Pediatric Ophthalmology Department Research Articles

Refractive errors in patients with Bardet Biedl syndrome

ABSTRACT Purpose Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy. Within corneal development, primary cilia serve a critical role. We sought to investigate the association of BBS with corneal astigmatism among a cohort of patients with BBS. Methods This was a cross-sectional, retrospective study performed at a pediatric ophthalmology department of a tertiary hospital. The study enrolled 45 patients with genetically confirmed Bardet-Biedl syndrome, encompassing a total of 90 eyes observed from February 2011 to August 2021. Spherical and cylindrical refractive errors and keratometry outcome measures, including diopter (D) values at the flattest and steepest axes, were recorded. Corneal astigmatism of greater than 3D is considered extreme corneal astigmatism based on previously published data. Results Among 45 patients (M:26; F:19), the mean age was 16.4 ± 8.2 years, and the mean best-corrected visual acuity was 20/60. The most common molecular diagnosis was BBS1, seen in 24 of 45 (53.3%). Among all the patients, the mean spherical refractive error was −2.9 ± 3.8D. The mean cylindrical refractive error was 2.6 ± 1.5D. The mean keratometry values at the flattest axis was 43.5 ± 5.3D (39.4–75.0) and at the steepest axis was 47.2 ± 7.3D(41.5–84.0). Among all the patients with BBS, the mean corneal astigmatism was 3.7 ± 1.0D(0.5–7.1), which is considered extreme. Conclusion A cohort of individuals with BBS demonstrated high corneal astigmatism. These results suggest an association between corneal astigmatism and primary ciliary dysfunction and may assist in clinical management and future therapeutic targets among BBS and other corneal disorders.

The distribution characteristics of strabismus surgery types in a tertiary hospital in the Central Plains region during the COVID-19 epidemic

ObjectiveThis study aimed to analyze the distribution of different types of strabismus surgery in a tertiary hospital in Central China during the three-year period of the COVID-19 pandemic.MethodsA retrospective analysis was conducted on the clinical data of strabismus patients who underwent surgery and were admitted to the Department of Strabismus and Pediatric Ophthalmology at the First Affiliated Hospital of Zhengzhou University between January 2020 and December 2022.ResultsA total of 3939 strabismus surgery patients were collected, including 1357 in 2020, 1451 in 2021, and 1131 in 2022. The number of surgeries decreased significantly in February 2020, August 2021, and November and December 2022. Patients aged 0–6 years accounted for 37% of the total number of strabismus surgery patientsr. The majority (60%) of all strabismus surgery patients were diagnosed with exotropia, with intermittent exotropia accounting for the highest proportion (53%). There was no statistically significant difference in the proportion of intermittent exotropia and constant exotropia during the three-year period (χ2 = 2.642, P = 0.267 and χ2 = 3.012, P = 0.221, respectively). Among patients with intermittent exotropia, insufficient convergence type was the most common form of strabismus (accounting for over 70%). Non-accommodative esotropia accounted for more than 50% of all internal strabismus cases.ConclusionDuring the period from 2020 to 2022, the total number of strabismus surgeries in our hospital did not show significant fluctuations, but there was a noticeable decrease in the number of surgeries during months affected by the pandemic. Exotropia accounted for the highest proportion among strabismus surgery patients. Intermittent exotropia was the most common type among patients undergoing surgery for exotropia, and the most prevalent subtype was the insufficient convergence type. The age distribution of patients varied in different months, with a concentration of surgeries for strabismus patients in the 7–12 years old age group during the months of July and August each year.

Odległe wyniki leczenia dzieci chorych na zaćmę wrodzoną jednostronną i ze stożkiem tylnym soczewki

The studies conducted were aimed at showing the importance of early diagnosis and appropriate treatment of congenital cataracts in children. We can see that the treatment is multi-stage and often difficult not only for the performed surgical procedures but also for the further rehabilitation of eyesight. At the same time, we show how many benefits can be obtained by properly treated children. The study group consisted of patients treated at the Department of Pediatric Ophthalmology in Katowice in 2007–2014 with unilateral congenital cataract with posterior cone or unilateral congenital cataract and with simultaneous or secondary implantation of an artificial intraocular lens. 104 eyes were examined in 52 children at the age of 52 from 1 to 17 years of age.

Incidence of Retinopathy of Prematurity at a Tertiary Care Children Hospital

Abstract
 Purpose: 
 To study the incidence of retinopathy of prematurity at a tertiary care children hospital
 Methods:
 After obtaining ethical approval, this cross sectional study was performed on all the patients who presented to pediatric ophthalmology department of CH & ICH from July 2018 to December, 2021. These included neonates admitted in NICU of CH&ICH and also referrals from other hospitals. The babies born before 34 weeks of gestation or birth weight less than 2000 grams, and given supplemental oxygen, who required hospital admission were screened in first 30 days of life. Prior to examination, the pupil was dilated using 10% phenylephrine and 0.5% cyclopentolate and 0.1% tropicamide eye drops by a trained nurse. The fundus examination was carried out under topical anesthesia using proparacaine 0.5%, after swaddling the baby. ETROP criteria was used for treatment, i-e patients with stage3 ROP or plus disease in Zone 1 were treated immediately. Other stages were kept on a close follow up.
 Results:
 Three hundred and seventy seven neonates were male (60.5%). Total number of patients with any stage of ROP was 40 (13.07%). Those with type 1 ROP were treated with laser or intra- vitreal anti- VEGF (bevacizumab 0.625 mg in 0.05ml). Those with type 2 disease were observed on weekly basis for worsening of features. There were 13 patients who received intra- vitreal injection and only one of them required diode laser after injection.
 Conclusion:
 A multidisciplinary team is essential to prevent blindness due to ROP in developing countries. Screening the babies who are at high risk of disease will lessen the burden on screening team.

Postoperative glaucoma following cataract surgery in children

Aims/Purpose: The aim of this work is to investigate the prevalence of secondary glaucoma and its associated risk factors in children undergoing congenital cataract surgery.Methods: A retrospective study was performed, spread over 8 years, from January 2014 to October 2021, in the paediatric ophthalmology department at the August 20 Hospital in Casablanca. It includes 516 eyes of children operated on for congenital cataract and aged under 16.Results: Development of glaucoma was defined as IOP > 22 mmHg, increased corneal diameter, increased cup to disc ratio, and reduced anterior chamber depth. We mainly evaluated the following risk factors: age at the time of surgery, unilateral or bilateral cataract, presence of microcornea, performance of posterior capsulotomy with anterior vitrectomy and primary implantation.Conclusions: Congenital cataract surgery at an early age increases the risk of developing glaucoma, whether the eye is aphakic or pseudophakic. The management of secondary glaucoma is heavy, the visual prognosis is compromised, hence the interest of long‐term follow‐up.

Glaucoma in Sturge–Weber‐Krabbe syndrome about 10 cases

Aims/Purpose: The objective of this study is to evaluate the results of glaucoma treatment in a series of 10 children with Sturge–Weber syndrome.Methods: The objective of this study is to evaluate the results of glaucoma treatment in a series of 10 children with Sturge–Weber syndrome collected between 2010 and 2023 at the paediatric ophthalmology department of the 20 August 1953 hospital of the University Hospital of Casablanca.Results: The mean age at diagnosis was 11 months, with a Sex‐ratio of 1.5. Seven patients had a unilateral facial angioma occupying the V1 territory and three had a bilateral angioma, the cutaneous angioma was extended to the neck and thorax in one patient of these 10 cases. Two patients had a meningeal angioma revealed by hemicorporeal seizures contralateral to the cutaneous angioma. Buphthalmia was found in five cases, dilatation of the episcleral vessels in four patients, predominantly in the temporal area. No cases of choroidal angioma were noted. The average preoperative ocular tone was 18 mm Hg. The average c/d was 0.5. All 10 eyes had trabeculectomy under 5 Fluorouracil. 4 eyes were reoperated. We noted 1 case of vitreous exit intraoperatively. The final ocular tone was <20 mm Hg in eight eyes, four of which had adjuvant hypotonizing treatment with Beta‐blocker and Dorzolamide, after a mean follow‐up of 24 months.Conclusions: The risk of Glaucoma being important, the Sturge–Weber‐Krabbe syndrome must be evoked in front of any facial hemangioma and its existence should not delay the therapy.

Syndromic congenital glaucoma clinical features and therapeutic results

Aims/Purpose: The objective is to study the clinical particularities and the results therapies.Methods: This is a retrospective study of 15 children (25 eyes) since 2012 until 2021 at the paediatric ophthalmology department of the August 20 hospital from Casablanca‐Morocco.Results: In our study, there were 15 cases including 9 cases (13 eyes) of syndrome of Sturge weber Krabb, 2 cases (4 eyes) of Axenfield Reiger syndrome, 2 case (4 eyes) of Peters syndrome 1 case (2 eyes) of lower syndrome, 1 case (2 eyes) of polymalformative syndrome (cardiopathy, pulmonary stenosis, bilateral femoral epiphyseal dysplasia). The average age is 8 years with a sex ratio of 1.7, the notion of inbreeding exists in 43%. The warning sign was buphthalmos in 72% of cases, on clinical examination the cornea was edematous in 60% of cases with an average diameter 13.2 mm corneal, with anterior iris synechiae in 32% of cases, bilateral cataract in 4% of cases, persistence of primary vascularization in 4% of cases and an average of excavation of 7/10, an average TO at 34 mmHg. The most common systemic abnormalities were facial angioma (56%), epilepsy (41%) and mental retardation (30%).Treatment was trabeculectomy in 96% of cases associated with medical treatment in 100% of cases.Conclusions: It is a rare, blinding pathology, the clinical forms of which are numerous with complex ocular and general malformations, which can pose etiological and therapeutic problems that are difficult.

Epidemiological profil of post contusive hyphaema experience of the paediatric ophthalmology department of Casablanca

Aims/Purpose: Hyphaema is defined as the presence of blood in the anterior chamber. It occurs after a contusive or perforating ocular trauma or in the aftermath of ocular surgery. The aim of our work is to analyse the clinical, therapeutic and evolutionary profile of post‐contusive hyphaema.Methods: A retrospective study was conducted on 66 children (33 eyes) admitted to the ophthalmologic emergency room for post‐contusive hyphaema followed and treated in the paediatric ophthalmology department of the 20 August hospital in Casablanca between January 2015 and January 2023.Results: There was a male predominance with 67% of boys affected. The average age was 9.5 years. The main cause of consultation was visual acuity (VA) loss in 49%. On examination, the initial VA was <1/10 in 38% of cases, the ocular tone was >20 in 30% of cases. Hyphaema was classified as stage I in 26.4%, stage II in 52%, stage III in 15.2%, stage IV in 6.4%. Post‐traumatic cataract was present in 50% of the cases, lens dislocation in 22% of the cases, angle recession in 6%. Intravitreal haemorrhage was present in 2 patients, berlin oedema in 3 patients. The treatment prescribed in all patients was strict rest, abundant drinks, oral and local corticotherapy and dilatation with atropine. In addition, a hypotonizing treatment was prescribed for the patients who presented an ocular hypertonia. The evolution was marked by the total resorption of the hyphaema in 90% of the cases. Surgical treatment (hyphaema lavage) in 10% of cases. The final VA was >6/10 in 60% of cases. The most serious complication was haematocornea in 6% of cases.Conclusions: Frequent and serious condition in children that can jeopardize the functional prognosis of the eye. When the diagnosis is made, the management must be early in order to avoid complications.

Steroid induced glaucoma in the paediatric population

Aims/Purpose: Steroid induced glaucoma is an iatrogenic pathology secondary to the prolonged use of corticosteroids, it is a serious pathology with a high risk of blindness. The aim of this study is to evaluate the epidemiological, clinical, therapeutic and evolutionary profile of steroid induced glaucoma in children.Methods: It is a retrospective study of cases treated between November 2007 and February 2022, including patients followed in the paediatric ophthalmology department of Casablanca for steroid induced glaucoma.Results: Our study involved́ 35 children (60 eyes), including 20 boys and 15 girls, with an average age of 12 years. The involvement was bilateral in 25 eyes. All the patients had a history of discontinuous self‐medication with local corticosteroids for a mean period of 5 years. The initial condition that led to the use of steroids was in 19 cases allergic conjunctivitis, in 10 cases it was used for recurrent meibomian cysts, 3 cases of uveitis, 2 cases of blepharitis and one episcleritis. 60% eyes had visual acuity raging between 0.1 to 0.3. Mean Intraocular pressure was 36 ± 1 2 mmHg. Mean vertical cup disc ratio was 0.68 ± 0.25. all our patients had an open angle on gonioscopy and severe perimetric deficits were noted in all our patients. 19 eyes (32%) had an associated cataract. IOP was controlled after the withdrawal of steroids in 8 eyes, associated to antiglaucoma treatment in 22 eyes. The surgical management consisted of a Trabeculectomy + IP + 5 F.U in 30 eyes. Cyclophotocoagulation was not required in any of the patients. On a follow up of 24 months, the average final visual acuity was <2/10th and the tonometric results were globally good with a stabilization of the papillary excavation and visual field in 82% of the cases.Conclusions: Steroid induced glaucoma is a condition in which the functional prognosis is at risk, especially in young patients. It shows the importance of regular monitoring of the IOP in patients undergoing corticosteroid treatment. The first line of treatment consist of the prevention: awareness of the risks of self‐medication by steroids.

From Bright to Brightness: Mastering the Management of Bilateral Congenital Cataracts

Congenital cataract is the leading cause of vision loss in newborns and children, and it is caused by an opacity of the eye's lens that occurs at birth or within the first few months of life. Congenital cataracts may develop as unilateral or bilateral. Around 50% of cases of it are considered as idiopathic. A 4-month-old boy was brought by his parents to the Department of Pediatric Ophthalmology and Strabismus in RSUD dr. Zainoel Abidin Banda Aceh with a chief complaint of a white spot on the patient’s right eye. The spot had appeared since birth and became more visible when he was 2 months old. The patient's overall condition was good. Both eyes' visual acuity was blink reflex. The ocular pressure in both eyes was normal. An ophthalmologic examination revealed a fully clouded right eye lens and aphakia in the left eye. The patient had undergone cataract surgery on his left eye on September 6th, 2023. He was diagnosed with Congenital Cataract Oculus Dexter (OD) and Aphakia Oculus Sinister (OS) before surgery. The patient underwent right eye cataract surgery with aspiration irrigation (AI), Primary Posterior Capsulotomy (PPC), and Anterior Vitrectomy (AV) without Intraocular Lens (IOL) implantation within the next two weeks. Following the surgery, the patient's visual function improved to fix and follow the object, the pupils looked round in both eyes, aphakia, and no membrane development. The patient was prescribed glasses for optical rehabilitation.

Study of Frequency and Nosology of Clinical Varieties of Retinal Dystrophies in Children and Adolescents

Background. Particular vigilance in timely detection of retinal dystrophies (RD) in children is necessary as effective measure to prevent formation of rhegmatogenous retinal detachment. Purpose. To study frequency and structure of clinical forms of RD in children of different age groups to find out most typical age of their primary formation, to assess the proportion of their prognostically hazardous forms. Materials and methods. Clinical material — 314 children aged 5 to 17 years, on average 11.0 ± 0.6 years, who applied with various ophthalmological pathologies in the Department of Pediatric Ophthalmology of the Khabarovsk Branch of the S. Fyodorov Eye Microsurgery Federal State Institution in the period from July 2020 to April 2021. All children underwent biomicroscopy, ophthalmoscopy with in-depth examination of the state of the equatorial and periphery parts of the retina in condition of maximum cycloplegia. All 4 quadrants of the fundus were examined using binocular indirect ophthalmoscope with 20D lens. The presence and frequency of RD, their clinical varieties, according to the classification of E.O. Saksonova (1979), were ascertained in each of the studied age groups. Their localization, their length, and eye refraction were also assessed. Results. Presence of RD was revealed in 34 (11 %) children. In structure of identified clinical forms of RD, 11 children had its prognostically non-hazardous forms of RD, 23 children had prognostically hazardous forms (33 % and 67 % respectively). According to our data, the earliest age of detection of RD was 6 years. Further progression of RD was noted in 2 out of 6 children after restrictive photocoagulation of prognostically hazardous forms of RD. Conclusion. Formation of RD occurs not only at puberty, but also at an earlier age, according to our data, from 6 years of age. In view of this, it is necessary to conduct a thorough ophthalmoscopic examination of the periphery parts of the retina, even in young children.

Etiology of Congenital Cataract in a Tertiary Hospital, Lahore

Purpose: To identify the etiology of congenital cataracts in a tertiary care center of Lahore. Study Design: Cross-sectional. Sampling Technique: Non-probability purposive sampling. Place and Duration of Study: Department of pediatric ophthalmology The Children’s hospital and Institute of Child Health, Lahore from May 2018-October 2019. .Methods: Children one year and younger diagnosed with congenital cataract were included in the study. A detailed ocular examination was done including B-scan. Blood samples of all the infants were tested for presence of specific immunoglobulin M (IgM) and immunoglobulin G (IgG) antibodies by the enzyme-linked immunosorbent assay (ELIZA). Specific blood tests were done to rule out any metabolic disorder. The children were referred to pediatrician for detailed systemic examination. Data were collected, and statistical analysis was done using Excel (Microsoft 2015, version 15.15) and Stata (version 13). Results: A total of 384 infants were included in the study. Mean age of the patients was 5.9 ± 5 months. No cause could be identified in 39.06% and familial pattern was seen in 28.12%. Consanguinity was seen in all familial cases. Rubella was found to be the causative agent in 17.7% participants of the study. Associated ocular problem was seen in 89 (23.17%) infants and microphthalmia being the most frequent. Developmental delay was seen in 126 (6.7%) children. Conclusion: Congenital cataract represents a complex and challenging ophthalmic condition that may result in significant visual impairment. Early identification and timely intervention are pivotal for achieving a positive visual outcome.

Infective Etiologies in Patients with Bilateral Congenital Cataract

Objective: To determine the frequency of positive Toxoplasma, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis serology in patients with bilateral congenital cataract and their correlation with different type of cataracts and age groups.
 Study Design: Cross sectional study.
 Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from May to Dec 2022.
 Methodology: Data was collected by a single investigator on Microsoft Excel sheet including patient’s age, gender, mode of delivery, consanguinity of parents, and type of congenital cataract, results of TORCH Screening and Presence or absence of amblyopia. TORCHS screening comprised of serum IgM and IgG levels for Toxoplasmosis, Rubella, Cytomegalovirus, Herpes Simplex virus and Syphilis. 
 Results: A total of 134 patients reported to our institute with bilateral congenital cataract during the study period. Out of them 56 patients had positive results of TORCH screening (41.7%) Out of total 56 patients with bilateral congenital cataract testing positive for TORCH, 30(53.6%) were male while 26(46.4%) were female. Age range was from 1-17 months (9.2±4.2 months).Lamellar cataract was the most common cataract type in our study sample 16(28.6%).
 Conclusion: In patients with bilateral congenital cataract positive TORCHS serology was most frequent. Serum Rubella IgM followed by Rubella IgG was positive in most cases. Most common age of presentation in our study was from 4-7 months. Furthermore, lamellar cataract followed by nuclear cataract was the commonest cataract type.

Clinical observation of bow-tie adjustable suture technique for overcorrection in intermittent exotropia

Objective: To investigate the clinical effects of the bow-tie adjustable suture technique in managing overcorrection in patients with intermittent exotropia after surgery. Methods: This was a retrospective case series study. Clinical data were collected from children with intermittent exotropia who underwent strabismus correction surgery, including the bow-tie adjustable suture technique and conventional techniques, at the Department of Strabismus and Pediatric Ophthalmology, Shanxi Eye Hospital, from January 2020 to September 2021. Children with postoperative esodeviation≥15 prism diopters (PD) within the first 6 days were treated differently based on the surgical technique and their individual conditions, including suture adjustment and conservative treatment. The overcorrection rate and its changes among different surgical groups, the recovery of ocular alignment and binocular visual function after different treatment methods in children with overcorrection on the sixth postoperative day, and the postoperative complications in different surgical groups were observed. Statistical analysis was performed using independent samples t-test, Wilcoxon rank-sum test, repeated-measures analysis of variance, Bonferroni test, chi-square test, or Fisher's exact probability test, as appropriate. Results: A total of 643 children who underwent intermittent exotropia correction surgery were included in the study. Among them, 325 children underwent the bow-tie adjustable suture technique, with 185 males and 140 females, and the mean age was (9.50±2.69) years. The remaining 318 children underwent conventional techniques, with 176 males and 142 females, and the mean age was (9.90±2.67) years. There were no statistically significant differences in age and gender distribution between the two surgical groups (all P>0.05). On the first postoperative day, among children who underwent the bow-tie adjustable suture technique, 40 had an esodeviation of≥10 PD, resulting in an overcorrection rate of 12.3% (40/325), while among children who underwent conventional techniques, 32 had an esodeviation of≥10 PD, resulting in an overcorrection rate of 10.1% (32/318). On the sixth postoperative day, these rates decreased to 5.5% (18/325) and 3.1% (10/318) in the two groups, respectively. At 1, 6, and 12 months postoperatively, the overcorrection rate in children who underwent the bow-tie adjustable suture technique was 0, while in children who underwent conventional techniques, the overcorrection rate did not show a significant decrease compared to before surgery. The differences between the two surgical groups were statistically significant (all P<0.05). On the sixth postoperative day, among children with an esodeviation of≥15 PD, 13 underwent suture adjustment and 7 received conservative treatment. The results of repeated-measures analysis of variance showed statistically significant differences in near and distance esodeviation angles among children who received different treatment methods (F=145.20, 106.87, both P<0.001), as well as statistically significant differences in near and distance esodeviation angles at different time points within each group of children (F=81.67, 35.09, both P<0.001). There were also significant differences in the trends of change in near and distance esodeviation angles at different time points among children who received different treatment methods (F=79.90, 36.73, both P<0.001). Further pairwise comparisons showed significant differences in near and distance esodeviation angles between the sixth postoperative day and 1, 6, and 12 months postoperatively in children who underwent suture adjustment (all P<0.05), while no statistically significant differences were observed in children who received conservative treatment (all P>0.05). At 12 months postoperatively, among the 13 children who underwent suture adjustment, 12 achieved stereopsis, while among the 7 children who received conservative treatment, all became stereo-blind after removing the prismatic correction. No serious complications occurred in any of the children postoperatively. Conclusion: The proportion of children with intermittent exotropia who achieved orthotropic alignment one year after surgery was relatively low among those who had an overcorrection of≥15 PD on the sixth postoperative day. The bow-tie adjustable suture technique is a simple and effective approach for managing overcorrection in patients with intermittent exotropia. Adjusting the sutures on the sixth postoperative day can reduce the overcorrection rate and is considered a safe and effective method.

Strabismus Surgery with Adjustable Suture Technique in Patients with Horizontal Strabismus

Objective: To evaluate the outcomes of squint surgery with adjustable sutures in patients with horizontal Strabismus.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Pediatric Ophthalmology and Strabismus, Al-Shifa Trust Eye Hospital, Rawalpindi Pakistan, from Jul 2016 to Jun 2018.&#x0D; Methodology: Adult patients with horizontal Strabismus and co-operative enough were selected for squint surgery with adjustable sutures. Squint surgery was performed under general anaesthesia. The recessed muscle was attached to the insertion site with hang back technique with a bow tie knot if required adjustment (further recession or advancement) was performed on the first post-operative day under topical anaesthesia. Preoperative, pre and post-adjustment and final postoperative orthoptic assessment were recorded. &#x0D; Results: One hundred thirty-two patients were selected for strabismus surgery with adjustable sutures. Eighteen patients (13.6%) had a history of previous strabismus surgery. 75(56.8%) patients required post-operative adjustment of sutures. Orthophoria was achieved in 107(81.1%) and residual exotropia of less than 10pd in 25(18.9%) patients. Desired surgical outcome of orthophoria or the residual squint of less than 10 prism diopters was achieved in 100% of patients.&#x0D; Conclusion: A positive surgical outcome was observed in our patients, and the second surgery for residual or consecutive squint was avoided.

Объем и разновидности офтальмохирургических вмешательств, выполняемых в детском офтальмологическом отделении, их эффективность

Purpose. To evaluate volume and nosological forms of ophthalmic surgery cases in the pediatric department of the ophthalmology surgery and analyze their effectiveness. Material and methods. A continuous retrospective number of all ophthalmic surgery in the pediatric ophthalmology department of the Khabarovsk branch of the S. Fyodorov Eye Microsurgery Federal State Institution for three years (from January 2019 to December 2021). Results. 5025 children aged from 1 month to 18 years old were operated. Surgical treatment of pathology of oculomotor apparatus was performed in 2304 (45.9%) patients, scleral remodeling in progressive myopia – 1088 (21.7%) people, probing for congenital lacrimal ducts obstruction – 619 (12.3%) children. In 463 (9.2%) children, surgical removal of the chalazion was performed. 166 (3.3%) children were operated for eyelid, conjunctival and orbital tumors. 120 patients (2.4%) underwent surgical revascularization for optic nerve atrophy of various origins. 96 children underwent surgical correction of various congenital eyelid anomalies. During this period, 169 premature babies (3.4%) were under observation in the department. Of these, at threshold stages of retinopathy of prematurity (ROP), 34 patients underwent laser coagulation of avascular areas of retina, 22 patients received intravitreal ranibizumab injection, 14 children with stage 4 or 5 ROP underwent endovitreal intervention of traction retinal detachment. Conclusion. The volume of ophthalmic surgery performed in the pediatric department is quite high, the largest proportions are various methods for eliminating the pathology of oculomotor apparatus and scleral remodeling in progressive myopia. In most cases of strabismus and ptosis surgery, it was possible to achieve complete or partial elimination of pathology. Stabilization of the progressive course of myopia was achieved in 67.9% of cases, threshold stages of ROP – in 91.7%. The high demand of population for surgical treatment of pediatric ophthalmopathology indicates the need for further development and improvement of this area. Key words: pediatric ophthalmology, structure of surgical pathology, main trends of ophthalmic surgery

Impact of COVID 19 pandemic lockdown in pediatric ophthalmology service in Kedia eye hospital, Nepal

Purpose: The Objective of the study is to know and record the effect of lockdown in the outpatient and emergency services of pediatric ophthalmology department of Kedia Eye Hospital.Method: Comparison of the children attending the Pediatric Eye Department of Kedia Eye Hospital during and before lockdown. Data of February 16 2021 to April 15 2021 was compared with April 16 2021 to June 15 2021. Collection of data was done from the Kedia Eye Hospital Outpatients and Emergency Eye Register.Results: Children below 15 years of age were enrolled in this study. Number of patients recorded from February 16 to April 15 2021 were 2030 and from April 16 to June 15 2021 were 318. Male patients attending hospital before lockdown was 51.62% and 55.47% during lockdown. Before lockdown female patient in the hospital was 55.47% and during lockdown was 44.02%. Total surgeries performed before lockdown was 94 and during lockdown was 11. Before lockdown Refractive error (43.15%) was the most common problem followed by Dry eye (16.55), vernal keratoconjunctivitis (15.41%). During lockdown Refractive Error (32.38%) was common followed by viral conjunctivitis (17.92%), Nasolacrimal duct obstruction (13.83%) and Trauma (11.63%).Conclusion: COVID -19 Lockdown reduced the number of patients and surgeries in the hospital. Trauma related eye disease, ocular infections and nasolacrimal duct obstruction increased in children during the lockdown.

Differences in Inferior Oblique Muscle Satellite Cell Populations between Primary and Secondary Inferior Oblique Muscle Overaction

Introduction: The aim of the study was to compare the number of paired box 7 (PAX7)-positive, myogenic differentiation 1 (MyoD1)-positive, and neural cell adhesion molecule-1 (NCAM)-positive satellite cells in human primary versus secondary inferior oblique muscle overaction (IOOA). Methods: This prospective observational study enrolled patients who underwent inferior oblique muscle myectomy at the Department of Pediatric Ophthalmology and Strabismus in Tianjin Eye Hospital between January 2020 and November 2020. The muscle specimens were processed. Immunohistochemistry and immunofluorescence were used to quantify inferior oblique muscle fiber diameter and PAX7-positive, NCAM-positive, and MyoD1-positive satellite cells. Results: Thirty-eight patients with inferior oblique overaction were enrolled: 18 with primary IOOA and 20 with secondary IOOA. The participants were significantly younger in the secondary IOOA group than in the primary IOOA group (2.8 ± 1.2 vs. 9.0 ± 3.2 years, p < 0.001). The muscle fiber diameter between the two groups was not significantly different (13.5 ± 1.4 vs. 13.8 ± 0.7 µm, p = 0.530), but PAX7+ (3.3 ± 2.8 vs. 1.8 ± 0.6, p < 0.001), NCAM+ (3.6 ± 1.5 vs. 1.7 ± 0.2, p < 0.001), and MyoD1+ (4.8 ± 1.9 vs. 2.7 ± 0.5, p < 0.001) cell counts were higher in primary IOOA than in secondary IOOA. Conclusions: PAX7pos, MyoD-1pos, and NCAMpos cell counts per laminar nucleus were almost 2-fold higher in the primary IOOA group than in the secondary IOOA group.

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.

Causes of Delayed Presentation of Retinoblastoma in a Tertiary Care Hospital of Pakistan

Purpose: To find out the causes of delayed presentation of Retinoblastoma in a tertiary care hospital. Study Design: Questionnaire based Survey. Place and Duration of Study: Pediatric ophthalmology department of The Children’s Hospital, Lahore, from January 2018 to December 2019. Methods: Mothers of patients who presented in the hospital were recruited for this survey. A questionnaire with details of the patient were noted. It included first symptom, time lapse since onset of first symptom, gender, age at presentation to first doctor (general practitioner), time lapse to presentation at tertiary care center (The Children’s Hospital &amp; Institute of Child health), gender and laterality. General physical Examination was done by an oncologist and examination under anesthesia was done by a pediatric ophthalmologist. Data was analyzed using SPSS version 20. Pearson Chi Square test was used to find significance of each cause. Results: Seventy participants were included in the study. Delayed presentation was seen in 42 patients (60%). The various factors identified for delay in diagnosis and treatment in descending order are residence in rural areas 54 %, lack of finances 64%, social pressure 27%, awareness about disease severity 60%, lack of transport 54%, Fear of enucleation 38% and seeking non-medical treatment/ alternate medication 32%. Significance of each factor was calculated using chi-square test. Conclusion: The causes identified can be highlighted on national level for development of health facilities in rural areas. Key Words: Retinoblastoma, Cancer, Malignant tumor, Leucocoria.