Prevalence and Treatment Outcome of Nasolacrimal Duct Obstruction in Saudi Children with Down Syndrome

Introduction

Congenital nasolacrimal duct obstruction (CNLDO) is one of the most common congenital abnormalities encountered by pediatric ophthalmologists, occurring in 20-30% of all neonates (range: 6-84%). The majority of the cases (up to 90%) resolve within the first year of birth. Many syndromes, such as Down syndrome, are associated with congenital lacrimal anomalies. The prevalence of nasolacrimal anomalies in Down syndrome has been reported to be 22%.

Methods

This was a retrospective study of all children diagnosed with Down syndrome at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia between 2010 and 2015.

Result

The total sample size was 175 patients; 15 patients were diagnosed with CNLDO with a prevalence of 8.57%. The prevalence among the gender was 53.3% male and 46.7% female, with a median age of eight years. Regarding ocular disorders, 20.0% cases were diagnosed with refractive error, 13.3% with nystagmus, and 13.3% with blepharitis. Myopia, strabismus, conjunctivitis, and cataract were observed in four different patients, and the remaining four cases reported no other ocular disorders. Tearing, alone or associated with other symptoms, was the main presentation of CNLDO (86.7%). Bilateral CNLDO was the most commonly observed abnormality, alone or associated with others. The median age at diagnosis was one year. Of the cases, 53.3% were treated medically, 26.7% by surgical correction, and 13.3% required both.

Conclusion

Bilateral CNLDO is the most observed disease pattern among children with Down syndrome. In our study, tearing was the most common clinical presentation and most cases were treated medically. Down syndrome patients should be carefully examined for nasolacrimal duct obstructions and treated medically.

Visual outcome with +10 diopter sphere correction after intracapsular cataract extraction

BACKGROUND

The aim of curing cataract blindness is to restore the patient's vision after surgery. The aim of the study was to determine the proportion of surgeries done for cataract blind patients and the visual outcome with +10 diopter sphere (DS) aphakic correction in two consecutive years.

METHODS

Of the cataract operations done in the years 1995 and 1996, 8-15 cases were selected from each month by proportionate simple random sampling. Thirty-two (32) were excluded for incomplete or missing records. One hundred and eighteen (118) and one hundred (100) patient records were analyzed for 1995 and 1996 respectively.

RESULTS

The patients' ages ranged from 40 to 80 years and all had age related cataract. There were 161 males and 57 females. All had intracapsular cataract extraction (ICCE) without intraocular lens implantation. Eighty-nine patients (75%) and seventy-six patients (76%) had their sight restored in 1995 and 1996 respectively. The proportion of surgeries on blind patients' was 31% and 42% respectively. The proportion of those who remained blind after surgery was the same for both years (2%). Using chi-square test, there was a statistically significant difference in the patients' vision status after ICCE with +10 DS correction (1995, p = 0.021; 1996, p = 0.017) but no difference in the visual outcome due to gender. [1995, p = 2.09; 1996, p = 1.98 (Yates correction applied)] [corrected].

CONCLUSION

Intracapsular cataract extraction with +10 DS correction improves the patients vision status and priority must be given to those already blind.

Prevalence and causes of blindness and low vision in Dambatta local government area, Kano State, Nigeria

In 1995 a population based cross sectional blindness prevalence survey was conducted in Dambatta local government area (LGA). 3596 people were examined. The prevalence of blindness was 1.14% with 95% confidence limit of (0.8-1.48%). The causes of blindness are cataract 54%, Trachoma 17%, Glaucoma 15%, Corneal opacity 7%, other blinding conditions 7%. The prevalence of low vision was 2.05% with 95% confidence limit (1.60-2.50%). One percent of the population were severely visually impaired (WHO category 2). The causes of low vision are cataract 55%, corneal opacity 14%, uncorrected aphakia 11%, Glaucoma 7%, Refractive error 5%, other conditions 8 percent. Cataract was the leading cause of uniocular blindness with 53%, others were phthisis bulbi 17%, Trauma 14%, corneal opacity 10%, and others 7 percent. Cataract was the single most important cause of blindness, low vision and uniocular blindness accounting for 54%, 55%, and 53%, respectively. Uncorrected aphakia accounted for 11% of the low vision group, 80% of these had couching. This study showed that 93% of the blindness was avoidable in the sense that it could have been primarily prevented or, is treatable. 92% of the causes of low vision are avoidable.