Open Access Case study

Retinal Astrocytoma: A Supportive Finding in Tuberous Sclerosis – An Experience from Nepal

Ranju Kharel (Sitaula), Barsha Suwal, Nabin Paudel, Jeevan Kumar Shrestha

Ophthalmology Research: An International Journal, Page 102-109
DOI: 10.9734/OR/2013/4127

Aims: Tuberous sclerosis is a multiorgan tumor syndrome that is characterized by retinal astrocytic hamartomas, astrocytic tumors of the CNS, several unusual cutaneous lesions, mental retardation, spasms and a variety of cysts and tumors of other organs.

Presentation of Case: Herein we report the cases of 2 children with a history of infantile spasm with angiofibromatosis lesions over the face, multiple ash-leaf lesions over the abdomen and retinal astrocytic hamartomas in the retina.

Conclusion: It is important to be cognizant of the likely presence of systemic and ocular pathology in a child with mental retardation and skin lesions. Identification of retinal phakomatosis during ocular evaluation in any suspected case of Tuberous sclerosis can aid in the establishment of the diagnosis of the disease.


Open Access Case study

Panophthalmitis Masquerading as Ocular Melanoma-an Eye Opener

Shashi Ahuja, Rajesh Nachiappa Ganesh, K. Praveen Kumar, Praveen Seth

Ophthalmology Research: An International Journal, Page 110-114
DOI: 10.9734/OR/2013/5295

Introduction: We report a clinicopathological correlation of a 45 year-old female who manifested as melanoma clinically and radiologically but turned out to have acute panopthalmitis on histopathology examination. We feel that there is significant clinical implication in sharing the knowledge of this clinico-pathological correlation.

Case Presentation: A 45 year- old female presented with complaints of sudden painful diminution of vision in left eye for five days. Examination revealed proptosis of left eye with neovascularization of iris, seclusiopupillae, and fundus details could not be visualized. Computerized Tomogram (CT) examination, 99m TC mibi whole body scan and Single-photon emission computed tomography (SPECT CT) were done. SPECT CT showed focal area of increased tracer uptake in anterior and superolateral aspect of choroid in left eye. Avid mibi tracer uptake in choroid of left eye suggested a high possibility of ocular tumor with involvement of retrobulbar portion of left optic nerve. Histopathological examination revealed panophthalmitis with dense neovascularization of the choroid and ciliary body. No tumor cells or necrosis were evident in the sections studied. Sections from optic nerve showed extensive perineurialedema. Immunohistochemistry with Melan A, S-100 and HMB-45 were performed on multiple sections and were negative, thus excluding the possibility of melanoma.

Conclusion: Painful blind eye is a major therapeutic dilemma for ophthalmologist and findings such as avid mibi tracer uptake in the choroid of left eye suggested a high possibility of ocular tumor. We wish to emphasise that inflammatory pathologies of the eye can masquerade as malignancies and to highlight the limitations of the state.


Open Access Original Research Article

Postoperative Use of Cyclosporine, Prednisolone or a Cyclosporine/Prednisolone Combination to Treat Inflammation of the Conjunctiva Following Trabeculectomy in Rabbits

Heloisa Helena Russ, Nubia Vanessa Lima de Faria, Palloma Rose, Fabiano Montiani-Ferreira, Paulo Augusto de Arruda Mello, Sebastião Cronemberger

Ophthalmology Research: An International Journal, Page 74-88
DOI: 10.9734/OR/2013/4933

Objectives: The objective of this investigation was to compare different topical treatment protocols for controlling inflammation in rabbits during the postoperative period following trabeculectomy.

Methods: Thirty rabbits had their right eyes treated with a daily eye drop of 0.03% bimatoprost for 30 days. All rabbits then underwent a trabeculectomy procedure and were divided into three groups (G1, G2 and G3). Rabbits from G1 received prednisolone acetate 1.0% four times a day, G2 received cyclosporine 0.05% twice a day and G3 received both prednisolone acetate 1.0% four times a day and cyclosporine 0.05% twice a day. Seven days after the surgery all rabbits were euthanized and enucleated. Histomorphometry was performed in HE-stained sections to evaluate epithelial thickness, blood vessel diameter and vascular area. Immunohistochemical staining using monoclonal antibodies against smooth muscle actin, factor VIII and IL-6 was performed to assessfibrosis, neovascularization and inflammatory cell infiltration, respectively.

Results: In group G3 there was a reduction in the thickness and diameter of the conjunctival epithelium and the diameter and number of blood vessels, and less inflammatory infiltrate and fibrosis.

Conclusion: This study suggests that a combination of prednisolone and cyclosporine is more effective than either of these drugs used alone to control postoperative conjunctival inflammation following trabeculectomy in rabbits.


Open Access Original Research Article

Utilization of Eye Care Services among Ghanaian Elderly Population: Evidence from a Peri-Urban Community

Stephen Ocansey, Akwasi Kumi-Kyereme, Kofi Awusabo-Asare, Alex Azuka Ilechie, Samuel Bert Boadi-Kusi, Carl Halladay Abraham

Ophthalmology Research: An International Journal, Page 89-101
DOI: 10.9734/OR/2013/5543

Introduction: Despite being more affected by visual impairment and blindness than any other population age group, the elderly are least likely to seek help when faced with eye problems. Eye care utilization among the aged is influenced by a number of predisposing, enabling and need factors.

Aim: To assess the eye care needs and utilization of eye care services among Ghanaian elderly population.

Methods: A cross sectional survey of 170 elderly persons (52.0% of those eligible) aged 60+ years in a peri-urban community in the Central Region of Ghana was conducted. They were purposively sampled and interviewed using a semi-structured questionnaire to collect information regarding demographics, eye care use, barriers and eye care seeking behavior. They also underwent ophthalmic examination.

Results: The mean age of the respondents was 70 years with 58.2% of them being females. About one third 61(35.8%) had never had an eye examination in their lifetime. Among 137 (80.5%) individuals identified with eye problems that needed care at the time of the examination, 76.9% self-reported eye problems before examination but only 51.2% had utilized eye services in the previous five years. Nearly three out of four (75%) were registered with the national health insurance scheme (NHIS). Conditions identified were cataract in 117 (29.2%) eyes, uncorrected refractive error 75(18.8%), pterygium/pinguiculi 55(13.8%), presbyopia 40(10.0 %), and retinal disorders in 23(5.8%) eyes.  By proportion, more males (59%) than females (45.5%), increasing age and those with higher level of education utilized eye care.  The study showed that sex, education but not age were statistically related to the utilization of eye care services (P = 0.05).

Conclusion: A large proportion of the elderly who require eye care are currently not utilizing eye care services. The barriers that lead to the low utilization of eye care services among the elderly should to be explored to reduce the burden of visual impairment.