Nystagmus And Beyond: A Rare Ocular Motility Disorder

Joubert syndrome is a rare autosomal recessive disorder predominantly involving the cerebellar vermis and brain stem. It is characterized clinically by global developmental delay, abnormal ocular movements, hypotonia, ataxia, intellectual disability and neonatal breathing abnormalities. Due to its uncommon and unconventional presentation, its diagnosis is usually delayed. Diagnosis of this atypical disease essentially relies upon the atypical finding of the "molar tooth" sign on Magnetic Resonance Imaging (MRI). We report a case of a 5-year-old boy who presented with abnormal eye movements, regression of milestones and developmental delay. MRI investigation revealed the distinctive molar tooth sign and bat wing shaped 4th ventricle. It requires high levels of clinical suspicion and holistic approach to such children who present with delayed milestones and abnormal eye movements, to reach at early detection and diagnosis of such rare pathologies.

Corneal Complications And Visual Impairment In Vernal Keratoconjunctivitis Patients

BACKGROUND

Vernal kerato-conjunctivitis (VKC) is an infrequent but serious form of allergic conjunctivitis common in warm and humid areas where air is rich in allergens. It affects both eyes asymmetrically. Although VKC is a self-limiting disease but visions affecting corneal complications influence the quality of life in school children. The aim of this study was to list the corneal complications due to this condition and to find out the extent of visual impairment among VKC patients.

METHODS

This cross-sectional study was conducted in the department of Ophthalmology, Benazir Bhutto Shaheed Hospital on 290 eyes of diagnosed cases of VKC. The diagnosis of VKC was made on the basis of history and examination. Visual acuity was recorded using Snellen's notation and visual impairment was classified according to World Health Organization classification for visual disabilities.

RESULTS

The mean age of presentation was 10.83±6.13 years. There were 207 (71.4%) males and 83 (28.6%) females. Corneal scarring was observed in 59 (20.3%) eyes. Keratoconus was found to be in 17 (5.9%) eyes. Shield ulcer was detected in 09 (3.1%) eyes while 07 (2.4%) eyes had corneal neovascularization. Majority of the patients with visual loss had corneal scarring and the complication that led to severe visual loss in most of the eyes was Keratoconus.

CONCLUSIONS

Vernal kerato-conjunctivitis in the presence of corneal complications is a sight threatening disease and can lead to severe visual impairment.

PREVALENCE OF REFRACTIVE ERRORS IN MADRASSA STUDENTS OF HARIPUR DISTRICT

BACKGROUND

Visual impairment due to refractive errors is one of the most common problems among school-age children and is the second leading cause of treatable blindness. The Right to Sight, a global initiative launched by a coalition of non-government organizations and the World Health Organization (WHO), aims to eliminate avoidable visual impairment and blindness at a global level. In order to achieve this goal it is important to know the prevalence of different refractive errors in a community. Children and teenagers are the most susceptible groups to be affected by refractive errors. So, this population needs to be screened for different types of refractive errors. The study was done with the objective to find the frequency of different types of refractive errors in students of madrassas between the ages of 5-20 years in Haripur.

METHODS

This cross sectional study was done with 300 students between ages of 5-20 years in Madrassas of Haripur. The students were screened for refractive errors and the types of the errors were noted. After screening for refractive errors-the glasses were prescribed to the students.

RESULTS

Myopia being 52.6% was the most frequent refractive error in students, followed by hyperopia 28.4% and astigmatism 19%.

CONCLUSION

This study showed that myopia is an important problem in madrassa population. Females and males are almost equally affected. Spectacle correction of refractive errors is the cheapest and easy solution of this problem.

Use of supero-temporal free conjunctivo-limbal autograft in the surgical management of pterygium: our technique and results

BACKGROUND

A pterygium is a fibro-vascular, wing shaped encroachment of the conjunctiva on to the cornea. The prevalence rates ranges from 0.7 to 31% among different populations and also influenced by age, race, and exposure to solar radiations. Ultraviolet light-induced damage to the limbal stem cell barrier with subsequent conjunctivalisation of the cornea is the currently accepted aetiology of this condition. Indication of surgery include visual impairment, cosmetic disfigurement, motility restriction, recurrent inflammation and interference with contact lens wear. This Study was conducted to know the safety, efficacy and success with supero-temporal free conjunctivo-limbal auto graft transplantation in the surgical management of pterygium.

METHODS

Prospective case series where supero temporal free conjunctivo-limbal auto grafting was performed on 72 eyes of 72 patients with vascular progressive pterygia. Pterygium recurrence was considered a surgical failure. Recurrence was defined as fibro vascular tissue crossing the corneo-scleral limbus on to the clear cornea in the area of previous pterygium excision before 6 months.

RESULTS

Recurrence of pterygium was noted in three out of 72 eyes (4.16%), after a minimum follow up of 12 months to maximum of 25 months (Mean 14.6 months). No major intra-operative or postoperative complications were encountered.

CONCLUSION

Supero temporal free conjunctivo-limbal auto graft appears to be a safe and effective technique in the surgical management of pterygium. The inclusion of limbal tissue in the conjunctival auto graft following pterygium excision appears to be essential to ensure low recurrence rate.

Eclipse retinopathy: follow up of 36 cases after April 1995 solar eclipse in Pakistan

BACKGROUND

A study was carried out at the Department of Ophthalmology Ayub Medical College, Abbottabad from April 1995 to April 2002 to study the visual acuity changes in patients of solar eclipse retinopathy.

METHODS

Thirty-six patients with solar eclipse retinopathy were seen. Examination included assessment of Visual Acuity (VA), Slit Lamp examination, Fundoscopy, Fundus Photography and Fundus Fluorescein Angiography where the VA was 6/60. The patients were seen at weekly intervals then at monthly interval and later annually.

RESULTS

Poor visual acuity was seen in all patients, after images in 28 patients, Erythopsia in 25 patients and Central Scotoma in 23 patients. Eye involvement was unilateral in 27 cases and bilateral in 9 cases. Twenty-nine patients were male and 7 patients were female. The commonest age group was between 10-30 years.

CONCLUSIONS

Complete recovery was seen in 26 patients, 7 made partial recovery while in three patients the visual acuity remained poor. Maximum recovery occurred between two weeks to six months. After six months, no changes in the visual acuity or macular lesion were noticed.

Postoperative nausea and vomiting--a review

Post operative nausea and vomiting (PONV) remains an unpleasant and persistent problem for patients undergoing surgery. In fact PONV are among the most important factors contributing to delay in discharge of patients and an increase in unanticipated admissions after ambulatory surgery. Anesthesia providers are most often blamed for PONV, sometimes rightfully so, many times wrongly so. PONV is a multifactorial issue involving many physiological and biological mechanisms. As the trend towards ambulatory surgery increases, PONV continues to pose serious challenges for anesthesia providers because the potential cost savings of performing surgeries on an ambulatory basis may be negated by unanticipated hospital admission. Although PONV may be unavoidable in some patients for reasons we do not fully understand, there are risk factors that can be identified. As anesthesiologists it is essential for us to understand the mechanisms involved in nausea and vomiting and the available perioperative treatment options. We must do whatever we can to prevent and treat PONV and improve patient outcome for both medical and economic reasons.

Effects of PKC isozyme inhibitors on constrictor responses in the feline pulmonary vascular bed

The effects of Gö-6976, a Ca(2+)-dependent protein kinase C (PKC) isozyme inhibitor, and rottlerin, a PKC-delta isozyme/calmodulin (CaM)-dependent kinase III inhibitor, on responses to vasopressor agents were investigated in the feline pulmonary vascular bed. Injections of angiotensin II, norepinephrine (NE), serotonin, BAY K 8644, and U-46619 into the lobar arterial constant blood flow perfusion circuit caused increases in pressure. Gö-6976 reduced responses to angiotensin II; however, it did not alter responses to serotonin, NE, or U-46619, whereas Gö-6976 enhanced BAY K 8644 responses. Rottlerin reduced responses to angiotensin II and NE, did not alter responses to serotonin or U-46619, and enhanced responses to BAY K 8644. Immunohistochemistry of feline pulmonary arterial smooth muscle cells demonstrated localization of PKC-alpha and -delta isozymes in response to phorbol 12-myristate 13-acetate and angiotensin II. Localization of PKC-alpha and -delta isozymes decreased with administration of Gö-6976 and rottlerin, respectively. These data suggest that activation of Ca(2+)-dependent PKC isozymes and Ca(2+)-independent PKC-delta isozyme/CaM-dependent kinase III mediate angiotensin II responses. These data further suggest that Ca(2+)-independent PKC-delta isozyme/CaM-dependent kinase III mediate responses to NE. A rottlerin- or Gö-6976-sensitive mechanism is not involved in mediating responses to serotonin and U-46619, but these PKC isozyme inhibitors enhanced BAY K 8644 responses in the feline pulmonary vascular bed.