eye hospital, the overall knowledge about these tumors can help ophthalmologists in diagnosis and proper referral.

J. Natl. Inst. Ophthalmol. 2022;5(1):51-68