Ocular alignment, media, and eyelid disorders in Down syndrome

Ocular abnormalities in Alagille syndrome

SummaryDevelopmental anomalies are one of the the main pathologies seen in infancy and childhood. Embryological development of the anterior segment structures are closely related to each other and the clinical manifestations can be complex with associated glaucoma and lens opacities. Also in infancy and childhood amblyopia is needed to addressed in order to support visual system development. The spectrum of developmental anomalies known as anterior segment dysgenesis can be mild as posterior embryotoxon or can affect iris, cornea and even crystalline lens in severe cases of Peters anomaly. Peters anomaly can be seen as a genetic syndrome (Axenfeld‐Rieger syndrome) or after congenital rubella. As the clinical manifestation vary, the treatment modalities vary accordingly.

To compare the prevalence of cataract in workers exposed to trinitrotoluene (TNT) to the prevalence in a group of unexposed workers, matched on age and sex, using Tiukina's description and grading of TNT-induced cataract. A total of 23 TNT-exposed and 44 unexposed workers underwent an eye examination performed by an ophthalmologist who did not know the exposure status of the subjects. All lens opacities matching Tiukina's description were classified as TNT cataract and graded on Tiukina's scale of stages 1-4. Four cases of TNT-induced cataract were identified among the 23 TNT-exposed workers and none in the unexposed group (p < 0.01). Exposure to TNT may cause a unique type of cataract, which a general ophthalmologist, using Tiukina's description and grading scale, will be able to distinguish from other cataracts.

Tearing, a common complaint in the daily oculoplastic clinic can result from hypersecretion of tears, eyelids or eyelash malpositioning, or more commonly from stenosis or obstruction in the lacrimal drainage system. Disorders of the lacrimal drainage system, which cause tearing, discharge, or medial canthal swelling, are common ophthalmic complaints and account for about 3% of visits to general ophthalmology clinics. Accurate evaluation and localization of the pathology is essential for proper treatment and management.

ObjectivesTo investigate the utilisation of eye disorder-related ambulatory medical services prior to the diagnosis of primary Sjögren's syndrome in female Taiwanese patients.DesignA nationwide, population-based case–control study.SettingTaiwan's National Health Insurance Research...

Objective: To compare the bed occupancy rates of various departments of Holy Family Hospital during January 2022. Materials &amp; Methods: A cross-sectional descriptive study was done to determine and compare the Bed Occupancy Rates (BOR) of January 2022 from numerous departments of Holy Family Hospital Rawalpindi. Medicine &amp; Allied departments in our study were those of Medicine, Nephrology and Paediatrics. Surgery and Allied departments were comprised of General Surgery, Plastic Surgery, Pediatric Surgery, Gynecology, Obstetrics, ENT, Ophthalmology and Neurosurgery. No. of beds for Medicine and Surgery &amp; Allied departments are denoted by “n”. Data was analysed by Microsoft Excel 2010. Data was also gathered from intensive care units of the hospital. BOR% of each department and mean BOR were calculated. Difference between Mean BOR ± SD of Medicine &amp; Allied and Surgery &amp; Allied was statistically confirmed by applying independent sample t-test. P ≤ 0.05 was taken as significant. 95% CI Results: Mean BOR of hospital wards was 97.6%. The greatest BOR was reported from Plastic Surgery department (154%) followed by that from Paediatrics (128%). Nephrology and Obstetrics with same BOR (121%) were ranked third. Mean BOR of Medicine &amp; Allied departments was 108.7 ± 27.59 while that of Surgery &amp; Allied was 93.4 ± 35.79. This difference of mean BOR was statistically significant (P = 0.000; 95% CI, 9.4 – 21.2). The crowning of BOR from Pediatric and Neonatal ICU was acknowledged with 247% and 223.10% respectively. The female patients in both medical and surgical departments were greater in magnitude than males. Conclusion: BOR of public sector teaching hospital is quite enormous that needs attention of policy makers for diminution.

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.