Ophthalmic Cases Research Articles

Surgical Outreach as a Tertiary Hospital's Corporate Social Responsibility

Introduction: The underserved populations of the rural and suburban communities of developing countries are challenged by the twin hurdles of low-income earning and out-of-pocket payment for surgical care services. This study aims at appraising the process, outcome, and impact of a free surgical outreach programme carried out by a Federal Teaching Hospital in South-western Nigeria. Methods: A free day-case surgical outreach programme was announced through a popular radio jingle for a period of 1 week to attract would-be beneficiaries of the programme. A 2-day screening exercise was conducted by the concerted efforts of various specialists in the department of surgery and ophthalmology to select those who are suitable for day-case surgery. A cross-sectional survey of patients who participated in the 5-day surgical outreach programme was carried out. A structured questionnaire was used to obtain information on biodata, diagnosis, surgical operations, complications, and level of satisfaction. A 3-point bipolar satisfaction outcome scale was used to assess the level of satisfaction. The data obtained were analyzed using the SPSS software version 20.0. Results: One hundred and fifty-eight patients were screened, but only 124 participated. Ophthalmic cases constituted 60.5%, whereas the rest (39.5%) were non-ophthalmic cases. Patients with cataract were 73 (58.9%) of all the surgical lesions operated during the outreach programme. Two (1.6%) patients with pterygium were the other ophthalmic cases, whereas the non-ophthalmic cases were mainly hernias. A total of 129 surgical operations were performed in the 124 patients, with 5 (0.4%) of them having bilateral cases. One hundred and seventeen patients (94.4%) expressed satisfaction with their experience of the programme. Conclusions: Optimal corporate social responsibility of tertiary hospitals can be performed effectively and satisfactorily through a properly organized surgical outreach.

Teleophthalmology for Eye Care during Coronavirus Disease 2019 Pandemic: Opportunities and Challenges

The coronavirus disease 2019 (COVID-19) pandemic illustrated the significance of using telemedicine for medical services to minimize the risk of infection more than ever. The implementation of telemedicine in the realm of eye expertise (teleophthalmology) has made it possible for both ophthalmic patients and COVID-19 positive cases to be taken care of in different ways of prevention, diagnosis, treatment, and follow-up. This study aimed to discuss the ophthalmology challenges during the COVID-19 outbreak based on existing evidence, followed by proposing some solutions for utilizing telemedicine.

Current practices of Nepalese veterinarians for the clinical management of pain in animals

The retrospective study was performed to know the trend of recent clinical practices for managing the post-surgical and non-surgical pain in animals. The study included government hospitals, private clinics, organizations working on animal birth control program of Chitwan, Kathmandu, Lalitpur, and Kaski districts of Nepal. Overall, 1,177 and 1,084 animals received analgesics in 2017 and 2018, respectively. Categorically, 81% of cases underwent for soft tissue surgeries, and analgesics were prescribed variably for 1–5 days. However, 5% and 1% were orthopedic and ophthalmic cases that were treated with analgesics for 1–8 days. Remaining, 13% cases that were grouped into miscellaneous type received analgesics for 1–7 days For analgesia, meloxicam was the most preferred non-steroidal anti-inflammatory drug (98%) followed by tramadol (9%), and lignocaine-HCl (8%). Tramadol (9%) and lignocaine-HCl (8%) were prescribed particularly in severely traumatized cases whereas ketorolac (5%) were used in orthopedic cases. Only 18% veterinary patients received preemptive analgesics. Most of the hospitals, clinics and organizations did not perform pain scoring. Proper pain assessment and their scoring are imperative for prescribing the right analgesic for the effective treatment of pain in animals.

Our experience with emergency ophthalmic surgery at Hospital Kuala Lumpur during the COVID-19 pandemic

As Malaysia called to arms its front liners for the COVID-19 pandemic, Hospital Kuala Lumpur was converted into a hybrid hospital to handle both COVID-19 and non-COVID-19 patients. There was a reprioritization of services affecting all hospital units, including ophthalmology. We illustrate the challenges faced with two ophthalmic emergency cases that presented during this trying period: a case of left eye posterior globe rupture sustained through a motor vehicle accident and another case of right eye bleb leakage 3 weeks post-trabeculectomy.
 This report highlights the various perioperative challenges faced by the ophthalmology team in managing these cases. Amongst them were logistic and technical challenges, which included the wait for COVID-19 test results, ophthalmic services scattered between three buildings, and the initial lack of guidelines. Disruption to our emergency ophthalmic workflow required adaptation and improvisation.
 As we transition to resume “normal” ophthalmic services, healthcare centres will undergo frequent remodelling in their usual work processes to ensure that high standards of care are upheld whilst protecting healthcare workers.

Malpractice Litigation in Ophthalmic Trauma.

ObjectiveTo report and analyze the causes and outcomes of malpractice litigation in ophthalmic trauma.MethodsThe Westlaw® database was reviewed for ophthalmology litigation in the United States between 1930 and 2014. All ophthalmic trauma cases were included and compared to non-traumatic ophthalmology malpractice cases.ResultsForty-four ophthalmic trauma cases were included. Of these cases, 90.9% of ophthalmic trauma plaintiffs were male compared to 54.8% of plaintiffs in ophthalmology as a whole (P=<0.001); 34.1% of cases involved minor plaintiffs compared to 6.4% in ophthalmology as a whole (P=<0.001). Cases involving minors were more likely to be resolved in favor of the plaintiff than cases involving adult plaintiffs (53.3% vs 37.9%); however, this was not found to statistically significant (P=0.35). Overall, 54.5% of cases were resolved in favor of defendants; 40.9% of cases were resolved via jury trial with 50.0% resulting in payments to plaintiffs compared to the 29.6% rate of plaintiff verdicts in ophthalmology as a whole. Open globe injuries represented 61.4% of cases; 55.6% of these cases had intraocular foreign bodies and 37.0% developed endophthalmitis. Most cases (63.6%) alleged insufficient intervention. Of these cases, 31.8% of cases involved surgical or procedural claims, and 4.5% involved medical claims only.ConclusionMales and minors were overrepresented among plaintiffs in ocular trauma litigation. Most cases involved open globe injuries, often complicated by retained intraocular foreign bodies and endophthalmitis. Analysis of malpractice litigation in ophthalmic trauma calls attention to commonly litigated scenarios to improve clinical practice and to inform risk management.

Review of Complete Repertory to the Homoeopathic Materia Medica Diseases of the Eyes, 2nd Edition, By Dr. E.W. Berridge

This Repertory is indispensable for every homeopath who is willing to practice with scientific accuracy &amp; exactness. One of the clearest and best arranged very useful repertories in the interpretation of the ophthalmic cases, marshaling both symptoms and conditions is adequate as the present state of our understanding.

ETIOLOGY OF OPHTHALMIC MEDICOLEGAL CASES PRESENTING TO TERTIARY CARE HOSPITAL.

Objectives: To study the etiology and visual acuity profile of ophthalmic medicolegal cases presenting to a tertiary care hospital. Study Design: Retrospective study. Setting: Lahore General Hospital, Lahore. Period: 1-3-2017 to 30-10-2018. Methodology: This retrospective study was conducted after taking ethical approval from the institutional review board. Record of medicolegal cases presenting during the study period were studied and assessed. In this study, etiology of trauma inflicted to eye and visual acuity at presentation were analyzed in addition to the age, gender and eye distribution. Age and visual acuity were categorized into subsets for assessment. Results: The authors reviewed the data of 40 ophthalmic medicolegal cases presenting to the department. The medicolegal cases were common in patients aging between 21-30 years (32.5%) which predominantly involved males (65%). Right eye was involved in 40% of patients and 35% of patients had normal (6/6) visual acuity. Most common trauma inflicted to eye was by fist or blow from hand in 75% of cases. Conclusion: Trauma to eye in medicolegal cases is common and is frequently inflicted by fist or hand.

Trichloroacetic acid 10% injection for treatment of conjunctival inclusion cysts

ABSTRACTPurpose: To evaluate the effect of intra-lesional injection of Trichloroacetic acid (TCA) 10% in patients with conjunctival inclusion cysts.Methods: This prospective case series study included all patients with conjunctival inclusion cyst who were referred to our referral center from August 2016 to August 2018. All patients received TCA 10% injection into the conjunctival cyst, and outcomes of the intervention were evaluated at least 6 months later.Results: Ten patients with mean age of 24 ± 17.6 (range 6–65) years including three children received TCA 10% injection into the conjunctival cyst. We included 6 anophthalmic and 4 ophthalmic cases. All patients were treated successfully and no recurrence of the lesion was observed in any case. Mean follow up duration was 18.1 ± 8.3 (range 6–28) months.Conclusion: Intra-lesional injection of TCA 10% is a safe, simple, and effective treatment in patients with conjunctival inclusion cysts including ophthalmic cases and anophthalmic cases, both in adults and in children. This concentration may avoid ocular surface complications.

English

A retrospective study was conducted to assess the health and welfare problems of working donkeys at the Merkato Donkey Sanctuary clinic in Addis Ababa, Ethiopia. Data on 12,991 working donkeys from 2008 to 2010 were analyzed from the data record sheet kept by the clinic. Results on the age distribution of donkeys showed that the average age of the donkeys was around nine years old. Only 7.37% of the donkeys were with good or ideal body condition (≤2.5), while the majority, 90.56% were with poor body condition (≤2). Multiple health problems were a common feature. Among the common health problems encountered parasitosis, hoof problems, wounds, musculoskeletal disorders, colic, ophthalmic cases and traffic accidents accounted for 55.68, 16.71, 14.9, 3.28, 2.59, 2.37, and 1.71%, respectively. Wounds due to ill fitted harnesses and inappropriate harnessing materials accounted for majority of the wounds observed. Back sore due to the absence of paddings, improper padding, inadequate and inappropriate padding materials was a common feature, and accounted for 62.6% of the overall different wounds. Hoof overgrowth and solar puncture and/or abscess due to sharp objects were the common hoof problems recorded, while hoof overgrowth accounts for 13.56%. Traffic accidents leading to death and injuries were common problems. Apart from the health related welfare problems, the questionnaire survey made also revealed that abuses and negligence by the owners, management constraints like overloading and overworking, beating, and shortage of feed, housing problems, wounds due to harnessing and physical injuries mainly due to traffic accidents were the major welfare problems of urban working donkeys. The retrospective study, the questionnaire survey and observations made provided the significant health and welfare problems of working donkeys that need to be addressed in order to improve their health and working efficiency. Key words: Retrospective study; working donkey; health and welfare problems.

Comparing hospital compensation to actual costs based on the Greek Diagnosis-Related Group system in ophthalmology.

The purpose of this study is to evaluate the effects of the new system of pricing medical services in the field of ophthalmology in Greece. In addition, it attempts to benchmark the system with respective interventions at an international level. The study deals with the implementation of the new system, presenting systematic pairing of ophthalmic coding with other coded information regarding registration and management. Statistical data analysis is performed related to the cost and, finally, proposals are formulated to improve the current system. A significant difference is noted in the quantitative and qualitative characteristics of the Greek system compared with internationally applied Diagnosis-Related Group (DRG) systems in the field of ophthalmology. The proposed funding for ophthalmic inpatient cases mostly meets real needs and costs of hospitals for supplies. Complicated cases, mainly in cataract surgery, increase the real cost and may cause a deviation depending on the rate of complications. In these cases, the average cost was 673.28 ± 58.7&OV0556; as opposed to uncomplicated cases (346.78 ± 21.3&OV0556;), bearing a statistically significant difference (P < 0.001, Mann-Whitney test). The total compensation of the hospital was higher than the actual cost for surgical procedures covering the respective expenses. Although the recently implemented compensation system for public hospitals mostly covers the actual cost for ophthalmic surgical cases, some deviations from the real needs are being identified. Several amendments could be applied to increase efficiency and improve the quality of health services provided by Greek hospitals.

Prevalence and associated factors of vernal keratoconjunctivitis among children in Gondar city, Northwest Ethiopia.

BackgroundVernal keratoconjunctivitis (VKC) is a common cause of ocular morbidity in children in warm dry climates such as Sub–Saharan Africa and accounts for about 3 % of serious ophthalmic cases in tropical countries. The purpose of this study was to assess the prevalence and associated factors of vernal keratoconjunctivitis among children living in Gondar City, Ethiopia.MethodsA Cross Sectional Design study was carried out in 737 children under the age of 18 years in Gondar City from April to May 2015. Basic ophthalmic examination was performed using a 3x magnifying loop and torch light and a pretested and structured questionnaire was completed. The association between vernal keratoconjunctivitis and factors such as socio-economic, demographic, and environmental status, and history of allergic disease in affected children and their family members was examined using logistic regression multivariate analysis.ResultsThe prevalence of vernal keratoconjunctivitis was 5.8 % (95 % CI: 4.14, 7.53) (43/737) and mixed type VKC was the most frequent form which was found in 35 out of 43 cases (81.4 %). The following were positively associated with vernal keratoconjunctivitis: use of kerosene/firewood for cooking (AOR = 6.25 (95 % CI: 1.61, 25)), child dust exposure (AOR = 10.0 (95 % CI: 4.16, 20.0)), child history of non-ocular allergic diseases (AOR = 4.0 (95 % CI: 1.92, 8.33)), family history of non-ocular allergic diseases (AOR = 3.57(95 % CI: 1.39, 9.09).ConclusionThere is a high prevalence of vernal keratoconjunctivitis in this region. The use of kerosene/firewood for cooking, child dust exposure, and non-ocular allergic disease in the child or their family were statistically significant risk factors for vernal keratoconjunctivitis.

Cases

SummaryCases in ophthalmic geneticsClinical cases will be shown. Everyone is encouraged to present unknown of interesting diagnostic cases in inherited eye disease. Submission of cases can be done in the room where the Grand Rounds in Ophthalmic Genetics are being held.

Evaluation of Aging Disorders by 54 000 Consecutive Ophthalmic Cases

Evaluation of Aging Disorders by 54 000 Consecutive Ophthalmic Cases

Patterns of ophthalmic emergencies presenting to a referral hospital in Medina City, Saudi Arabia

BackgroundData are required on ophthalmic cases that present to the emergency eye clinics in Madinah, Saudi Arabia for proper allocation of healthcare resources. ObjectivesTo determine the frequency and various diagnoses of patients presenting to the A&E at Ohud Hospital, Madinah, Saudi Arabia. MethodsData was collected prospectively for all patients who presented to the A&E ophthalmology clinic from June 2014 to September 2014. The data was analyzed and presented using frequency of incidence and percentages. Chi-square tests were used to evaluate the diagnoses based on age, sex and nationality. P≤0.05 indicated statistical significance. ResultsThe study sample included 868 patients. The male-to-female ratio was 1.1:1.0. The main age categories included patients ≥45years of age (256 patients) and 251 patients between the ages of 15–30years. Various types of Conjunctivitis was the most common diagnosis, reported in 282 patients (32.5%), and followed by dry eye syndrome in 156 (18%) patients. Nasolacrimal duct obstruction in 156 patients (18%). Eyelid infections were detected in 102 patients (12%), corneal abrasion in 102 patients (9.3%). Various eye traumas was diagnosed in 30 patients (3.5%), increased intraocular pressure (IOP) in 17 patients (2%), ruptured globe in 2 patients (0.2%) and various other non-emergency pathologies in the remaining eyes. There were no significant differences in patient’s characteristics and categories of diagnoses. ConclusionNon-emergent ophthalmic cases were the most common reason for the ophthalmology emergency room visits. It was observed that most cases could be referred to outpatient departments and potentially be managed by primary healthcare providers. This would be more cost effective and will also allow for better management of vision threatening ocular emergencies.

Pattern of ocular trauma among the elderly in Kashan, Iran

ObjectiveOcular trauma is a common cause of visual impairment and accounts for 38% to 52% of all patients presenting as ophthalmic accident and emergency cases to the hospital. The purpose of this study is to describe the pattern of ocular injuries that leads to hospitalization in the elderly in Kashan, Iran. MethodsIn the retrospective consecutive case series, a total of 94 geriatric patients (≥65 years) who admitted and underwent management for ocular trauma from April 2001 to March 2011 at Matini Hospital of Kashan, the only center of eye surgery in the region of Kashan, were reviewed. The items include age, sex, injury mechanism, site and extent of damage, presenting and final best corrected visual acuity at least 3 months after trauma, which were reviewed and analyzed with SPSS software. ResultsDuring the 10 years, 94 eyes of 94 patients with ocular trauma were included. Mean age of patients was (77.5±5.1) years (range 65 to 102 years). Male to female ratio was 2.76. The mechanism of ocular injury included sharp trauma in 56 patients (59.6%) and blunt in 38 patients (40.4%). Trauma occurred mostly in males (69 patients, 73.4%) and at the work place (38 patients, 40.4%). On admission the visual acuity in 50 patients (53.2%) with damaged eyes was light perception to hand motion. While the final best corrected visual acuity in 36 patients (38.3%) was better than hand motion. ConclusionOcular trauma is a serious cause of visual impairment in the elderly. Appropriate and timely management may improve their visual prognosis.

Ophthalmic Anesthesia Society 2014 Annual Scientific Meeting Summary

Ophthalmic Anesthesia Society 2014 Annual Scientific Meeting Summary

A retrospective analysis of severe intraoperative respiratory compliance changes during ophthalmic arterial chemosurgery for retinoblastoma.

Ophthalmic arterial chemosurgery for retinoblastoma has been associated with intraoperative decreases in respiratory compliance. Through the analysis of data from computerized records, we objectively defined severe respiratory compliance events and correlated them with demographic and clinical information in patients undergoing this procedure. Data were collected from ophthalmic arterial chemosurgery cases from 2006 to 2013. Intraoperative PIP, PEEP, TV, SpO2 , and EtCO2 were analyzed. Compliance changes, desaturations, decreases in EtCO2 , and clinical outcomes were assessed. Respiratory compliance decreases with a bimodal distribution. Severe events were defined as exhibiting a minimum compliance decrease of 40%. Seventy-eight of 122 children (64%) experienced a severe compliance event during at least one treatment, and it occurred in 137/468 cases (29%). A subset of 94 children had complete or at least the first three records. The incidence of a severe respiratory compliance event in this subgroup was 17/94 (18%) on the first and 84/261 (32%) on subsequent procedures. The probability of developing a severe respiratory compliance event on a subsequent procedure was 0.40 if the child developed it on the first procedure, 0.30 if he did not; this difference was not significant. The incidence of desaturation below 90% with severe respiratory compliance events was 0.20; the incidence of a 30% drop in EtCO2 was 0.34. No morbidity, no extended recovery, and no admissions were associated with intraoperative severe respiratory compliance events. We found no correlation between history, age, sex, weight or allergies, and intraoperative severe respiratory compliance events. Here, most patients experienced a severe respiratory compliance event during at least one of their procedures. Overall incidence was 29% and was more likely on subsequent procedures. A severe respiratory compliance event at the initial procedure was poorly predictive of its occurrence on subsequent procedures. No morbidity was associated with intraoperative severe respiratory compliance events.

John Erichsen's Tonsillectomy Scissors

Removal of the tonsils is reported by Celsus in the first century AD when he recommended working a finger round them before extraction with same finger or alternatively elevation with a hook and excision by scalpel. Cultivation of a long index finger nail for tonsillectomy and umbilical cord division, and of a thumbnail for circumcision, etc. is authenticated in certain communities. (1) As I Moore’s historical account indicates, tonsillectomy was eventually avoided when the organ was inflamed and vascular due to post-operative haemorrhages. Fear of the latter also induced partial tonsillectomy by scalpel, sometimes after ligaturing the base; by the 18th century the scalpel was substituted by scissors and in the 19th century by the guillotine first introduced by Benjamin Bell for the uvula. (2) Meanwhile scissors were modified to both incise and prevent the remnant falling into the pharynx, as evident in Erichsen’s variations (Figure 1(g) and (h)). Sir John Erichsen FRS, FRCS (1818–1896), born in Copenhagen of a Danish father and English mother, was educated in London and qualified in 1839. After teaching anatomy and writing ‘An Essay on Asphyxia’ to win the Fothergillian Gold Medal, he was appointed Assistant Surgeon at University College Hospital in 1848 and Professor of Surgery there in 1850. He established a reputation for sound judgement and vast experience, becoming President of the Royal College of Surgeons in 1880 and Surgeon Extraordinary to the Queen. He attracted men of talent as house surgeons including Joseph Lister and wrote widely, including a treatise ‘Concussion of the Spine’ based on his experience of railway accidents. Importantly his textbook ‘The Science and Art of Surgery’ of 1853 achieved fame with 10 editions, plus American versions, and German, Italian, Spanish and Chinese translations. 3 Apart from ophthalmic cases, Erichsen was a complete general surgeon, operating initially without the aid of anaesthesia. Curiously, despite accepting Schimmelbusch’s work on post-mortem prophylaxis, initially he failed to embrace phenol wound antisepsis, a product of his pupil Lister. References

Entropion surgery – a nurse's viewpoint

ABSTRACT:There are many conditions which affect the eye and require surgery. Often these procedures require specialised equipment and the veterinary nurse may need specialised knowledge to assist the veterinary surgeon. Implementing some small changes in your approach to dealing with ophthalmic cases can make a positive difference to their outcome. Abnormal conformation of the eyelids is one of the most common eyelid problems encountered in small animal practice. For this reason I have concentrated here on entropion surgery as the patient undergoing this procedure requires special attention from the veterinary nurse at many different stages throughout.

Reader’s Views Lacrimal Sac Diverticulum due to Rhinosporidiosis

We have gone through the article by Dr. S. Varshney et al. in the October–December 2007, issue of Indian Journal of Otolaryngology and Head & Neck Surgery which is reported as a Lacrimal sac diverticulum. The case report itself indicates the lack of exposure of faculty (reporting this case) to clinical presentations of Rhinosporidiosis. At Raipur (Chhattisgarh) Medical College hospital, we have seen more than thousand cases of rhinosporidiosis. Amongst cases of rhinosporidiosis with mucosal involvement, lacrimal sac is second to nasal & nasopharyngeal disease. Lacrimal sac involvement may occur due to access of spores through lacrimal pathways or it could be ascending involvement via nasolacrimal duct, in which appearance like lacrimal sac diverticulum as reported in the case is most commonly seen feature. Presence of nasal disease in itself verifies this fact. Management of rhinosporidiosis cases by lateral rhinotomy or any other surgical procedure causing exposure to more healthy tissue is almost contraindicated, as it is likely to open new frontier for dissemination of disease. Removal of lacrimal sac disease is also advisable (as far as possible) through endoscopic approach. Biopsy and CT Scan for confirmation of disease is almost unnecessary and undesirable. The discussion part of article is focused only regarding the disease, which has been published many times in number of journals and does not concentrate on the involvement of lacrimal sac, as is expected in a case report. At this center in Raipur, we have seen more than 300 numbers of ophthalmic cases and even bizarre presentations where the disease has involved structures like tongue, parotids, larynx, pharynx, tracheostomy stoma, bones, skin & subcutaneous tissue. It is obvious that the article was not sent to suitable reviewers for comments before accepting it for publication.