Background:
A 6 months old female Baby was seen on 23.11.2021 by our paediatric ophthalmologist. The baby was referred to us from Indira Gandhi Institute of Child Health Centre for eye evaluation and needful management. The baby was evaluated and was diagnosed to have both eyes cataract with microcornea. The TORCH profile test (The TORCH Profile or Panel tests are a group of tests performed to detect congenital or birth defects in newborns caused by infectious disease) confirmed of positive for Toxoplasma and IgG infection. The baby was also very obese (infantile obesity) weighing 10 kgs. The child was advised to undergo RIGHT EYE PARSPLANA LENSECTOMY + PRIMIRAY POSTERIOR CAPSULOTOMY + ANTERIOR VITRECTOMY UNDER GENERAL ANAESTHESIA.
Surgical Management:
After undergoing all preliminary investigations (paediatrician fitness) the baby was posted for surgery on 26.11.2021 @ 02:30pm. The operating team consisted of Dr.Geethanjali & Dr.Praveen R Murthy – Operating surgeons, Dr.Varsha – Assistant Doctor, Mr.Umesh - Surgery Assistant, Dr. Raghavendra – Anesthetist, and OT Assistants- Mrs.Archana & Mr.Anilkumar.
The surgery lasted for 1 hr 15 min. The baby was discharged on 27.11.2021 with an advice to follow all medication and to review after 1 week. As on 22.12.2021 the baby is doing well.
As children grow, their eyes change quickly. Careful attention to a child's eye health can help catch problems early, while their eyes are still developing. Children generally can accommodate by using their focusing muscles to see clearly near and far. As they age, children’s eyes grow and lengthen, and farsightedness often improves on its own. Significant farsightedness, however, can lead to strabismus and amblyopia ("lazy eye") if left uncorrected.
Good screen time hygiene may help lower the risk of myopia and digital eye strain. Children can get cataracts too, congenitally or after birth. Without proper treatment, pediatric cataracts can cause abnormal connections between the brain and the eye that may become irreversible.
1. A 8 yr old boy child was seen on 29.06.2021 by Dr.Netra Harsha, Consultant & Surgeon – paediatric Ophthalmology Services. On examination the parents gave a history of injury to his right eye with stone 2 month back. Following which the child had pain and redness in the eye and the parents visited eye doctor near their place and the child was treated with some eye drops. They started noticing white reflex in right eye since 1½ months post injury. They were referred to higher centre for needful management. The child’s visual acuity in right eye was hand movements close to face with presence of projection of rays. Surgeon was unable to view the fundus of the eye due to presence of cataract. B scan was done to know the status of retina; the scan findings showed retina ON. The child was diagnosed to have right eye traumatic cataract with anterior capsular rupture with lens matter in anterior chamber of the eye.The child was advised to undergo RIGHT EYE CATARACT EXTRACTION + ANTERIOR VITRECTOMY + POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA. The child underwent the suggested surgery on 01.07.2021. As on 20.09.2021; the child is doing well and his visual acuity in right eye is counting fingers at 1 mtr distance with +11 Diopter eye glasses. Child has been advised to review after 1 month.
2. A 1 year old female child was seen at our hospital on 14.07.2021 by Dr.Netra Harsha, Consultant & Surgeon – paediatric Ophthalmology Services. On examination the child’s parents gave a history of systemic illness of gross developmental delays + epilepsy + respiratory distress syndrome + inborn errors of metabolism- IEM (a rare cause of epilepsy, but seizures and epilepsy are frequently encountered in patients with IEM. Since these disorders are related to inherited enzyme deficiencies with resulting effects on metabolic/biochemical pathways, the term “metabolic epilepsy” can be used to include these conditions. These epilepsies can present across the life span, and share features of unresponsiveness to anti-epileptic drugs, and are often associated with co-morbid developmental delay/regression, intellectual, and behavioral impairments). They informed of noticing white reflex in both eyes and consulted their treating paediatric neurologist who advised and guided the baby for eye evaluation and further management. During visual acuity examination the baby was able to fix and follow light in both eyes. Surgeon was unable to view the fundus of the eye due to presence of cataract. Bscan was done to assess the status of retina and optic nerve head; the scan findings showed retina ON and normal optic nerve head. The baby was diagnosed to have both eyes developmental cataract and advised to undergo BOTH EYES CATARACT EXTRACTION + ANTERIOR VITRECTOMY + POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA
The baby underwent the same on 18.09.2021. As on 27.09.2021 the baby is doing well and is advised to review after 3 weeks.
Learning disabilities are another concern with school-age children. Vision problems are common among school-age kids. In this age group children have vision problems that, if left untreated, can affect their learning ability, personality and adjustment in school. School-age children also spend a lot of time in recreational activities that require good vision but playing outside or participating in a team sport may not be as fun if the child faces vision problem. Frequent eye exams are important to identify eye ailments in children.
1. Traumatic Cataract
A 13 year old female child was seen at our hospital on 10.02.2021 by Dr.Vandana Sayra, Consultant & Surgeon - Cornea & General Ophthalmology Services. On examination the child’s father gave a history of trauma to her right eye 5 days ago while tearing a piece of cloth which hit her right eye while doing so. The child did not inform the parents out of fear. When her right eye became red ; her parents noticed and purchased eye drops in pharmacy and instilled to her right eye; when the redness did not subside and the child complained of dimness of vision; parents consulted eye doctor nearby where she was advised surgery.Her visual acuity in right eye was presence of projection of rays and hand movements close to face. Anterior segment examination showed cortical matter in anterior chamber with anterior capsule breach, + traumatic cataract. Bscan was done to assess the status of retina; the scan findings showed retina ON. The child was advised to undergo RIGHT EYE CATARACT EXTRACTION + ANTERIOR VITRECTOMY+ 3PIECE INTRAOCULAR LENS IMPLANTATION UNDER GENERAL ANAESTHESIA
The child underwent the same on 11.02.2021 and as on 27.03.2021 she is doing well and her visual acuity is 6/12, ph 6/9.
2. Medial Coloboma with lipodermoid
A 9 months old male child with Goldenhar syndrome was seen at our hospital 06.04.2021 by Dr. Smitha- Squint and Orbit surgeon. Goldnhar syndrome is a craniofacial syndrome, which means that it causes certain abnormalities in the formation of the face and head. It is considered a rare disease and a congenital one, meaning it is present at birth. In people with Goldenhar syndrome, abnormalities appear mostly in the areas of the ears, eyes, and spine. This condition can also affect the structure of the face, and some internal organs. The most recognizable symptom is the presence of facial abnormalities, in particular hemifacial microsomia. These occur when the bones and muscles in the face are underdeveloped on just one side of the face. Those with Goldenhar may also have a cleft lip or cleft palate. Other characteristics of the syndrome include defects in the eyes, ears, and spine. This can mean growths on the eyes, small eyes, missing eyelids, small ears, missing ears, ear tags, or even hearing loss. A dermoid is an overgrowth of normal, non-cancerous tissue in an abnormal location. Dermoids occur all over the body. The ones in and around the eye are usually comprised of skin, hair, and/or fat. The child was advised for upperlid reconstruction + lipodermoid excision + amniotic membrane + tisseal glue under general anaesthesia.
The child underwent the surgery on 07.04.2021.
In accordance to our driving spirit to fulfill the dream of our founder, we are continuously striving to spread awareness and educate regarding childhood vision problems and its side effects in children. Eye exams by your child's doctor are an important way to identify problems with your child's vision. Problems that are found early have a better chance of being treated successfully.
1.Cryptococcal Retinitis
A 17 yrs old boy was seen at our hospital by Dr.Krishna R Murthy on 14.12.2020. The child is HIV positive and is on ART treatment. The child was diagnosed to have both eyes Cryptococcal Retinitis. Cryptococcus is an AIDS-defining illness, and is a common cause of infectious choroiditis in immune deficient patients. The illness initially presents as mild headaches, fatigue, fever, and nonspecific eye complaints such as intermittent blurring or loss of vision. Patients should be followed closely initially, until a clinical response is seen. The child was advised for surgical intervention of Vitrectomy under sedation.
The child underwent the same on 30.12.2020 and presently is on close follow-up.
2. Congenital cataract with mixed nystagmus
A male baby aged 1 month 25 days was seen at our hospital in the month of October 2020. The baby was seen by Dr.Vinay Kumar K, Vitreo-Retinal Surgeon. Parents informed of noticing white reflex in both eyes since 20 days. On examination the baby was unable to perceive light in both eyes. The baby was diagnosed to have both eyes congenital cataract. The baby was advised to undergo both eyes lensectomy + Vitrectomy under general anaesthesia.
The baby underwent the same at the age of 5 months on 08.01.2021 and presently is on follow-up. The child will need occlusion therapy - Occlusion of the good eye in order to facilitate vision in a deviating eye.
Healthy eyes and vision are a critical part of child's development. Several eye conditions can affect children. Most are detected by a vision screening using an acuity chart during the preschool years. The problem of poor vision is particularly important in young children, who without appropriate correction struggle to see the blackboard in the classroom. This means that they can have great difficulty in learning at school, which has an untold impact on their education, their social participation, their overall quality of life. Vision is more than just the ability to see clearly or having 20/20 eyesight. It is also the ability to understand and respond to what is seen. There are many basic visual skills beyond seeing clearly that are important to supporting academic success.
CHEMICAL INJURY
A 4 year old female child was seen at our hospital on 17.08.2020. On examination the child’s mother informed of chemical injury to child’s left eye on 16.07.2020. The child was on topical treatment for the injury. It was a grade 4 chemical injury with total corneal opacity with 360 deg limbal stem cell loss. (Chemical (alkali and acid) injury of the conjunctiva and cornea is a true ocular emergency and requires immediate intervention. Chemical injuries to the eye can produce extensive damage to the ocular surface and anterior segment leading to visual impairment and disfigurement. Early recognition and treatment ensures the best possible outcome for this potentially blinding condition). The child was suggested for surgical intervention to left eye under general anaesthesia. LEFT EYE – AMNIOTIC MEMBRANE GRAFT WITH SYMBLEPHARON RELEASE.
The child underwent the above suggested surgery on 20.08.2020. The surgery lasted for 3hrs 45 min and was uneventful.
INJURY WITH TOP
A 10 year old male child was seen at our hospital on 19.09.2020. The child’s mother gave a history of alleged trauma with top to his right eye while playing on 17.09.2020. His visual acuity in right eye was presence of perception of light and projection of rays. Anterior segment examination showed full thickness corneal tear with iris prolapse and vitreous in the wound + hyphema. The child was advised for emergency intervention of Corneal tear repair + Vitrectomy + intravitreal antibiotic and antifungal injection under general anaesthesia.
The child underwent the suggested surgery on 20.09.2020. The surgery lasted for 3 hrs & was uneventful.
NUCLEAR CATARACT
A 1yr old male baby was evaluated at our hospital on 15.09.2020. Parents informed of noticing white reflex in right eye since 1 month. The baby was diagnosed to have nuclear cataract. (A cataract is a clouding of the lens in the eye leading to a decrease in vision. It can affect one or both eyes). On examination the baby’s visual acuity in right eye was presence of perception of light and in left eye the baby was able to fix and follow light. The baby was suggested for RIGHT EYE CATARACT EXTRACTION WITH IOL IMPLANTATION UNDER GENERAL ANAESTHESIA.
The baby underwent the suggested surgery on 24.09.2020. The surgery lasted for 2 hrs and was uneventful.
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