Assessment of delays in presentation of patients with retinal detachment to a tertiary referral centre

The referral pathway of patients with retinal detachment from primary care providers to a tertiary care ophthalmic unit was examined, in order to determine the length and source of any delays between the onset of symptoms and arrival at the hospital. A prospective survey of all symptomatic patients (n = 60) admitted for primary rhegmatogenous retinal detachment surgery was carried out over an 8 week period. Twenty-one patients were referred by their optometrists and 18 by their general practitioners. The remainder were referred by local accident and emergency and ophthalmic departments or presented directly to the tertiary referral centre. Patients who presented to their optometrists were symptomatic for an average of four times longer. More than half the patients thought that the time to initial presentation was the most significant delay. Referral from optometrists via general practitioners and local ophthalmic clinics was considerably longer. Increased awareness of symptoms, necessity of urgent referral and knowledge of available services locally may reduce delay for those who require emergency sight-saving surgery.     

Patterns of uveitis in a tertiary eye care center in Iran

Purpose: To identify the distribution and characteristics of new uveitis referrals to a tertiary eye care center in Tehran. Methods: A three-year prospective study was carried out to obtain information on 544 new patients referred with uveitis. A complete ophthalmologic examination was performed in all cases; a routine set of tests and an additional battery of directed workup were conducted when indicated. Results: Mean age was 32.3 years. There was no significant sex predominance. The most common forms of uveitis were anterior (38.4%) vs. other anatomical forms, chronic (62.1%) vs. acute (28.3%), nongranulomatous (85.5%) vs. granulomatous (14.5%), and noninfectious (83.5%) vs. infectious (16.5%). With regard to etiology, 45.5% were idiopathic, 19.9% were due to specific ocular disease, and 37.3% were associated with systemic disorders. Behçet's disease was the most common noninfectious disease and toxoplasmosis the most common infectious entity. The most prevalent causes were idiopathic, Fuchs' heterochromic iridocylitis, and seronegative spondyloarthropathies in anterior uveitis; toxoplasmosis, Eales disease, and toxocariasis in posterior uveitis; idiopathic, sarcoidosis, and multiple sclerosis in intermediate uveitis; and, finally, Behçet's disease, idiopathic, and Vogt-Koyanagi-Harada syndrome in panuveitis. The most frequent cause in patients under 16 years of age was pars planitis. Over 80% of the patients belonged to middle-to-upper socioeconomic classes. Uveitis significantly affected patients' lives in 63.1% of the cases. Conclusion: Although the current study was performed at a referral center, it may reflect to some extent the different distribution of uveitis in Iran and probably other Middle Eastern countries. Some entities such as presumed ocular histoplasmosis were not found, cytomegalovirus retinitis and birdshot chorioretinopathy were extremely rare, and HLA-B27-associated iridocyclitis was less commonly observed. In contrast, Behçet's disease, Fuchs' heterochromic iridocyclitis, Eales disease, and toxocariasis were among the more prevalent entities.     

Status of pediatric eye care in India

Purpose:

To document the status of pediatric eye care in India.

Materials and Methods:

A list of institutions providing eye care was compiled from various sources, including government officials, professional bodies of ophthalmologists, and national and international non-governmental organizations (NGO) working in the field of eye care in India. A questionnaire on eye care services was sent to all known eye care institutions in the country. Workshops and regional meetings were organized to maximize response. Validity of data was ensured by observational visits to 10% of the institutions who responded.

Results:

Out of 1204 institutions contacted, 668 (55.5%) responded to the questionnaire. Of these, 192 (28.7%) reported that they provided pediatric eye care services. A higher proportion (48.3%) of NGO hospitals reported separate pediatric ophthalmology units compared to other providers (P< 0.001). Eighty per cent of advanced care eye hospitals had dedicated outpatient, and 40% had dedicated inpatient facilities for children (P< 0.001). The advanced eye care hospitals attended to a larger number of pediatric clients (P < 0.001), and performed more pediatric eye surgeries compared to secondary and tertiary care hospitals (P < 0.001). Eighty- three per cent of advanced care centers and 72.4% of NGO hospitals had an anesthesiologist for pediatric eye service. Refractive error was the commonest reason for seeking service. The commonest surgical procedure was pediatric cataract surgery followed by squint surgery.

Conclusion:

Pediatric eye care services are not adequate in India.     

马来西亚西部小儿眼外伤研究

目的：调查5a 期间就诊于马来西亚西部三级转诊中心的小儿眼外伤患者的视力结果。
　　方法：回顾性研究。对所有2009-01/2013-12就诊于急诊创伤科的连续患者进行筛检,选取年龄在15岁以下的眼外伤患者纳入研究对象。排除随访患者。收集患者人口统计学数据、既往治疗和眼部病史资料。详细记录眼外伤情况,治疗和疾病发展情况。
　　结果：小儿眼外伤的患病率为每年17.6/100000。其中男性患者占69.5%(296/426例)。患者的平均年龄为6.08依2.24岁。家用工具(19.7%)和摔伤(19.7%)是致眼外伤最常见的原因。多数患者(79.9%)救诊时的视力≥6/12。眼前节(93.9%)最容易受伤,22.8%的患者需要手术治疗。相对性瞳孔传入障碍与闭合性眼球损伤程度(P =0.001)及不良视力预后( P =0.001)相关。大多数患者(92.7%)的最终视力≥6/12。
　　结论：须提高对小儿眼外伤的预防意识并及时进行治疗,以确保患者视力的最大程度恢复。     

Patient expectations for medical and surgical care: a review of the literature and applications to ophthalmology

Over the past several decades, emphasis on patient-centered care, the dramatic growth of refractive surgery in the United States, and increasing competition in the eye care marketplace have made patient expectations increasingly important in the field of ophthalmology. Patient-centered care recognizes the obligation to understand and meet patient's expectations. Despite increasing patient expectations for refractive surgery and eye care in general, however, there has been limited research on patient expectations within the field of ophthalmology. The vast majority of existing research on patients' expectations has focused on expectations of primary care physicians. Because ophthalmologists are involved in both surgical and medical care, it is important to expand the consideration of patient expectations beyond the traditional primary care setting. Using elements of the taxonomy developed by Kravitz (Kravitz RL: Patients' expectations for medical care: an expanded formulation based on review of the literature. Med Care Res Rev 53:3-27, 1996), this article reviews the existing literature on patient expectations and draws attention to the limited research in specialty and surgical fields. This article has the following objectives: 1) provide a context for understanding what patient expectations are, 2) review the different ways that patient expectations are measured, 3) illustrate the content of patient expectations from empirical research, 4) outline potential determinants of patient expectations, and 5) discuss the role of patient expectations in ophthalmology.     

Role of pre-operative percutaneous embolization in orbital alveolar soft part sarcoma – An experience from a tertiary eye-care center

Purpose:To describe the clinic-radiological, pathological profile, and management outcomes of primary alveolar soft-part sarcoma (ASPS) of the orbit.Methods:A retrospective analysis of all histopathologically proven cases of orbital ASPS that presented between May 2016 and September 2019 was done. Data collected included demographics, clinical features, imaging characteristics, metastatic workup, management, and follow-up.Results:Five patients, of which four were males, presented to us during the study period. The mean age of presentation was 12.6 years (range 3–22 years). The most common presenting features were abaxial proptosis (n = 4) and diminished vision (n = 4). Imaging showed a well-defined orbital mass in all patients with internal flow voids in three. Preoperative percutaneous embolization with cyanoacrylate glue was done in these three patients owing to high vascularity. Four patients underwent complete tumor excision. One patient underwent exenteration. Histopathology showed polygonal tumor cells arranged in a pseudo-alveolar pattern and Periodic Acid-Schiff (PAS) positive crystals in the cytoplasm in all patients. One patient had systemic metastasis at presentation and developed a local recurrence after 3 months. No recurrence or metastasis was noted in the remaining four patients at a mean final follow-up of 11.2 months (range 5–15 months).Conclusion:ASPS is a rare orbital neoplasm that poses a diagnostic and therapeutic challenge. Imaging might show a soft-tissue tumor with high vascularity. Multidisciplinary management with interventional radiologists for preoperative embolization of vascular lesions helps minimize intraoperative bleeding and aids in complete tumor resection. A localized orbital disease carries a better prognosis.     

Trends in vitreoretinal surgery at a tertiary referral centre: 1987 to 1996

AIM: To identify trends in vitreoretinal surgery at a tertiary referral centre from 1987 to 1996. METHODS: A retrospective study of patients who had undergone vitreoretinal surgery at St Paul's Eye Unit over two 6 month periods in 1987 and 1996. Preoperative ocular status, surgery details, and outcome were collected. chi 2 and Mann-Whitney U tests were used to analyse the data. RESULTS: The two periods under study were July to December 1987 and January to June 1996. 110 operations performed during 1987 (96 patients) and 330 operations during 1996 (289 patients) were analysed. There was a fourfold rise in the number of tertiary referrals and a seven-fold rise in the number of operations performed for conditions other than rhegmatogenous retinal detachment (RRD). Increasing indications for surgery included diabetic eye disease, macular hole, dropped nucleus, endophthalmitis, and subretinal neovascular membrane. There was a rise in the proportion of patients with RRD following cataract surgery (from 19.5% to 29.5%). For both primary repair and reoperation, vitrectomy with internal tamponade was more commonly used in 1996. The anatomical success rate for primary repair changed from 76.6% to 84.7% after one operation and from 89.1% to 94.3% following additional surgery. CONCLUSIONS: This study points to a trend towards subspecialisation and tertiary referral in vitreoretinal surgery. Vitrectomy techniques are more commonly used for the primary repair of RRD and are applied to a wider spectrum of diseases.     

Cross-sectional observational analysis of the genetic referral practices across pediatric ophthalmology outpatient departments in an urban setting

Purpose:To analyze the genetic referral practices of pediatric ophthalmologists in an urban setting.Methods: (1) The first limb of the study: cross-sectional, observational study among children visiting the outpatient department of pediatric ophthalmology across five centers in Mumbai. All pediatric patients were screened separately by pediatric ophthalmologists and a clinical geneticist for their ophthalmic and systemic complaints. Children were marked for referral to genetics (RTG) by both the specialists based on identification of distinctive features (red flag) and were requested to meet a local geneticist. (2a) Twenty-three months later, patients who had been marked for RTG were contacted telephonically to follow-up if they had met the geneticist. (2b) Additionally, the last 20 proformas from each center were checked retrospectively to note the RTG marked by the ophthalmologist alone.Results: (1) In the first aspect of the study, 126 patients (male: female = 1.2:1) were included. Forty-nine (38.3%) patients were referred for genetic evaluation, of which three (6.1%), 31 (63.26%), and 15 (30.6%) cases were referred by the ophthalmologist alone, geneticist alone, and by both the specialists, respectively. Glaucoma (100%), nystagmus (86%), and leukocoria (83%) were the most prominent ocular diagnoses in cases referred for genetic evaluation. Facial dysmorphism (55.1%) and neurodevelopmental delays (51%) were among the most common systemic red flags found in patients referred to genetics. (2a) Twenty-three months later, on contacting the 49 patients marked for RTG, only one family had met the geneticist. (2b) Retrospective evaluation of 100 proformas: only three patients were marked for RTG by ophthalmologist alone.Conclusion: This study found that the genetic referrals by pediatric ophthalmologist were far lesser than those by geneticist. The study highlights an area of knowledge gap among pediatric ophthalmologists, prompting a need for heightened awareness in this area.     

A survey of the availability of state-funded primary eye care in the UK for the very young and very old

BACKGROUND: The National Health Service (NHS) provides General Ophthalmic Services (GOS) to eligible patients in the UK. Nearly all community optical practices have a contract with the NHS via local primary care organisations (primary care trusts in England) allowing the practices to provide NHS sight tests to eligible patients. OBJECTIVE: To determine the accessibility of GOS sight tests for certain groups of patient in the UK. METHOD: A telephone survey was carried out to investigate the availability of GOS sight tests for two categories of eligible patient. A total of 200 primary eye care practices were randomly selected, of which 100 were telephoned to establish the availability of a sight test for a child aged 1 year whose mother is concerned due to the presence of a family history (parental) of strabismus. The other 100 practices were telephoned to investigate the availability of a sight test for a person aged 90 years who was described as having dementia. RESULTS: A total of 199 of the 200 practices provided GOS sight tests. The mean age at which practices declared that they start examining children was 3.1 years. Most (76%) practices recommended an eye examination for the 1-year-old child, but only 46% said that they would carry this out themselves. Of the other 100 practices telephoned across the country, 93% said that they could arrange an eye examination for the patient with dementia. DISCUSSION: Of the UK optical practices that participated in this study, 99.5% provide GOS sight tests. About half of these would not offer a GOS sight test to a 1-year-old child. It has been suggested that the GOS Terms of Service do not permit practitioners to exclude categories of patients from GOS services, although we argue that this interpretation is equivocal. Indeed, it is suggested that clinical and ethical reasons may sometimes require practitioners to decline to examine certain categories of patient. It is worrying that one quarter of practices did not recommend an eye examination for a young child with a family history of strabismus. It is hoped that a continuing education and training project will increase interest in paediatric optometry.     

Cost of pediatric cataract surgery in Maharashtra, India

AIM: To calculate the direct cost of pediatric cataract surgery, from the provider's perspective. METHODS: The direct cost was calculated using standard costing methods in a pediatric ophthalmology department of a comprehensive community eye care center in western India. Fixed costs included those of the building, interior decoration, out patient department's equipment, operation theater equipment, personnel, administration and hospital maintenance. The consumable costs included materials used during surgery. Only direct costs were considered. RESULTS: The average direct costs were Indian rupees (Rs.) 69 ($1.77) for an outpatient department consultation, Rs.606 ($15.53) for operation theater equipment use, and Rs. 2 427($62.23) for personnel. The consumable costs ranged from Rs.1 452 ($37.23) to 15 267 ($391.46), depending on the protocol used. The net average cost of pediatric cataract surgery ranged from Rs. 4 722 ($122) to Rs. 18 537 ($475) per eye. CONCLUSION: Cataract surgery is cost intensive for children with cataract. Pediatric ophthalmologists should decide about most cost effective standards of care to rationalize consumable cost.     

印度马哈拉施特地区儿童白内障的手术费用

目的:评估儿童白内障手术患者所需的直接费用。方法:在印度西部的一个综合社区护眼中心的小儿眼科,使用标准成本评估患者所需的直接费用。固定费用包括外部建设、室内装修、门诊设备及手术室设备、人员、管理和医院维护费用。消耗品费用包括用于手术的材料。同时,计算患者的直接费用。结果:门诊检查平均直接费用为印第安卢比(Rs.) 69( $1.77)。手术室设备使用费用为Rs.606 ( $15.53),而职工工资为Rs. 2427 ( $62.23)。根据诊治记录计算得出消耗品费用在Rs.1452( $37.23)到15267( $391.46)范围之间。而儿童白内障手术每只眼睛所需平均费用从Rs.4722 ( $122)到Rs.18537 ( $475)不等。结论:儿童白内障患者手术费用在较大的范围内变动。小儿眼科医生应以最节约有效的治疗方案达到手术消耗品的费用合理化。     

印度马哈拉施特地区儿童白内障的手术费用

目的：评估儿童白内障手术患者所需的直接费用.方法：在印度西部的一个综合社区护眼中心的小儿眼科,使用标准成本评估患者所需的直接费用.固定费用包括外部建设、室内装修、门诊设备及手术室设备、人员、管理和医院维护费用. 消耗品费用包括用于手术的材料.同时,计算患者的直接费用. 结果：门诊检查平均直接费用为印第安卢比（Rs.） 69 （$1.77）.手术室设备使用费用为Rs.606 （$15.53）,而职工工资为Rs. 2 427 （$62.23）.根据诊治记录计算得出消耗品费用在Rs.1 452（$37.23）到15 267（$391.46）范围之间.而儿童白内障手术每只眼睛所需平均费用从Rs.4 722 （$122）到Rs.18 537 （$475）不等.结论：儿童白内障患者手术费用在较大的范围内变动. 小儿眼科医生应以最节约有效的治疗方案达到手术消耗品的费用合理化.     

Cost of pediatric cataract surgery in Maharashtra,India

AIM:To calculate the direct cost of pediatric cataract surgery,from the provider’s perspective. METHODS:The direct cost was calculated using standard costing methods in a pediatric ophthalmology department of a comprehensive community eye care center in western India. Fixed costs included those of the building,interior decoration, out patient department’s equipment,operation theater equipment,personnel,administration and hospital maintenance.The consumable costs included materials used during surgery.Only direct costs were considered. RESULTS:The average direct costs were Indian rupees (Rs.)69($1.77)for an outpatient department consultation, Rs.606($15.53)for operation theater equipment use,and Rs. 2 427($62.23)for personnel.The consumable costs ranged from Rs.1452($37.23)to 15 267($391.46),depending on the protocol used.The net average cost of pediatric cataract surgery ranged from Rs.4 722($122)to Rs.18 537($475) per eye. CONCLUSION:Cataract surgery is cost intensive for children with cataract.Pediatric ophthalmologists should decide about most cost effective standards of care to rationalize consumable cost.     

Incidence of re-surgery after manual small-incision cataract surgery at a tertiary eye-care center in South India

Purpose:To study the incidence of re-surgery after manual small-incision cataract surgery (MSICS) at a tertiary eye-care center in South India and to compare the re-surgery rate between trainees and experts.Methods:A retrospective study was conducted at a tertiary eye-care center in Andhra Pradesh state of South India, which included 19,515 patients who underwent MSICS between 2012 and 2022 with 369 eyes of 369 patients who underwent re-surgery within 1 week of primary surgery. Factors included demographic data, type of re-surgery, that is, wound re-suturing, IOL repositioning, cortical wash, as well as anterior chamber (AC) wash.Results:19,515 eyes from the year 2012–2022 were analyzed. Most of the patients undergoing re-surgery belonged to the age group of 61–70 years (40.3%). Wound re-suturing was the more frequently performed re-surgery (47.6%). Wound re-suturing rates were comparable between the trainees and experts, whereas IOL repositioning, cortical wash, and AC wash were higher in the cases performed by trainees though statistically not significant.Conclusion:Careful pre-operative assessment, training under supervision, and other measures can be taken to reduce the re-surgery rates. Timely diagnosis and early treatment can give better outcomes and prevent devastating complications like endophthalmitis.     

Rhino-orbital-cerebral mucormycosis: An epidemiological study from a tertiary care referral center in Western India

Purpose:Rhino-orbital-cerebral mucormycosis (ROCM) is a rare opportunistic fungal infection with a fulminant course and an often fatal outcome. It can occur in immune-compromised patients such as those having uncontrolled diabetes, on long-term corticosteroid or immunosuppressive therapy, with COVID-19 infection, renal failure, AIDS, malignancy, or organ transplant. The aim of our study was to study the epidemiology of mucormycosis in COVID-19 patients and identify its risk factors.Methods:Ours was an epidemiological study wherein we gathered the demographic, clinical, histopathological, and radiological data of 458 patients of mucormycosis who presented to us between August 2020 and May 2021. Mucormycosis was defined through clinical and radiological findings or positive culture reports.Results:Out of all, 20.74% of patients did not have any past or concurrent history of COVID-19. The most common symptom of mucormycosis was orbital/facial pain (38.64%) and the most common sign was periocular/facial edema (50.74%). Mucormycosis involving the nose and sinuses (94.54%) was most common followed by rhino-orbital (45.41%) and brain involvement (10.04%). The most common risk factor for mucormycosis was diabetes [81.92%], followed by corticosteroid use [79.69%] and supplemental oxygen [48.90%]. Most of the patients received similar treatment with IV amphotericin B [88.64%] and local debridement [80.74%]Conclusion:With the third wave of COVID-19 still lurking, a fatal fungal infection should be kept in mind in COVID-19 active as well as recovered patients, especially those who have co-morbid medical conditions such as uncontrolled diabetes and who are treated with large doses of corticosteroids.     

A study of the spectrum of Acanthamoeba keratitis: a three-year study at a tertiary eye care referral center in South India

PURPOSE: To determine the epidemiological and clinical characteristics of Acanthamoeba keratitis and also to determine the sensitivity and specificity of smears in the detection of Acanthamoeba. MATERIALS AND METHODS: A retrospective review of all culture-positive cases of Acanthamoeba keratitis seen between October 1999 and August 2002 was performed. Corneal scrapes were subjected to culture and microscopy using standard protocols. RESULTS: Out of 3183 consecutive patients with clinically diagnosed corneal ulcers evaluated, 33 (1.04%) were found to be due to Acanthamoeba. Twenty-four out of 33 (72.72%) were less than 51 years of age (P<0.001). All patients were from rural areas (P<0.001) and 26 (78.79%) of them were agricultural workers (P=0.031). All 33 had history of corneal injury (P<0.001) and 28 (84.85%) patients had injury with mud (P<0.001). All 33 (100%) patients had previous medical treatment (P=0.009) and 10 (30.3%) had used traditional eye medicines (P=0.183). A clinical pattern of ring infiltrate was characteristic in 15 (45.45%) patients. The diameter of the corneal ulcer was more than 6 mm in 27 (81.82%) eyes (P<0.001). Twenty-six (78.79%) patients had visual acuity of perception of light on initial presentation (P<0.001) and 24 (72.73%) had the same as their final visual outcome. The sensitivity of 10% potassium hydroxide (KOH) preparation was found to be higher (P<0.001) in the detection of Acanthamoeba cysts. CONCLUSION: The incidence of Acanthamoeba keratitis amongst the corneal ulcer patients was 1% in this setting and it was mainly due to corneal injury by mud. The KOH preparation is a sensitive diagnostic tool for the detection of Acanthamoeba. Delayed diagnosis or misdiagnosis and inappropriate antimicrobial therapy results in poor visual outcome.     

Human papillomavirus in retinoblastoma: A tertiary eye care center study from South India

Purpose:This study is aimed to investigate the presence of Human papillomavirus (HPV) DNA in tumors obtained from sporadic retinoblastoma patients.Methods:One hundred six tumor tissues obtained from sporadic RB patients were analyzed for HPV infection by use of both seminested PCR and real-time quantitative PCR.Results:Of 106 RB patients, 55 were male and 51 were female. The mean age at diagnosis was 26.77 ± 15.36 (mean ± Std. dev) months. Almost all patients presented with leukocoria. Molecular investigation by different methods revealed no HPV positivity in any tumor genome.Conclusion:Our study demonstrates no association between HPV and RB, postulating HPV may not be a major risk factor in the etiology of RB.     

角膜病进修医师临床教学模式探讨

 角膜病是眼科常见病和多发病,在基层医院眼科疾病的诊治中占有较高的比例,对眼科进修医生进行有针对性的专科门诊、手术和理论体系的培训,可以使进修医生在短期内掌握规范的角膜病诊断和治疗技术,提高基层的眼科医疗水平。     

Clinical profile of medicolegal cases presenting to the eye casualty in a tertiary care center in India

Purpose:The purpose of this study was to analyze the clinical profile of medicolegal cases (MLCs) presenting to the eye casualty in a tertiary care hospital.Results:Out of 188 MLCs, 164 (87.2%) were male. Mean age (±standard deviation) was 31.6 (±12.7) years. Age ranged from 7 to 75 years. Twenty-six (13.8%) patients had bilateral involvement. The fist was the most common mode of injury, which was seen in 109 (58%) cases. A total of 27 (14.3%) patients had associated extraocular injury. No evidence of ocular or orbital trauma (malingering) could be found in 13 (7%) patients. Mechanical trauma was present in 169 (90%) patients with injury to globe in 129 (69%) patients and injury to lid or orbit without damage to the globe in 40 (21%) patients. Chemical injury was observed in 6 (3%) patients. Closed globe injury (CGI) was seen in 116 eyes and open globe injury (OGI) was noted in 29 eyes. The most common type of injury, zone, pupil, and grade of injury in CGI were Type A or contusion (79%), Zone I (72%), Pupil B (absence of relative afferent pupillary defect) in 95%, and Grade A [visual acuity (VA) ≥20/40] in 68% of the eyes, respectively. The most common type of injury, zone, pupil, and grade of injury in OGI were Type B or penetrating (48%), Zone II (38%), Pupil B (59%), and Grade D (VA 4/200-light perception) (42%), respectively.Conclusions:The most common form and mode of ocular injury in MLC were closed globe injury and fist, respectively. The most common type of injury in CGI and OGI was contusion and penetrating injury, respectively.