Syeed Mehbub Ul Kadir

Patients with preeclampsia or eclampsia may be associated with hypertension, seizures and other neurologic symptoms and deficits. A young female patient presented with a neurological and visual disturbance which included variable symptoms like visual disturbances, headache, seizures and altered consciousness or mental status with a history of postpartum eclampsia after an uneventful LUCS. She also gave a history of a two-bag blood transfusion one month ago. A neurological and ophthalmic evaluation was performed. Detailed history taking and clinical evaluation followed by an imaging study, potentially magnetic resonance imaging (MRI), helped to confirm the diagnosis of Posterior reversible encephalopathy syndrome (PRES). PRES is a clinico-neuroradiological disorder of neurotoxicity that typically involves headache, mental confusion, seizures, and occasionally loss of vision. The exact pathophysiology of PRES is still unclear and has not been thoroughly explained. Hypertension and endothelial cell injury may be pathognomic. Prompt management may help to recover early.   Keywords: Hypertension, Eclampsia, Visual disturbance, Altered consciousness, Posterior reversible encephalopathy syndrome.

Purpose: To report a rare case of living parasite in the eyelid. Materials and Methods: This case report was done in a tertiary care eye hospital in Bangladesh. We evaluated the patient thoroughly. CT scan of the orbit and histopathology were helped to diagnose the case. Per operative video recording, preoperative and postoperative photograph was documented properly. Case Report : A young boy presented with gradual swelling in the right upper eyelid. Clinically a firm mass was found in the right upper eyelid. CT Scan of the orbit revealed a cystic lesion in the eyelid. A live worm was extracted from the right upper eyelid. Conclusion: Parasitic lesion may be occurred in the eyelid. Ophthalmologist should be aware of the atypical presentation of the eyelid.   Keywords: Parasite, Cystic, Eyelid, Loa Loa

Objective: To compare the outcome of revision external dacryocystorhinostomy (DCR) with or without mitomycin C. Materials and Methods: This Quasi prospective study was conducted over 30 diagnosed patients with failed external dacryocystorhinostomy came to the Oculoplasty clinic at Ispahani Islamia Eye Institute and Hospital from July 2019 to June 2020. Results: Maximum of 40.0% of the patients were 41–50 age group in Group A (Mitomycin C) and 40.0% in 41-50 age group in Group B (without Mitomycin C). There were 7(46.7%) males, and 54-58 8(53.3%) females in Group A, 6(40.0%) male and 9(60.0%) female in Group B. 18(60%) patients underwent left-sided and 12(40%) patients underwent right-sided revision dacryocystorhinostomy respectively. Most patients had no complications in both groups of this study. Only one patient reported with corneal epithelial defect in the mitomycin C group. After six months follow up, 93.3% success rate was seen in revision external DCR with mitomycin C group and 66.7% in revision external DCR without mitomycin C group. Conclusion: Mitomycin C has a beneficial effect in preventing reclosure of the dacryocystorhinostomy stoma after revision external dacryocystorhinostomy and no significant complications resulting from its use.   Keywords: Failed DCR, Revision DCR surgery, Mitomycin­C, Surgical outcome.

Objectives: This study aimed to assess the demographic and clinical characteristics, prognostic factors, and visual outcomes of open globe injury on the repair. Materials and Methods: This was a retrospective cross-sectional study including all patients who underwent repair surgery following open globe injury and are on regular follow-up visits postoperatively in a tertiary eye hospital from 1st July to 31st December 2021. Patients were divided into two groups. Group A include OGI patients undergoing repair within 24 hours, and Group B includes OGI patients who underwent repair after 24 hours of injury. All the study patients were studied in detail, including the Presenting features, mechanism of injury, preoperative and postoperative visual acuity, demographic data, and postoperative complications. Results: This study studied a total of 100 patients (46 in group A and 54 in group B). Male predominance (>70%) was seen in both groups. In both groups, the highest number of patients (61% in group A and 52% in group B) were in ?18 years of age. In both groups, the majority of OGI (52% in group A and 61% in group B) were Iron induced. In groups A and B, Zone I is affected chiefly, about 85% and 81%, respectively. Most OGI patients were admitted to the hospital with severe low vision on VA examination, about 54% and 63% in Group A and B, respectively. At three months of postoperative follow-up, BCVA was significantly improved In Group A than in Group B (p-value 0.05). 80% patients improved to normal vision in group A compared to 50% in group B. Conclusion: Open globe injuries should be repaired as soon as possible, even within hours. Initial visual acuity remains the strongest predictor of outcome; however, delay to primary repair reduces final visual acuity.   Keywords: Open globe injury, Repair, early, late, visual outcome

Sixth nerve palsy is the commonest isolated cranial nerve palsy. Possessing the longest course, it is susceptible to damage through a myriad of etiologies, hence termed ‘false localizing sign’. Though frequently being a benign process with spontaneous recovery, it may be due to serious underlying pathology. Therefore, sixth nerve palsy requires careful clinical workup with tailored investigation. We are presenting three cases of isolated sixth nerve palsy having different etiologies.   Keywords: Sixth nerve palsy, False localizing sign, Etiology, MRI of the brain

A 33-year-old male patient presented with swelling and pain in the left upper eyelid, forward protrusion and downward displacement of the left globe for the last 2½ months. He was pretty good before that time. He has visited a nearby ophthalmologist and treated him as a non-specific orbital inflammatory disease (NSOID), and he has taken oral corticosteroids for the last two months. The pain was reduced but not completely regressed. Then, He referred to Oculoplastic services in a tertiary eye hospital and underwent an incision biopsy to confirm the diagnosis. The histopathology report confirmed high-grade lymphoma diagnosis and advised open biopsies for immunohistostaining. Orbital inflammation may mask malignancy.   Keywords: Orbit, Inflammation, corticosteroids, Immunohistochemistry, Diffuse large B cell lymphoma

Purpose: To assess the interference of patient care due to COVID 19 related restrictions and to formulate the future guidelines. Methods: This cross-sectional online survey-based study was carried out among the ophthalmologist of Bangladesh in the early lock down period (01 April to 30 April) 2020. Results: Total 93 ophthalmologists responded to the study. Most of the ophthalmologist were seeing the patients with red eye (40.9%), ocular trauma (40.9%), acute infections and inflammations (35.5%), and vision loss (31.2%). 80.6% responder informed that they wear Mask, gloves, and head cap during patient evaluation. 51.6% used Personal protection equipment. 55.9% used a breath shield with the slit lamp settings. 60.4% maintained hand wash, and disinfectant facilities for the patients. 85.7% ophthalmologist had ensured for wearing the mask to all patients before entering the examination and consultancy room. 86% ophthalmologist of our study had performed their surgeries for ophthalmic emergency. Conclusions: Wearing mask is an important tool to prevent transmission of COVID-19 for both patients and ophthalmologists in working place. Maintaining normal ophthalmic practice and surgery are challenging during COVID-19 pandemic. Keywords: Covid­ 19, Lockdown, Ophthalmic, Practice, Pattern.

Aims: To assess the outcome of lateral tarsal strip (LTS) for the involutional entropion and ectropion.  Materials and Methods: A quasi study was carried out in a tertiary eye hospital of Dhaka, Bangladesh, between January 2013 and December 2020. This study included all patients who underwent lateral tarsal strip (LTS) procedure for the correction of involutional entropion and ectropion. Group A patients were presented with involutional entropion and group B patients were presented with involutional ectropion. We assessed surgical outcome and postoperative complications. Results: Out of 48 lower eyelids marginal malposition of 43 patients were studied in this study and 5 cases were presented bilateral lower lid marginal malposition. Lateral tarsal strip (LTS) procedure was a unique procedure to correct the involutional entropion (24 eyelids 50%), involutional ectropion (24 eyelids 50%), involving the lower eyelid. The male to female ratio was almost 2.6:1. The mean age was 68.49 years with 54 years to 90 years age range. The surgical correction was satisfactory in 95.9%, and 91.7% of lower eyelids involutional entropion, and involutional ectropion respectively. Conclusions: Lateral tarsal strip (LTS) is a unique procedure to achieve better cosmetic and functional outcome for the correction involutional eyelid marginal malposition (entropion, and ectropion). Keywords: Lateral tarsal strip, Involutional, Entropion, Ectropion.

Purpose: To assess the surgical outcome of Blepharophimosis syndrome (BPES). Materials and Methods: This interventional study has been evaluated pre and postoperatively of fifty patients in two tertiary eye hospital in Bangladesh. All patients were divided into two groups like as group-A (35 patients) and group-B (15 patients). Telecanthus, Epicanthus and ptosis were corrected 3 months apart in group-A. All procedures were done in single setting in group-B. Results: Male patients were 21 (42%) and female patients were 29 (58%). In group-A, Satisfactory outcome of Y-V plasty was 89%, and 11% patient presented unsatisfactory correction of telecanthus. Under correction after ptosis surgery was observed in 02 patients. In group-B, satisfactory outcome of C-V plasty was 93% and under correction was observed in 4 patients followed by ptosis surgery. Conclusion: There is no significant difference between Y-V plasty and C-V plasty to correct telecanthus and epicanthus. Ptosis correction resulted well in separate sittings. Keywords: Blepharophimosis syndrome, Y-V Plasty, C-V Plasty.

Non-specific orbital inflammatory disease (NSOID) is a inflammatory condition involving orbit and adnexa. It has is a recurrence with relapse & remission. It may cause irreversible damage and loss of function. On the contrary, prompt management may reduce the complications. Here we will present a case of a patient of non-specific orbital inflammation managed by pulsed corticosteroid therapy which reduces the disease progression and vision threatening condition in one eye. But, unfortunately he lost his vision in another eye.   Keywords: Non-specific orbital inflammatory disease, CT scan of orbit, Pulsed steroid therapy.  

Purpose: To present the demographic and clinical profile and management strategies of patients with periocular and orbital amyloidosis. Materials and Methods: This study retrospectively reviewed the clinical records of twelve patients with periocular and orbital amyloidosis between January 2011 and February 2019 in Bangladesh. Clinical evaluation and Imaging studies were helpful to diagnosis the patients, but surgical biopsy followed by histopathological study was done to confirm the diagnosis. All cases were investigated to rule out systemic amyloidosis with limited facility and no systemic involvement was found. Informed written consent for surgical procedure and Clinical photographs were taken for all patients for documentation and clinical research. Results: The study included thirteen patients including nine male (69.2%) and four female (30.8%) patients. Among the patients, seven (53.8%) were unilateral and six (46.2%) were bilateral. Clinical signs and symptoms were visible or palpable periocular mass or tissue infiltration in all 13 (100%) cases, mechanical ptosis was observed in 6 (46.2%) cases, and proptosis or globe displacement was found in 4 (30.8%). Age ranges from 25 years to 65 years. The Mean age ± SD was 48.23 ± 10.64 years. Treatment modalities were mainly open surgical biopsy either excision (53.8%) or debulking (46.2%). Conclusions: Periocular and orbital amyloidosis may present with a wide spectrum of clinical findings depending on the location of the disease. The goal of treatment is to preserve function and to prevent sight-threatening complications. Keywords: Amyloidosis, Eyelid, Conjunctiva, Orbit, Histopathology

Purpose: To describe a minimally invasive technique of harvesting fascia lata, and also to analyze the clinical uses and the outcome of fascia lata in Ophthalmic Plastic and Reconstructive surgery. Methods: This interventional study was done in three tertiary care eye hospitals in Bangladesh from July 2014 to June 2020. We obtained autologous fascia lata for the correction of congenital ptosis with poor levator function (⩽4 mm), covering the ciliary staphyloma, repair of the extruded implant following anophthalmic socket surgery, and was also used to wrap the orbital implant after enucleation. Preserved FL was used only for children before 6 years of age for the treatment of congenital ptosis. Results: Out of 60 subjects, 38 (63.3%) were male and 22 (36.7%) were female. Autogenous fascia lata was used for frontalis brow suspension (FBS) in 25 (41.67%) patients of congenital ptosis with poor levator function, as patch graft in ciliary staphyloma (11 cases, 18.3%), to wrap orbital implant following enucleation in intraocular malignancies (nine cases, 15%), to repair of implant extrusion following evisceration (five cases, 8.3%), and as fascial sling to correct recurrent paralytic ectropion (one case, 1.67%). Allogeneic or preserved fascia lata was used to correct congenital ptosis in patients less than 6 years of age (nine cases, 15%). Mean follow-up time was 5.32 months. Conclusion: Fascia lata (autogenous and allogeneic preserved) has varied uses in ophthalmic plastic surgery. Harvesting fascia lata (FL) using with minimally invasive method was successful with the least scar on the thigh to correct congenital ptosis, ciliary staphyloma, repair of extruded implant, and in wrapping implant after enucleation to get better cosmesis and motility.

Objective: The aim of the study was to describe the clinical presentation, management strategies, and outcomes in a case series of primary lacrimal sac tumors. Methods: This retrospective study was conducted in Sheikh Fajilatunnessa Mujib Eye Hospital and Training Institute, Bangladesh, from July 1 to December 31, 2020, and included all patients who were evaluated, treated, and followed up for at least 6 months from January 2013 to October 2020. One patient developed a recurrence of the adenocarcinoma of the lacrimal sac after 1 year of primary treatment. Patients’ demographic data were analyzed and reviewed from published articles on lacrimal sac tumors. We assessed patients clinically, followed by radiological evaluation. We also analyzed the biopsy technique, treatment modality, and recurrence. An oncologist reviewed all patients to prepare a plan for adjuvant treatment. Results: Ten patients with lacrimal sac tumors were included in this study. Swelling in the medial canthal region was the most common presenting feature (100%), followed by epiphora (60%) and pain (30%). Open biopsy was preferred over fine-needle aspiration biopsy. Incisional biopsy or complete excisional biopsy was performed for all suspected malignancies. Malignant tumors were found in 7 (70%) cases, and benign tumors in 3 (30%) cases. Non-Hodgkin’s lymphoma (NHL) (40%) was the most common malignant lacrimal sac tumor. Mucosa-associated lymphoid tissue lymphoma was 75%, and diffuse large B-cell lymphoma was 25% among the cases of NHL. Patients with epithelial malignancy were treated with external beam radiation therapy, while NHL patients were treated with chemotherapy (CHOP regimen). Recurrence was noted in 1 case (10%) of epithelial malignancy after 1 year of treatment. Conclusion: Successful management of lacrimal sac tumors requires a high index of suspicion, as these are fatal tumors, often misdiagnosed as dacryocystitis. Nonepithelial malignancies are more predominant than epithelial malignancies, and hematolymphoid tumors are most frequent.