Blood within the bone: orbital intraosseous venous malformation

PURPOSE

Description of clinical features, radiological characteristics, and management strategies in primary orbital intraosseous venous malformation (OIVM) with pertinent literature review.

METHODS

A retrospective analysis including clinical, radiologic, operative, and histopathological data of six cases of histopathologically proven OIVM was done. A comprehensive literature review was conducted using online databases and augmented with manual search to identify reported cases of OIVM.

RESULTS

Study data showed five females and one male in young to middle-age group, with an average age of 30 years (range: 20-48 years). Proptosis was noted in five cases (83.33%), and the duration of symptoms ranged from 6 months to 10 years. Frontal and zygomatic bones were most frequently affected and expansile bony lesion was the most common CT scan finding. Three patients underwent pre-operative embolization of feeders followed by en bloc excision of mass and surgical reconstruction (50%); one patient was managed with partial excision (16.66%) while two were regularly followed-up after incision biopsy (33.33%). Histopathology revealed vascular spaces with endothelial lining, separated by bony trabeculae in all patients. Follow-up periods ranged from 6 to 48 months and no recurrence or progression were noted.

CONCLUSIONS

OIVM is an exceptionally rare disorder with a gradually progressive benign course. Ophthalmologists need to be mindful of this entity during patient evaluation as it has propensity for large volume blood loss intra-operatively, owing to its vascular nature. Complete excision with reconstruction of resultant defect is the preferred treatment strategy and without known recurrence.

Changing pattern of childhood blindness in eight North-Eastern states and review of the epidemiological data of childhood blindness of India

Purpose:

To assess the causes of visual impairment and blindness in children in all the schools for the blind in eight northeastern states and to determine its temporal trend, and to analyze the result with reference to various regional epidemiological data on childhood blindness in India.

Methods:

Children aged ≤16 years, with a visual acuity of ≤6/18 in the better eye, attending 17 schools for the blind were examined between November 2018 and March 2020. WHO protocol and reporting format was used for the evaluation, diagnosis, and classification of the causes.

Results:

Out of 465 eligible study participants, 93.76% were blind and only 12.26% of causes were avoidable. Anatomical causes of childhood blindness were whole globe (43.2%), cornea (17.20%), optic nerve (12.04%), retina (9.68%), and lens (9.46%). Etiological causes were unknown (52.69%), hereditary (26.02%), intrauterine (15.05%), and 26.08% had blinding congenital ocular abnormality (s). Regional temporal trend revealed a decrease in corneal and childhood causes and an increase in retina, optic nerve, hereditary, and intrauterine causes.

Conclusion:

A constellation of causes were differentiable but matched with the overall emerging trend of childhood blindness in India. Higher corneal, unavoidable, and unknown causes suggest a region-specific action plan for controlling childhood blindness as well as rehabilitation.

Safety and efficacy of riboflavin-assisted collagen cross-linking of cornea in progressive keratoconus patients: A prospective study in North East India

INTRODUCTION:

Riboflavin- and ultraviolet (UV)-A-mediated collagen cross-linking of the cornea is a frequently used therapeutic measure for the treatment of progressive keratoconus (PK). First, riboflavin increases cross-linking and second, it serves as a protective shield to other deep ocular structures. However, pharmacogenomic variation in riboflavin efficacy is reported. As the Northeast Indian population represents a genetically diverse group of population compared to mainstream India, we have assessed the efficacy of the procedure in a northeastern population with PK.

METHODS:

In this study, 78 eyes with PK were included (n = 39 in the treatment arm and n = 39 in the control arm). The primary objective was to evaluate the effect of corneal collagen cross-linking using riboflavin (C3R) (epithelium off) on maximum keratometry. The secondary objectives were evaluation of change in corneal topography parameters, i.e., minimum keratometry (K_min), simulated keratometry (Sim K), subjective refraction (cylinder power, spherical power, and spherical equivalent [SE]), uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and contrast sensitivity (CS) and safety (intraocular pressure, endothelial cell density, and percentage hexagonality) at 1, 3, and 6 months following C3R procedure.

RESULTS:

Statistically significant improvement was noted in K_min (6 months), Sim K (3 and 6 months), cylinder power (3 and 6 months), spherical power (3 and 6 months), SE (3 and 6 months), BCVA (6 months), and UCVA (1, 6 months) in the C3R group (n = 39) when compared to the control group (n = 39). The mean CS decreased at 1 month and gradually improved to achieve statistically significant value at 6 months in the C3R group (P < 0.05).

CONCLUSION:

Riboflavin-assisted C3R treatment showed promising efficacy in the treatment of PK patients in our population. As the collagen turnover rate of cornea is 2–3 years and the progression of PK is highly variable, we need long-term studies to evaluate the efficacy of C3R over time, requirement of repeat therapy, and safety of repeat cross-linking.