May 29, 2019

LITTLE STARS

5 weeks female baby treated for APROP
5 weeks female baby treated for APROP

Retinopathy of prematurity (ROP) is a potentially avoidable cause of irreversible, and usually total blindness in infants who are born premature. It is a major cause of blindness in children and has lifelong implications for the child. This occurs because all preterm infants were given 100% oxygen whether they needed it or not. Oxygen is highly toxic to blood vessels, including those in the retina. Infants with ROP have a massively increased risk of other pathology like high degrees of myopia; squint; cortical brain damage. They need regular follow up so these problems can be detected and managed.

 

  1. A 5 weeks female baby born in 27 weeks of gestation weighing 920 gms was reviewed on 21.02.2019 by Dr.Krishna R Murthy.  The baby was at high risk of APROP. Aggressive posterior retinopathy of prematurity (AP-ROP) is a severe and rare form of ROP which is characterized by fast progression to an advanced stage. The baby was advised for antivegf injection to both eyes at the earliest. Anti-VEGF drugs work by blocking the overgrowth of blood vessels in the retina.  The baby underwent both eyes antivegf injection on 23.02.2019 followed by laser treatment. As on 09.05.2019 ROP has regressed in both eyes and the baby has been advised to review after 2 weeks.

 

  1. A 7 weeks male baby born in 28 weeks of gestation weighing 1000 gms was reviewed on 25.03.2019 on follow-up for detection of ROP. The baby was diagnosed to have both eyes ROP in stage 2 in zone 2 (zone means part of the retina affected, a) central b) peripheral & c) outer part of retina) with plus disease. The baby was advised for laser intervention to both eyes to avascular retina.  The baby underwent both eyes laser treatment on 27.03.2019. As on 08.04.2019 ROP has regressed in both eyes and the baby is doing well.
APROP fundus photo
APROP fundus photo
7 months male baby treated for ROP
7 months male baby treated for ROP
May 15, 2019

Eyes - Light interpreter

7 months old baby operated for lamellar cataract
7 months old baby operated for lamellar cataract

In order to prevent Blindness a continuum of eye care for children that can include both vision screening and comprehensive eye exams are recommended. All children, even those with no signs of trouble, should have their eyes checked at regular intervals. Any child who experiences vision problems or shows symptoms of eye trouble should receive a comprehensive eye exam.There are different treatments to correct a child's eye problems. These treatments may be used alone or in combination. Glasses compensate for refractive error, eye drops or ointments are used to treat infections, Patching one eye is common in treating amblyopia, and surgery may be needed to remove the lens if the child has a cataract. Eye exercises (orthoptics) can improve focusing and help the eyes move better and work together.

PENETRATING KERATOPLASTY

A 16 year old boy was reviewed by us in the month of March 2019. The boy was treated with penetrating keratoplasty for Keratoconus grade 4 in left eye in 2016, when he was reviewed in March 2019 graft scarring was noticed, his visual acuity dropped to counting fingers at 1 mtr distance. The child was suggested to undergo LEFT EYE PENETRATING KERATOPLASTY (re-graft) UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery on 28.03.2019.

(A cornea transplant (keratoplasty) is a surgical procedure to replace part of the cornea with corneal tissue from a donor. Cornea is the transparent, dome-shaped surface of the eye that accounts for a large part of eye's focusing power. A cornea transplant can restore vision, reduce pain and improve the appearance of a damaged or diseased cornea.)

LAMELLAR CATARACT

A 7 months old male baby was seen at our hospital in the month of March 2019 by our Paediatric Ophthalmologist. The baby is under treatment for gross developmental delays and milestones. (Gross developmental delay is an umbrella term used when children are significantly delayed in their cognitive and physical development. It can be diagnosed when a child is delayed in one or more milestones, categorized into motor skills, speech, cognitive skills, and social and emotional development).

The baby was diagnosed to have both eyes lamellar cataract. (This type of cataract is bilateral. It can be congenital or it can be acquired. The cataract is always large enough to occlude the pupil. Its effect on vision depends primarily on the density of its components - especially the nucleus). The baby was advised to undergo BOTH EYES CATARACT EXTRACTION + ANTERIOR VITRECTOMY + PARSPLANA CAPSULOTOMY UNDER GENERAL ANAESTHESIA. The baby underwent the suggested surgery on 28.04.2019.

ZONULAR CATARACT

A 5 year old child was seen by us in the month of Feb 2019. The child’s visual acuity was 6/60 in both eyes. He was diagnosed to have zonular cataract in both eyes. (Zonular Cataract is a rare inherited disorder, and is characterized by zonal opacification of lenses, the disease is progressive. It may result in vision impairment if left untreated). The child was advised to undergo BOTH EYES PHACOEMULSIFICATION + FOLDABLE HYDROPHOBIC IOL IMPLANTATION UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery for left eye on 07.03.2019.

 

COLOBOMA CORRECTION

A 4 yrs old male child who was operated for a rare eye condition with diagnosis of Midline facial dysmorphism with upper lid coloboma + medial canthal dystopia (Eyelid Coloboma is an uncommon, unilateral or bilateral, partial or full-thickness eyelid defect. It is caused by failure of fusion of the mesodermal lid folds. It may be isolated or associated with other ocular or systemic anomalies. Immediate attention at an early age through corneal protection, surgical repair of the eyelid defect, and monitoring of the visual development are essential to prevent complications: corneal leukoma, symblepharon, and amblyopia). The child was suggested to undergo surgical management in 2 stages.

Stage – 1 - Coloboma correction

Stage - 2 - Debulking, medial canthal reconstruction with transnasal wiring.

 

The child underwent 1st stage of correction on 27.06.2018.

2nd stage correction was done on 30.04.2019

5 yr old boy operated for zonular cataract
5 yr old boy operated for zonular cataract
4 yr old operated for rare eye condition
4 yr old operated for rare eye condition
Apr 5, 2019

RETINA - THE PHOTORECEPTOR

62 yr old operated for retinal detachment
62 yr old operated for retinal detachment

Background:
A 62 yr old male was reviewed at our hospital on 29.01.2019 by retinal surgeon Dr.Krishna R Murthy. On examination his visual acuity in left eye was presence of perception of light and projection of rays. Fundus examination showed retinal detachment with breaks - The retina is a light-sensitive membrane located at the back of the eye. When light passes through your eye, the lens focuses an image on your retina. The retina converts the image to signals that it sends to your brain through the optic nerve. The retina works with the cornea, lens, and other parts of your eye and brain to produce normal vision. Retinal detachment occurs when the retina separates from the back of your eye. This causes loss of vision that can be partial or total, depending on how much of the retina is detached. When your retina becomes detached, its cells may be seriously deprived of oxygen. Retinal detachment is a medical emergency.

He was advised to undergo LEFT EYE REVITRECTOMY + MEMBRANE PEELING + FLUID GAS EXCHANGE + ENDOLASER + SILICONE OIL INJECTION UNDER LOCAL ANAESTHESIA.

 

Surgical Management:
After undergoing all preliminary investigations (physical fitness) he was posted for surgery on 29.01.2019. The operating team consisted of Dr. Krishna R Murthy – Operating surgeon, Dr. Rohini – Assistant Doctor, Mr.Ravikumar - Surgery Assistant, Dr. Naveen – Anaesthetist, OT Assistant-Mr.Anil.

The surgery lasted for 1 hr 15 min. He was discharged on 30.01.2019 with an advice to follow all medication and to maintain strict prone position for 13 to 14 hours a day for 3 weeks. As on 19.03.2019; he is doing well, Retina is attached and his vision in left eye is counting fingers at 3 mtr distance enabling him carry on his activities without dependency.

 
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