Cataracts, Camps and Curries in India

Rachel Hui Fen Lim

Cite as: BUJO 2014;2:bujo.2014.009 | Published: 4 September 2014


In India, the problem of blindness secondary to cataracts remains a formidable one; a problem that is unlikely to be resolved in the foreseeable future despite the increase in number of cataract surgeries being performed. In December of 2012 I undertook a placement at the Ruby Nelson Memorial Hospital in Jalandhar, India. The hospital coordinates eye camps with great efficiency and skill, restoring the sight of tens of thousands every year. During my stay I observed two camps where over 200 surgeries were performed using the Manual Small-Incision Cataract Surgery (MSICS) technique. The MSICS technique has been shown to be advantageous for high-volume caseloads whilst maintaining excellent visual outcomes. By employing this safe and cost-effective method, eye surgeons can combat cataract blindness not only in India but also across the developing world.

Keywords: manual small incision cataract surgery, eye camp

[Full Article]



One Man’s Eye-land

Anna Louise Pouncey

Cite as: BUJO 2014;2:bujo.2014.010 | Published: 4 September 2014


St Vincent and the Grenadines, best known as the filming location for Pirates of the Caribbean, may sound like an ideal elective location; however, the reality held a few surprises. In a stretched Ophthalmology department, held together by one man, Anna learnt about the principles of eye care provision, how to work in an environment with limited resources and saw a few operations along the way.

Keywords: manual small incision cataract surgery, elective, caribbean

[Full Article]

Preventing Ocular Trauma: national survey of eye injuries in female lacrosse players

Zofia Zielicka, Susan Sarangapani, Louis Koizia, Naresh Joshi

Cite as: BUJO 2014;2:bujo.2014.008 | Published: 5 September 2014


Aims: To identify ocular trauma and the sentiments towards the implementation of protective eyewear in female English lacrosse.

Methods: Two anonymous retrospective questionnaires were devised, one for women’s lacrosse coaches and players respectively. Surveys were undertaken either anonymously online or in person during national secondary school and university tournaments. 

Results: Surveys were collected from 648 players and 85 coaches. 157 players reported sustaining an eye injury, 13 of those had long-term adverse consequences on their vision.    46% of coaches and 24% of players, reported ocular injuries involving doctor based care, including specialist units. The majority of coaches (64%) and players (52%) would recommend the implementation of protective eyewear, into English lacrosse.

Conclusion: Data collected from this study suggests that ocular injuries, including serious visual loss, occur during lacrosse. The mandatory adoption of ocular protection should be considered in England as a matter of urgency.

Keywords: female, lacrosse, ocular injuries

[Full Article]



A Case of Central Serous Retinopathy

Aria Mohammad-khani, Hannah Timlin, Kamran Saha, Narciss Okhravi

Cite as: BUJO 2014;2:bujo.2014.007 | Published: 4 September 2014


Introduction: Clinicians frequently prescribe systemic and topical steroids. However, many are unaware of the potential ocular side effects, including central serous retinopathy (CSR). Additionally, patients displaying multiple retinal cotton wool spots (CWS) must have blood pressure measurements to eliminate uncontrolled / inadequately treated systemic hypertension. This case illustrates how vigilance in both these areas is paramount.

Case Report: Examination of a 56-year-old type II diabetic gentleman twelve months post uncomplicated left eye cataract surgery revealed bilateral new retinal findings suggestive of CSR. Further questioning revealed the use of topical steroid cream in addition to the prescribed postoperative steroid eye drops. Whilst the CSR resolved spontaneously, CWS were noted bilaterally. As his eyes demonstrated minimal other signs of diabetic retinopathy, attention reverted to his poorly controlled systemic hypertension.

Conclusion: CSR is an important side effect of topical steroids.  Systemic hypertension should be excluded from the differential diagnosis of CWS, even in diabetic patients.

Keywords: Central serous retinopathy, cotton wool spots, diabetic retinopathy, steroids, hypertension.

[Full Article]

Retinoblastoma in Nepal: case report and review

Stephen V Lau, Ben Limbu

Cite as: BUJO 2014;2:bujo.2014.006 | Published: 5 September 2014


Retinoblastoma often sparks interest because the underlying cancer gene mutation was the first to be identified and cloned. However, apart from its genetic intrigue, the condition illustrates the health disparities between more and less developed countries. We present a case of retinoblastoma in a 6 month old boy who presented with left eye leukocoria and slight proptosis to the Tilganga Institute of Ophthalmology in Kathmandu, Nepal. Urgent left eye enucleation with orbital implant under general anaesthesia was recommended. Histological examination of the left globe revealed gross involvement of the choroid and optic nerve and poorly differentiated tumour cells. The tumour was staged as pT4a in the TNM classification system and 6 cycles of adjunctive chemotherapy were advised. The epidemiology of retinoblastoma between Nepal and developed countries is compared. We propose reasons for the apparent discrepancy between the two settings and identify areas of weakness which can be improved in Nepal.

Keywords: retinoblastoma, leukocoria, enucleation

[Full Article]



Post Cataract Surgery Endophthalmitis in the “Constant Gardener”

Tahir A Farooq, Yajati Ghosh

Cite as: BUJO 2014;2:bujo.2014.005 | Published: 4 September 2014


We describe a case of endophthalmitis following routine cataract surgery caused by the aerobic gram negative organism, Rhizobium radiobacter. The low virulence of this organism is demonstrated through the late clinical presentation of sight-threatening signs and symptoms. This case highlights the importance of the high levels of suspicion required in postoperative cataract patients, prompt diagnosis and treatment with appropriate antimicrobials. Indeed, the array of cases reported in the literature demonstrates the varying severity of post-cataract endophthalmitis and delays in presentation. Specifically, this case highlights shifting sensitivity of R. radiobacter, from gentamicin to ciprofloxacin, and confirms that this species can be treated safely with a good visual outcome, without requiring the removal of the intraocular lens implant. Moreover, this case should remind clinicians of the need to advise patients not to undertake activities which involve exposing the eye to organic material, such as gardening, following cataract surgery.

Keywords: cataract surgery, complications, endophthalmitis, rhizobium radiobacter, agrobacterium, gardening

[Full Article]



How to conduct a slit lamp examination

Anika Nanda, Aachal Lotecha

Cite as: BUJO 2014;2:bujo.2014.003 | Published: 4 September 2014


This article aims to introduce the uses of slit lamp bio-microscopy to medical students and junior doctors, providing a brief overview of techniques. It outlines the skills necessary to set up an examination for each patient. The paper summarises a few vital techniques enabling exploration of each part of the eye from outermost lids and tear film to the retinal layers. Finally, it provides advice on certain sight-threatening signs as well as additions such as filters and lenses, which may be used alongside this instrument.  Being proficient in using the slit lamp is  important not only in ophthalmology clinics but a valuable asset in  accident and emergency.

Keywords: red eye, clinical skills, slit lamp, examination

[Full Article]

Management of Glaucoma

Syed M Shahid, Syed M Naqib, Laura Crawley

Cite as: BUJO 2014;1:bujo.2014.004 | Published: 4 September 2014


Glaucoma is a common cause of irreversible blindness in the developed world. Management includes medical, laser and surgical treatment options. Regardless of whether the presenting IOP is high or within the normal range, IOP lowering is the only treatment option at the present time. Having said this however, there is growing evidence for IOP independent neuroprotection, but this lies outside the remit of this paper. First-line treatment usually involves topical therapies, whilst surgery is usually reserved for patients who have failed to respond or are intolerant of medical and or laser therapies. There are many different types of topical agents available, and this article aims to describe the mode of action, side effects and effectiveness of the different types of topical medications. In addition, it briefly looks at various types of laser therapies and surgical procedures used to manage glaucoma, as well as discussion on when to start treatment and how to monitor patients with glaucoma.

Keywords: glaucoma, primary angle glaucoma, medical treatment, laser treatment, trabeculectomy, laser iridotomy

[Full Article]

Spectacles and Sight-Saving Surgeries in Central America

Sophie Poore

Cite as: BUJO 2013;1:bujo.2013.011 | Published: 15 July 2013


In August 2012 I was privileged to visit Tegucigalpa, the capital city of Honduras in Central America, volunteering as a ‘Global Impact Fellow’ for Unite For Sight, an American non-governmental organisation. Unite For Sight was not an ordinary medical elective provider, in that clear expectations were set forth that we should not only observe, but work as volunteers, raise funds and provide spectacles. Furthermore, in their mission to apply the best practices in global health, I was to receive extensive pre-departure training, enabling an earlier transition into a culturally competent and effective volunteer. This month would teach me, not only many essential life-skills, but improved awareness of sustainable, ethical global health provision and knowledge regarding eye conditions in hot, dusty environments in the less economically developed world. Through personal observations, interactions and the absorption of Honduran culture I would learn about a culture so different to my own, allowing my world-view to shift and perspectives to change. My time in Honduras was split two ways: between the clinic and outreach camps or ‘brigadas’.

Keywords: unite for sight, elective, honduras, social entrepreneurism

[Full Article]

Vascular Endothelial Growth Factor: from discovery to therapy

Gemma Manasseh, Marcus Fruttiger

Cite as: BUJO 2013;1:bujo.2013.005 | Published: 15 July 2013


Blood vessels are fundamental to life, facilitating delivery of vital nutrients to tissues. If vascular function is interrupted tissues may perish, as occurs in many disease states. Understanding basic vascular biology is essential for the identification of potential therapeutic targets and the development of treatment modalities. A key success story in the translation of basic science research to clinical medicine is that of vascular endothelial growth factor (VEGF). It was identified in relation to increased vascularity associated with tumour growth, and work began to define its role in human health and disease. The role of VEGF in ocular neovascular disease became particularly apparent in the pathogenesis of age-related macular degeneration (AMD), directly leading to the development of anti-VEGF therapy. VEGF is also central to normal retinal vascular development, and when interrupted by premature birth, retinopathy of prematurity can result. The successful translation of VEGF research into effective therapy has heralded much success in ophthalmology practice.

Keywords: VEGF, vascular endothelial growth factor, age-related macular degeneration, retinopathy

[Full Article]

Ocular disorders in Marfan's Syndrome

Fred Clough, Sonia Szamocki, Alex Ferdi, Andrew Coombes

Cite as: BUJO 2013;1:bujo.2013.003 | Published: 15 July 2013


Marfan's syndrome (MFS) is an autosomal dominant connective tissue disorder where ophthalmic problems are often the presenting symptom in childhood. Diagnosis is based on established criteria outlined by expert opinion in 1996, known as the Ghent criteria. These criteria have recently been revised, and place more weight on two cardinal features of MFS: ophthalmological and cardiovascular pathology. Ophthalmologists thus have a prominent role to play in both diagnosis and lifelong care for MFS patients. This article aims to outline the presentations of ocular pathology and diagnostic challenges for aspiring ophthalmologists who will be key members of the multi-disciplinary team in future. In light of the revised Ghent classification, ophthalmology trainees must have a low threshold for investigation of a suspected MFS patient with a working knowledge of the diagnostic criteria. This will allow prompt correction of the sight threatening complications of MFS and early initiation of long- term monitoring of the life-threatening cardiovascular complications.

Keywords: marfan's, ghent nosology, ectopic lentis, marfanoid habitus, pathological myopia

[Full Article]