Ophthalmology

Complicated lower lid ectropions presenting to tertiary care hospital in Sub-Himalayan Region of Himachal Pradesh and their management Gaurav Sharma, Sushma Sawaraj Sudanese Journal of Ophthalmology 2018 10(2):39-43 Introduction: Ectropions of the lower lid area are of diverse etiology. They may be involutional, mechanical, paralytic, or cicatricial. The patients have lot of discomfort due to exposure and epiphora. Some of them also develop complications like infectious keratitis that are vision threatening as well. Cicatricial ectropions, severe ectropions with tissue laxity are sometimes difficult to manage. In this study, we intend to describe techniques we have used for the management of selected complicated cases of Ectropions. Aim and Objectives: The aim of the study is to describe the complicated cases of ectropions presenting to a tertiary care hospital in Sub-Himalayan region of Himachal Pradesh, India, and the various techniques used in their management. Materials and Methods: Cases of complicated ectropions fulfilling the inclusion and exclusion criterion which presented to the department of ophthalmology were included in the study. The patients were subjected to detailed history and clinical examination according to a predesigned pro forma. They were divided into four subtypes and managed surgically. Results: Horizontal lid shortening with or without blepharoplasty was performed in the cases of involutional ectropions and showed good outcome in all cases. There was no significant lid notching postoperatively. The cicatricial ectropion cases were managed surgically using Z plasty in all but one case of generalized cicatricial ectropion where skin grafting using postauricular graft was used. Postoperatively, the patients improved symptomatically, and cosmetic outcome was also acceptable. Conclusions: Horizontal shortening with or without blepharoplasty if performed meticulously is a good procedure providing excellent results; however, the site for pentagon excision and the amount of resection required needs to be decided, along with any medial or lateral canthal tendon stabilization. Cicatricial ectropions unless are generalized or very severe managed well with Z plasty, however, it is very important to understand the dynamics of the scar before deciding the site and dimensions of the Z plasty. Full-thickness skin graft is sometimes the only option for generalized cicatricial ectropions.

Donor factors influencing corneal tissue utilization in North India Anuradha Raj, Garima Mittal, Harsh Bahadur Sudanese Journal of Ophthalmology 2018 10(2):44-49 Purpose: The study aimed to determine the effect of various donor factors on utilization pattern of donor corneal tissue. Methods: This was a cross-sectional, retrospective study. Data of 509 donors with 1007 eyes details from eye bank (EB) were reviewed from December 2012 to June 2017. Donor data was analyzed including the age, sex of the donor, cause of death, source of tissue, death to enucleation time (DET), death to preservation time (DPT), type of tissue collected, grades of the tissue, serology reports and various utilization parameters. Results: Tissue utilization of EB was 356 out of 1007 which made 35.35% with cumulative utilization to the tune of 512 out of 1007 (50.84%). 82.50% tissues utilized for surgical use were from donor>65 years of age. Type and grading of tissue influenced the utilization of the tissues significantly (P = 0.00) each. Maximum keratoplasties 179 (50.28%), 202 (56.74%) were done with DET>3 hrs and DPT ≤4 respectively. DET, DPT and serology showed significant influence on the utility of the tissue (P = 0.00) each. Major cause of exclusion of the tissue for utilization was poor quality of the tissue which was C grade. Grading of tissue was significantly affected by DET, DPT and mode of tissue procured. Donor age >65 years showed higher surgical utility. Conclusion: Various donor factors like DET, DPT, tissue grade and type and serology results affects the utility of harvested corneal tissue. Potential modifiable donor factors needs to be addressed such as attention must be paid to the cause of death, contraindications and time factors related to donor.

Ocular injuries associated with traumatic hyphema in a tertiary hospital Olusola Joseph Omotoye, Iyiade Adeseye Ajayi, Emmanuel Chinwedu Abah Sudanese Journal of Ophthalmology 2018 10(2):50-53 Introduction: Traumatic hyphema is one of the most challenging clinical problems frequently encountered by ophthalmologists. Aim: The aim of this study is to determine the prevalence of ocular injuries in patients being managed for traumatic hyphema in this center to have a strategic plan to reduce consequential visual sequelae from the injury. Materials and Methods: This was a cross-sectional study conducted based on the data obtained from an eye clinic from January 2010 to July 2017. Information on demographic characteristics, chief presenting complaints and duration of symptoms before presentation, laterality, presenting visual acuity, grade of hyphema, intraocular pressure, associated ocular injury, and treatment offered were obtained. Results: Traumatic hyphema constituted 4.2% of all ocular emergencies seen in this center. There were 37 (82.2%) males and 8 (17.8%) females with a male-to-female ratio of 4.6:1.0. Of the 45 cases, 32 (71.1%) patients presented with blindness in the affected eye with the worst presentation occurring in Grade 4 hyphema. Thirty-three patients (73.3%) presented more than 24 h to the eye facility, age, and eye pain significantly affected the duration of presentation. The prevalence of ocular injuries in patients that had traumatic hyphema was 34 (75.6%). Fourteen (31.1%) patients presented with corneal injury ranging from corneal abrasions to corneal laceration. Conclusion: The prevalence of associated ocular injuries in patients with traumatic hyphema was high with corneal injuries as the most ranked complications. Reduction of consequential poor visual prognosis would include counseling on early presentation, meticulous examination of the injured eye, and quick and appropriate surgical intervention as indicated to prevent corneal staining.

Comparison of eye patching with cyanoacrylate glue application for anterior chamber reformation in infected perforated corneal ulcers Rini Saha, Gautam Singh Parmar, Ashok Kumar Sudanese Journal of Ophthalmology 2018 10(2):54-59 Objectives: This study was designed with the primary objective to compare between eye patching and cyanoacrylate glue application for anterior chamber (AC) reformation in infected perforated corneal ulcers. Subjects and Methods: This is a nonrandomized prospective comparative study conducted in a tertiary eye hospital. Patients with perforated keratitis were offered either eye patching (Group 1) or cyanoacrylate gluing (Group 2) under hospital admission and medical treatment to reform the AC. Success was defined as a formed AC at the time of discharge from the hospital. Patients were followed up to 1 month after discharge. Normally distributed data were expressed as mean ± standard deviation and skewed data as median. Nominal data between the two groups were compared using Chi-square test or Fisher's exact test. Results: Forty eyes underwent eye patching and 38 eyes cyanoacrylate gluing to reform the AC. The number of eyes with formed AC was more in Group 2 (92%) compared to Group 1 (70%) (P = 0.020). Subgroup analysis on the basis of the size of perforation and size of ulcer showed that AC reformation was better in Group 2 compared to Group 1 in all aspects [Table 1]. In intragroup analysis, success in Group 1 was significantly better in small perforations (P = 0.001) and in small ulcers (P = 0.032) and ulcer in central location (P = 0.004). In Group 2, there was no significant difference in AC reformation between small and large perforation or ulcer. In both groups, AC reformation in peripheral perforations was poor compared to central and paracentral perforations (P = 0.004, 0.032). Conclusions: Cyanoacrylate glue is better than eye patching to restore ocular integrity. However, eye patching showed promising results in subgroup of patients with small perforated ulcers.{Table 1}

Impact of cataract surgery on visual functions and quality of life in Azare, North-Eastern Nigeria Mohammed Dantani Adamu, Ahmed Saidu, Mahmud Alhassan Babanini, Ahmadu Shehu Mohammed Sudanese Journal of Ophthalmology 2018 10(2):60-63 Purpose: The purpose of this study is to assess the impact of cataract surgery on the subjective visual functions (VFs) and quality of life (QoL) of patients who had cataract surgery at the Federal Medical Centre Azare, Bauchi State, Nigeria. Materials and Methods: This was a hospital-based prospective observational study which used the VF and QoL questionnaires. These were administered to the patients preoperatively and also 6 weeks' postoperatively. The visual acuity, VF, and QoL scores of the pre- and post-operative period were compared. A paired t-test was used for comparison. Results: A total of 181 patients were recruited. The mean age of the patients was 60.5 years, and 110 (60.8%) were males. The mean preoperative VF and QoL scores were 55.1 (Standard deviation [SD] ± 19.7) and 39.5 (SD ± 17.8), respectively. The mean postoperative VF and QOL scores were 31.5 (SD ± 9.9, t = 18.79, P = <0.001) and 25.4 (SD ± 2.4, t = 10.87, P ≤ 0.001) respectively. Conclusion: This study shows that both VFs and QoL of cataract patients can be greatly improved with cataract surgery.

Distribution of xerophthalmia among children in the traditional quranic schools in Al-Gezira State of Sudan Zoelfigar Dafalla Mohamed, Saif Hassan Alrasheed Sudanese Journal of Ophthalmology 2018 10(2):64-67 Background: Vitamin A deficiency is considered a serious public health issue in poor nations, which leads to corneal opacity and results in childhood blindness in most of the low-income countries. Aim: To determine the prevalence of xerophthalmia among children at traditional Quranic schools in Al-Gezira state of Sudan. Materials and Methods: This was a quantitative cross-sectional study conducted on 822 children aged from 5 to 15 years, living in traditional Quranic schools. The clinical examinations for all children in this study include the demographics of patients (name, gender, age, and duration of students in schools), symptoms (vision during the day and night), and then outer eye checked for all children by lope and magnifier and visual acuity using Snellen's chart. Results: The prevalence of night blindness, conjunctival xerosis, corneal xerosis, and Bitot's spots was 17.3%, 20.3%, 0.2%, and 0.7%, respectively. There was a significant association between the duration of staying the children at the schools and the development of night blindness (P ≤ 0.02). Conclusion: Children of this community are susceptible to xerophthalmia because food is inadequate of Vitamin A. The governmental and nongovernmental organization should supply this community by the diet rich of Vitamin A and Vitamin A supplementation orally for affected children as well as annually comprehensive eye examinations.

A 28-Year-old male with anterior ectopic cilia and hypermetropic anisometropic amblyopia Hina Kauser, Monica Kapoor Sudanese Journal of Ophthalmology 2018 10(2):68-70 Only few cases of Eptopic cilia have been reported in literature. Anterior ectopic cilia cause no apparent ocular symptoms and can be surgically excised for cosmetic improvement. We report a case of a 28-year-old male with anterior ectopic cilia in association with hypermetropic anisometropic amblyopia. Only 15 cases of anterior ectopic cilia have been reported in literature. Few of them were associated with some conditions such as choristoma, aberrant lacrimal glands, atopic eczema, nail–patella syndrome, and hypochromic nevus. To the best of our knowledge, this is the first reported case of anterior ectopic cilia associated with hypermetropic anisometropic amblyopia. No underlying common causative disorder became evident. The observed association was considered as coincidental.