Journal of National Institute of Ophthalmology

A Review on Prognostic Factors for Successful Outcome of Horizontal Strabismus Surgery in Pediatric Group

Sidratul Muntaha Naznin — Wed, 29 Nov 2023 00:00:00 +0000

Introduction: Strabismus is a misalignment caused by abnormalities in binocular vision or by anomalies of neuromuscular control of ocular motility. Both children and adults may present with strabismus in the health care center for management. Proper choice of management plan can provide satisfaction to the patients. The aim of surgical management is to optimize the best corrected visual acuity (BCVA) of both eyes, maintain normal binocular fusion and improve cosmesis.

Purpose: To review the scientific literature that evaluates the prognostic factors for successful outcome of horizontal strabismus surgery in pediatric group.

Methods: The relevant articles are collected and reviewed from Google scholar, PubMed web search and published national and international journals. Our main focus is to concentrate about factors of successful strabismus surgery for pediatric group.

Results: This review shows that factors affecting surgical and cosmetic outcome of squint surgery are related to age of presentation, gender distribution, pattern of laterality, types of squint- alternate / unilateral, Pre-operative deviation, binocular vision, association of refractive error etc. This resultant workable framework further helps to evaluate and take proper decision regarding management of these patients for better successful outcome.

Conclusion: Proper preoperative assessment followed by proper choice of surgical options leads to surgical success. Effective surgical options coupled with effective post-surgical rehabilitation will provide the best outcome for such strabismus surgery.

J.Natl.Inst.Ophthalmol.2023;6(1): 48-53

Congenital Rubella Syndrome-a Case Report with Clinical Manifestation and Management Approach

Sidratul Muntaha Naznin, Mohammad Mostafa Hossain — Wed, 29 Nov 2023 00:00:00 +0000

Congenital rubella syndrome (CRS) is an illness in infant resulting from maternal infection with rubella virus during pregnancy. Patients suffer from some complications included deafness, cataract, heart defects, mental retardation, bone alterations, liver and spleen damage. Purpose of this study is to create attention, early identification and keep special concern in management of such case. A 15 years old girl presented with dimness of vision since childhood. Her mother had a history of fever and skin rash during prenatal period. She had mental retardation, deafness, dumbness, thin stature, microchephaly. Unaided vision fixed and follows in both eyes. Anterior segments showed bilateral microphthalmos, nystagmus, microcornea, aphakia. Intraocular pressure was 40 mm of Hg in each eye. Color fundus photograph showed myopic crescent with tessellated fundus. Echocardiogram showed pulmonary stenosis. Ultrasonography whole abdomen revealed chronic hepatitis. LDH level was 380 units/L. She had hyperthyroidism. Her sensory neural hearing loss was detected by audiometry. She was referred to glaucoma clinic for raised ocular pressure; low vision clinic for visual rehabilitation; medicine specialist for cardiac problem, liver problem and hormonal imbalance. All presenting features revealed that it was a case of congenital rubella syndrome as the girl had deafness, cardiac problem and ocular abnormality which are triad of CRS. Early diagnosis, timely management and proper counseling to patient and guardian will consequently increase life quality of this patient. National awareness should be increased for full coverage of antenatal check up with MMR vaccination in all health care centers of developing countries.

J.Natl.Inst.Ophthalmol.2023;6(1): 54-59

Reviving Hope: Amniotic Membrane Transplantation in Chemical Ocular Burns

Md Abdul Quader — Wed, 29 Nov 2023 00:00:00 +0000

Abstract not available

J.Natl.Inst.Ophthalmol.2023;6(1): 8

Socio-economic Factors Responsible for Delayed Presentation of ROP in a Tertiary Neonatal Care Unit in Bangladesh

KM Mizanur Rahman, - Rashid, - Afsana, - Sumiya, - Asma, Dipak Nag — Wed, 29 Nov 2023 00:00:00 +0000

Purpose: To evaluate the socio-economic factors responsible for delayed presentation of ROP in a tertiary neonatal care unit in Bangladesh.

Methods: This observational study was conducted on fifty babies, who were presented delay at screening were purposively selected for the study at Dhaka Shishu Hospital, National Institute of Ophthalmology & Hospital. Study period was 12 months and data collection was done by face to face interview from legal guardians with pre designed questionnaire. Information regarding gestational age, birth weight, condition of health at birth,parents education level and economic condition were obtained by face to face interview from parents. They were also asked whether the baby was advised for screening or not. Screening was done by indirect ophthalmoscopy by using 20D condensing lens.

Results: Among the 50 babies, prevalence of ROP was 66.0% (95% CI: 52.87-79.13). Mean gestational age was 29.10(±1.5) weeks and mean birth weight was 1250(±0.24) gm. After taking account of all possible confounders, we found that place of residence of the parents is associated (p=0.011) as well as adviced for screening is marginaly assocated (p= 0.05) with delayed presentation of ROP for screening.

Conclusion: There are many risk factors for delayed presentation of ROP at screening. Among the factors palce of residence (rural) and advice for screening are found to be significant. Further study regarding this issue is necessary to explore all other factors and formulate plans to overcome them.

J.Natl.Inst.Ophthalmol.2023;6(1): 9-15

Association of Fasting Serum Lipid Level with Diabetic Retinopathy

Wed, 29 Nov 2023 00:00:00 +0000

Background: Diabetic eye disease is now one of the major causes of blindness in the world. Elevated serum lipids have been speculated to cause or exacerbate diabetic retinopathy by several mechanisms.

Objectives: To observe the relationship of serum lipids with diabetic retinopathy.

Methods: This cross sectional observational study was carried out in the Department of Ophthalmology, Combined Military Hospital Dhaka, from July 2016 to December 2016. A total of 150 patients were selected for the study and divided into three groups. Group I comprises 50 patients with different stages of retinopathy. Group II comprises 50 diabetic patients without retinopathy, and group III comprises 50 non diabetic healthy control people.

Results: The age range was 27 to 70 years; Male and female ratio was 1.54:1. The mean duration of diabetes in group I was 9.82 ± 4.04 years and 8.38 ± 3.39 years in group II. Measuring Fasting lipid profile in between group I and group II and between group I and III were statistically significant (p< 0.001).

Conclusion: Patients with diabetic retinopathy have been found to have a close association with elevated serum lipid levels.

J.Natl.Inst.Ophthalmol.2023;6(1): 16-20

Clinical Outcome of Amniotic Membrane Transplantation in Chemically Injured Eyes

Wed, 29 Nov 2023 00:00:00 +0000

Purpose: To evaluate the clinical outcome of Amniotic Membrane Transplantation (AMT) in chemically injured eyes for ocular surface reconstruction.

Methods: A prospective study of 30 consecutive chemically injured eyes was performed from December 2022 to May 2023 in National Institute of Ophthalmology & Hospital (NIO&H), Dhaka, Bangladesh. Twenty-seven patients (30 eyes having corrosive chemical injuries) were included in the study according to the inclusion & exclusion criteria. AMT was performed within 21 days of injury by single surgeon with modified surgical procedure. Post operative evaluation was done by Snellen chart, slit lamp biomicroscope and Schirmer-II test.

Results: After 3 months of AMT, there was no pain or inflammation. Improvement of vision found in 20 (66.67%) of 30 eyes, 4 (13.33%) eyes of rest 10 eyes showed inaccurate Projection of Rays (PR) vision and rest 6 (20.0%) eyes of rest 10 eyes found deteriorated vision. Epithelialization occurred in all eyes. Twenty-four (80.0%) eyes had limbal stem cell deficiency and they experienced superficial corneal vascularization. Symblepharon was seen in 18 (60.0%) eyes, 6 (20.0%) of these 18 eyes developed marked conjunctival shortening with ankyloblepharon. None of the eyes showed perforation.

Conclusions: AMT increases patient comfort and reduces inflammation. In mild burns, AMT alone restores corneal and conjunctival surfaces. In moderate to severe burns, it reduces conjunctival scarring sequelae, but does not prevent the sequelae of limbal stem cell deficiency that requires further limbal stem cell transplantation. In the acute stage, AMT has a protective role against the progressive melting and perforation.

J.Natl.Inst.Ophthalmol.2023;6(1): 21-26

Visual Outcomes & Associated Factors in Patients with Chemical Injury in a Tertiary Eye Care Hospital in Bangladesh

Wed, 29 Nov 2023 00:00:00 +0000

Purpose: To study the clinical profile & visual outcome of ocular chemical injuries.

Methods: This observational retrospective study was performed on 50 patients with chemical injuries attending in cornea clinic from January 2022 to December 2022 in a tertiary Eye Institute & Hospital in Bangladesh. A detailed history of the patients and history of presenting complaints was taken. An ocular examination was performed. Visual acuity was recorded by using Snellen’s test-type Chart. A thorough examination was carried out on slit-lamp, direct & indirect ophthalmoscopes. Clinical grading was done by Roper Hall Classification. Other’s ocular investigations were done when required.

Results: In the present study, 50 patients were included of which 60% (30) were male and 40% (20) were females. In the present study, 11-20 years of age patients are 18(36%) & 0-10 years of age are 12(24%).Most of the cases were day labor 16(32%), followed by students12( 24%) ,housewife 4(8%) & others are 18 (36%). As per the Roper Hall Classification, most of the eyes sustained grade II chemical injury at 36% (30 eyes); followed by grade IV at 26%: grade III was 20%, and grade I was 18%. The visual acuity at presentation, 17(34%) patients had visual acuity 6/12- 6/24. On the other hand, 14(28%) have a counting finger. Visual acuity at the final follow-up, 19(38%) patients had visual acuity 6/12- 6/24. On the other hand, 16(32%) had a counting finger. The management of chemical injury, AMG + BCL was done on 54% of patients & conservative management was done on 32% of patients.

Conclusion: The incidence was more in the younger working population, with a majority of injuries occurring in less than 30 years of age. The severity of chemical burn belonging to grade II and grade IV injuries. Henceforth the visual outcome was better and complications were much less after immediate management. Saline wash & Amniotic membrane Grafting(AMG) with fresh amniotic membrane increases patient comfort and reduces inflammation. Public health initiatives are critical to prevent chemical injuries in mitigating the poor visual prognosis.

J.Natl.Inst.Ophthalmol.2023;6(1): 27-31

Barriers of High Cataract Surgery Rate in Rural Area of Barisal Division

Wed, 29 Nov 2023 00:00:00 +0000

Background: Cataract is the leading cause of preventable blindness in the world. the most important component of vision 2020 to eliminate the cataract related blindness as a signatory of vision 2020 programme the government of Bangladesh takes many effective steps to increase cataract surgery rate CSR through national eye care operation plan but still there are some obstacles that desisted the rural people to undergo surgery for cataract

Aim of the study: To find out the reasons for the low cataract surgery rate among the cataract patients in rural area of Barisal division.

Methodology: This cross-sectional study was conducted on the District Sadar Hospital, Jhalkathi from January 2016 to December 2016 over 200 patients out of 500 cataract patients who are selected for cataract surgery but did not under one the procedures finally not the medical ground. The causes of unwilling to undergo surgery was asked about by personal discussion through a structured questionnaire. All the relevant information was recorded in the data collection sheet and were analyzed and displayed for dissemination.

Result: Out of 200 patients 91 patients did not undergo surgery due to fear about the surgical procedure, which followed by 43 patients who abstained from surgery due to fear of become total blind after surgery, 41 patients did not undergo surgery for not to bear the relevant expenditure the other reasons are no care giver for post-operative care and fear of complications (as experienced by persons, previously underwent surgery) which refrained 14 and 11 patients respectively from surgery.

Conclusion: To increase the cataract surgery rate (CSR) in rural area among the under privileged people to achieve the goal of VISION 2020, it is necessary to conduct awareness program as well base hospitals should be equipped with effective instruments and skilled manpower.

J.Natl.Inst.Ophthalmol.2023;6(1): 32-36

Assessment And Comparison of Bacterial Contamination in Anterior Chamber Aspirates in Small Incision Cataract Surgery (SICS) And Phaco-Emulsification

Wed, 29 Nov 2023 00:00:00 +0000

Introduction: The rate of occurrence of endophthalmitis after cataract surgery has been reduced to a greater extent now a day. Even then endophthalmitis related consequences are devastating. Several sources of infection, including contamination by air, solutions, surgical instruments, intraocular lens, and wound leakage have been identified.

Aim of the Study: The study aimed to evaluate the influence of two methods of surgical technique of cataract surgery in bacterial as well as comparison of contamination by these two techniques.

Methods: This prospective observational study was conducted over 60 patients with age related cataract in the department of Ophthalmology and Microbiology in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh, from 1^st January, 2009 to 30^th June, 2009. Patients were selected purposively based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic evaluation as well as relevant investigations. Cataract extraction followed by intraocular lens implantation was planned for all patients. The two techniques of cataract surgery such as SICS and Phacoemulsification were assigned to the patients randomly by 1:1 basis. 1 ml of anterior chamber contents were aspirated through aseptic technique by 26G needle from each patient pre-operatively, after capsulorrhexis (early per-operative) and just before wound closure by stromal hydration (late per-operative). All samples were sent for 10% KOH staining and culture and sensitivity test after proper leveling.

Results: Micro-biological examination shows no sample was positive for 10% KOH staining. In SICS group, out of 30 samples 3 were found culture positive, which were positive in 4 and 5 samples in early per-operative and late per-operative sample respectively and in Phacoemulsification group, it was 2, 3, 5 pre-operative, early per-operative and late per-operative sample respectively. The common organisms isolated were Coagulase positive Streptococcus, Corynebacterium species, Streptococcus viridans, and Staphylococcus aureus etc. Almost none of the patients showed clinical activity except few cells and flare in the anterior chamber in early post-operative period.

Conclusion: The microbiological examination shows the incidence of microbial contamination of anterior chamber contents is very low after cataract surgery by both form of technique, and there was no statistically significance difference in incidence between these two techniques.

J.Natl.Inst.Ophthalmol.2023;6(1): 37-41

Refractive Status after Phacoemulsification with Biometry Done by Haigis and SRK-T Formulae in Myopic Patients

Wed, 29 Nov 2023 00:00:00 +0000

Background: Optimum refractive outcome is the key indicator for assessing the success of cataract surgery. Accurate biometric calculation of IOL is an important contributor of post-operative refractive status. There are several formulae for calculation of IOL power depending on axial length of eyes. Haigis is the formula of choice for calculating IOL power in myopic patients, whereas, SRK-T is a versatile formula irrespective of axial length. For IOL power calculation by Haigis formula needs expensive instrument. On the other hand, biometry by SRK-T formula can be done by less expensive and easily available instrument.

Objective: To assess and compare post-operative refractive status after phacoemulsification where biometry done by Haigis and SRK-T formulae.

Methods: This prospective observational study was conducted over 60 diagnosed patients of cataract with axial length more than 24 mm attending in the cataract clinic of NIO&H for phacoemulsification. Patients were selected based on specific selection criteria. Selected patients underwent detail ophthalmic and systemic examination as well as relevant investigation. Biometric calculation of IOL power was done by a single skilled technician by using Haigis formula (group A) in 30 patients and SRK-T formula (group B) in 30 patients. Visual acuity was assessed by LogMAR unit after 4 weeks of surgery and compared between two groups, p value ≤0.05 was considered as significant.

Results: Mean age of the study subjects were 57.7±6.0 (SD) years in group A and 57.27±5.48 (SD) years in group B. In group A 14(46.7%) were male and 16(53.3%) were female and in group B 16(53.3%) were male and 14(46.7%) were female. Mean axial length was 25.05±0.45 (SD) mm in group A and 24.88±0.32 (SD) mm in group B. Mean IOL power was 18.23±0.76 (SD) diopter in group A and 18.23±0.65 (SD) diopter in group B. Post-operative mean visual acuity was 0.19±0.26 (SD) LogMAR unit in group A and 0.18 ±0.27 (SD) LogMAR unit in group B. Regarding post-operative refractive status of the study subjects, in group A, out of 30 patients 14(46.7%) were emmetropic, 7(23.3%) were myopic, 5(16.7%) were hypermetropic and the rest 4(13.3%) patients had astigmatism and in group B, out of 30 patients 16(53.3%) were emmetropic, 5(16.7%) were myopic, 4(13.3%) were hypermetropic and the rest 5(16.7%) patients had astigmatism.

Conclusion: Quantitative assessment and statistical analysis shows there was no significant difference in post-operative refractive status and mean visual acuity between two groups.

J.Natl.Inst.Ophthalmol.2023;6(1): 42-47