May 31, 2018

Avoidable blindness

11 months male baby with both eyes ROP
11 months male baby with both eyes ROP

Retinopathy of prematurity (ROP) is a potentially blinding eye disorder that primarily affects premature infants weighing about 1250 grams or less that are born before 31 weeks of gestation (A full-term pregnancy has a gestation of 38–42 weeks). The smaller a baby is at birth, the more likely that baby is to develop ROP. This disorder which usually develops in both eyes is one of the most common causes of visual loss in childhood and can lead to lifelong vision impairment and blindness.

In addition to birth weight and how early a baby is born, other factors contributing to the risk of ROP include anemia, blood transfusions, respiratory distress, breathing difficulties, and the overall health of the infant.

The most effective proven treatments for ROP are laser therapy or cryotherapy. Laser therapy “burns away” the periphery of the retina, which has no normal blood vessels. While ROP treatment decreases the chances for vision loss, it does not always prevent it. Not all babies respond to ROP treatment, and the disease may get worse. If treatment for ROP does not work, a retinal detachment may develop. 

1. 11 month old male baby was seen at our hospital on 18.01.2018. Baby is a preterm baby born at 32 weeks of gestation. The child’s parents informed of noticing white reflex in both eyes since 2 months. During visual acuity examination the child was not able to fix and follow light in both eyes. Anterior segment examination showed white reflex in both eyes. B-scan was done to know the status of retina. The test showed bilateral funnel retinal detachment secondary to ROP. As child was uncooperative for detailed examination, the child was suggested for EXAMINATION UNDER ANAESTHESIA.

The findings of the examination were as below:-

Right eye – stage 4 ROP

Left eye – Stage 5 ROP with closed funnel retinal detachment

ADVICE:-

  • RIGHT EYE – LASER TREATMENT
  • LEFT EYE - SURGICAL INTERVENTION OF VITRECTOMY + LENSECTOMY + MEMBRANE PEELING    UNDER GENERAL ANAESTHESIA UNDER VERY GUARDED VISUAL PROGNOSIS.

The child underwent the above suggested surgery on 16.03.2018. As on 18.05.2018 the baby has been advised to review after 1 month for visual assessment.

2. A female baby born in 25 week of gestation weighing 660 gms was evaluated on 12.02.2018; the baby was diagnosed to have Retinopathy of Prematurity (ROP) in stage 2 in zone 1 with plus disease. The baby was advised for laser intervention at the earliest. The baby had conjunctivitis; it was treated with topical drops for clear of infection and the baby underwent both eyes laser treatment on 15.02.2018. As on 17.03.2018; ROP has regressed in both eyes post laser treatment and the baby is doing well. Baby has been advised to review after 2 weeks.

3. A female baby born in 29 week of gestation weighing 760 gms was evaluated on 19.02.2018; The fundus photos did not show presence of ROP and the baby was advised for review after 2 weeks. The baby was reviewed on 19.03.2018; diagnosed to have ROP Retinopathy of Prematurity (ROP) in stage 2 in zone 2 with plus disease. The baby was advised for laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 24.03.2018.

 

11 month male baby operated for stage 5 ROP
11 month male baby operated for stage 5 ROP
29 weeks old female baby treated for ROP
29 weeks old female baby treated for ROP
May 21, 2018

Eyes - The Interpreter of mind

4 yr old female child operated for squint
4 yr old female child operated for squint

Childhood blindness is an important cause contributing to the burden of blindness. Preventing childhood blindness requires access to prenatal care, primary health care, and good nutrition. Children’s eyes are very sensitive and are easily affected by infection and nutritional deficiencies. Childhood blindness is caused by a number of diseases and conditions. Vitamin-A deficiencies, cataracts from rubella, corneal scarring from measles, strabismus, and retinopathy of prematurity from premature birth. Prevention and treatment depends on the cause of blindness

 

Squint

A 6 yr old male boy was operated for squint. The child was diagnosed to have bilateral alternating exotropia (SQUINT) - A squint is a condition where one eye is out of alignment, Squints can affect the eyesight in childhood, as the brain will begin to ignore a squinting eye causing the sight in it to be worse that in the other eye. The child was advised to undergo bilateral squint correction surgery (2 muscles) under General Anaesthesia. The benefits of squint surgery are an improvement in the appearance of the squint, reduction in the severity or frequency of double vision, an improvement in the control over the squint. In young children a benefit may be allowing the eyes to work together as a pair.

Congenital Glaucoma

A 7 months old baby was seen by us. The baby is under treatment for coronary heart disease (CHD) + PDA (CHD means a child is born with an abnormally structured heart and/or large vessels & Patent ductus arteriosus (PDA) is a persistent opening between two major blood vessels leading from the heart). On examination the child was able to fix and follow light in both eyes. Anterior segment examination showed Megalocornea (Megalocornea is an extremely rare non-progressive condition in which the cornea has an enlarged diameter, reaching and exceeding 13 mm). Fundus examination showed pigmentary changes in both eyes. The child was advised for EXAMINATION UNDER GENERAL ANAESTHESIA. Impression – both eyes congenital glaucoma with irido/ trabecular dysgenesis will need to plan both eyes trabeculotomy under GA.

Superomedial Dermoid

A 4 yrs old female child was operated for dermoid. The mass is a firm one, non mobile, non tender, fixed to bone. Dermoid cysts grow slowly and contain mature tissue; this type of cystic teratoma is nearly always benign. In rare cases the dermoid cyst is malignant. The child was advised forLEFT EYE – Superomedial Orbitotomy & biopsy under General Anaesthesia.

ORBITAL CELLULITIS

A 9 ½ yr old female child was operated for ORBITAL CELLULITIS. Orbital cellulitis is an inflammation of the soft tissues of the eye socket behind the orbital septum, a thin tissue which divides the eyelid from the eye socket. Orbital cellulitis most commonly refers to an acute spread of infection into the eye socket from either the adjacent sinuses, skin or from spread through the blood. The child was advised for ORBITOTOMY UNDER GENERAL ANAESTHESIA. The complications of orbital cellulitis are meningitis and death. As the fungal infection had spread to brain; we were unable to save the life of the child.

LIMBAL DERMOID.

A 3 yrs old male child operated for Limbal dermoid. Limbal dermoids are benign congenital tumors that contain choristomatous tissue (tissue not found normally at that site). They appear most frequently at the inferior temporal quadrant of the corneal limbus. The child was advised for LIMBAL DERMOID EXCISION WITH AMNIOTIC MEMBRANE GRAFT UNDER GENERAL ANAESTHESIA.

6 yr old male child operated for squint
6 yr old male child operated for squint
3 yr old male child operated for limbal dermoid
3 yr old male child operated for limbal dermoid
4 yr old female child operated for dermoid
4 yr old female child operated for dermoid
7 mths old baby examined for congenital glaucoma
7 mths old baby examined for congenital glaucoma
female child operated for orbital cellulitis
female child operated for orbital cellulitis
Mar 5, 2018

TWINKLE STARS

ROP - Pre and post laser photos
ROP - Pre and post laser photos

Retinopathy of prematurity (ROP) is a disease of the retina that can occur in premature babies. The retina is the thin, light-sensitive tissue that lines the inside surface of the eye. Cells in the retina convert incoming light into electrical impulses. These electrical impulses are carried by the optic nerve to the brain, which finally interprets them as visual images. ROP is classified by the part of the retina affected (zone), the degree of involvement (stage), and the appearance of the blood vessels (presence or absence of "plus" disease).

 Individuals with ROP are considered to be at higher risk for developing certain eye problems later in life, such as retinal detachment, myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye), and glaucoma. In many cases, these eye problems can be treated or controlled. Thus, it is important for patients with a history of ROP to have regular dilated eye examinations by an ophthalmologist even after the ROP has regressed.

 

  1. Baby of Madhavi born in 27 week of gestation, weighing 1000 gms male baby was evaluated in 8th week post birth. The baby was diagnosed to have Retinopathy of Prematurity (ROP) in stage 2 in zone 1 with plus disease in both eyes. The baby underwent both eyes laser treatment on 04.12.2017. As on 30.12.2017; the baby is doing well and ROP has regressed post laser treatment.
  2.  Baby of Reena born in 30 week of gestation, weighing 1200 gms female baby was evaluated in 6th week post birth. The fundus pictures showed presence of ROP in left eye in stage 2 in Zone 2; right eye was within normal limits. The baby was advised to review after 1 week. The baby was reviewed on 11.12.2017; fundus pictures showed presence of ROP in both eyes in stage 2 in zone 2 with plus disease. The baby was advised for early laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 14.12.2017. As on 05.02.2018; the baby is doing well and ROP has regressed post laser treatment.
  3.  Baby of Leela Bai born in 30 week of gestation, weighing 1300 gms male babywas evaluated in 2nd week post birth; the fundus pictures were within normal limits. The baby was advised to review after 2 weeks as retina was vascularized beyond equator in both eyes. The baby was reviewed on 11.12.2017; fundus pictures showed presence of ROP in stage 2 in Zone 2 with plus disease; left eye in stage 2 in zone 2 with no plus disease. The baby was advised for early laser intervention to both eyes to avascular retina. The baby underwent both eyes laser treatment on 14.12.2017. As on 08.01.2018; the baby is doing well and ROP has regressed post laser treatment.
  4. Baby of Nilafar born in 26 week of gestation, weighing 850 gms female baby. The baby was evaluated in 2nd week post birth; there was no presence of ROP. The baby was on close review to monitor the ROP status. When the baby was reviewed in 6th week; the fundus pictures showed Retinopathy of Prematurity (ROP) in stage 2 in zone 1 with plus vascularisation close to fovea. (Choroid vascularises at 6 weeks, Retinal Vascularisation starts at optic nerve head at 16 week gestation. Vascularisation is almost complete by term). The Baby was advised for administration of Antivegf intravitreal injection - Accentrix to both eyes at the earliest. Antibody binds the VEGF inside the eye almost immediately. The baby was administered Antivegf injection to both eyes on 15.01.2018. As on 24.02.2018; the eye quite and has been advised for close observation.
Baby of Nilafar - treated with antivegf injection
Baby of Nilafar - treated with antivegf injection
Baby of Leela Bai
Baby of Leela Bai
Baby of Reena
Baby of Reena
 
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