dos_feb_2014

5 Editorial Miscellaneous

Experts’ Corner 59 Orbital Exenteration for Uncontrolled Facial
Fungal Cellulitis: A Dilemma and Review of
13 Pediatric Cataract Surgery Literature
Prakashchand Agarwal, Anjali Sharma,
Theme: Pediatric Ophthalmology V.K. Saini, Anil Kapoor, Shaji Thomas,
Navinchandra M. Kaore
23 IOL Power Calculation in Children
Evolution
Sandeep Gupta, Parth Patel,
Gagandeep Kaur, V.S. Gurunadh, 65 Evolution of Pediatric Cataract Surgery
M.A. Khan, V.K. Mohindra
Neelima Aron
31 Congenital Corneal Opacities
PG Corner
Rajat Jain, Rashmi Nautiyal
69 An Approach to a Child with Leukocoria
41 Pediatric Epiphora
Vijay Kumar Sharma, Tarun Arora
Saurbhi Khurana, A.K Grover
Monthly Meeting Corner
47 Childhood Nystagmus
77 Iatrogenic Globe Perforation
Rohit Saxena, Reena Sharma
Bhartendu Kumar Varma, Harbansh Lal,
Diagnostics Tinku Bali Razdan

55 RETCAM: Clinical Applications in Tear Sheet

Retinopathy of Prematurity 87 Visual Development Milestones and Visual
Parijat Chandra, Anil Gangwe, Vivek Kumar,
Mayank Bansal, Rajvardhan Azad Acuity Assessment in Children
Digvijay Singh

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“For me, conferences are like little mental vacations: a chance to
go visit an interesting place for a couple of days, and come back
rested and refreshed with new ideas and perspectives.”

-Erin McKean

Respected Seniors & Dear Friends,
It was a pleasure to have an August gathering at the DOS Annual conference
2014. Various dignitaries not only from different corners of the country but
also from across the globe met to exchange ideas and take ophthalmology
to the next level. With halls full of dignitaries till the end of conference and
discussion at the pinnacle, it was indeed a pleasurable sight.
The idea of having a sub-specialty meet had a great response where all the
specialists had the opportunity to discuss, debate and interact with their
respective counterparts under a single roof and take their specialty one step
ahead. First ever Young ophthalmologist (YO) session was appreciated by one
and all. Young ophthalmologists took the full advantage for having sessions
specially customized for them while simultaneously enjoying meeting their
counterparts from across the country and making new friends.
Ophthalmology seemed to have undoubtedly evolved to be one of the most
developed specialties in modern medicine. A giant leap in technology was
seen in the conference and live surgeries demonstrated a perfect example of
the same. It surely felt great to be a part of the organizing committee of the
annual conference and meet you all. I am sure we can improvise on this to
have an even larger and more interactive gathering in the coming year.

Sincerely Yours

Rajesh Sinha
Secretary,
Delhi Ophthalmological Society

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DOS Correspondents
Dr. Stephen Hing,
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Published by Dr. Rajesh Sinha for Delhi Ophthalmological Society
Printers: K.D. Printo Graphics, 2/20, 1st Floor, D.D.A. Market Nasreen
Complex, Near SBI, Dr. Ambedkar Nagar, New Delhi, 5DYLVK .LQNKDEZDOD
Email: [email protected]
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Pediatric Ophthalmology

Figure 2 1HZHU FODVVLÀFDWLRQ V\VWHP EDVHG RQ SDWKRJHQHVLV VXUJLFDO LQWHUYHQWLRQ DQG SURJQRVLV

Figure 3: Examination under anesthesia kit diagnosis, differentiation and management. For the ease of
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Congenital corneal opacity is an emergency and requires
management by a paediatric corneal specialist. If not treated 1. 5ENGTQEQTPGC Sclerocornea is the primary CCO present
early, these would lead to permanent visual deprivation at birth. It is unilateral or bilateral usually asymmetrical
amblyopia. In this communication we describe the salient scleralization of the peripheral or total corneal tissue. It
clinical features of common etiologies of congenital corneal is usually occurs sporadically but could also be familial
opacities which would help the clinician in accurate or autosomal dominant3,4.

The corneal opacity is usually non-progressive and
is an extension of the sclera on the cornea with
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landmarks. (Figure 4) Histologically, there is an
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the lamellar arrangement of the corneal stroma with
presence of vessels. Four variants of sclerocornea have
been described5:

I. +UQNCVGF 5ENGTQEQTPGC No other ocular
abnormalities

II. Sclerocornea plana

III. Sclerocornea associated with Peter’s anomaly

IV. Total Sclerocornea

Management plan should be made after a UBM examination

32 l DOS Times - Vol. 19, No. 8 February, 2014













































Miscellaneous

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paranasal skin eschar-like lesion

Discussion Figure 7: Patient with healthy wound after radical
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Fungal cellulitis involving the face, paranasal sinus and
QTDKV CTG XGT[ FKHſEWNV VQ VTGCV CPF OC[ ECWUG OQTVCNKV[ KH PQV from bacterial cellulitis as the management is different and
treated appropriately1-3. Presence of immunocompromised misdiagnosis can lead to severe complications13 J.P. Davis
status due to uncontrolled diabetes, steroid abuse, drug and M.P. Stearns in their series of four cases, highlighted
abuse or infection due to HIV may be another cause leading the importance of early CT scan in diagnosing sinusitis
to unrelenting infection and eventually causing death6,7. In along orbital cellulitis, which improved the outcome of
diabetic patients apart from treating the infection, managing management14.
the systemic metabolic parameters is also very important8,9.
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Review of medical literature regarding management and that prevented the treating ophthalmologist to do
of fungal facial cellulitis revealed that it is a rare entity enucleation or exenteration. Talmi YP et al have reported
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suspicion in appropriate settings and clinical presentation on CT scan is mild mucosal thickening of the paranasal
is most important for early diagnosis and successful sinuses or thickening of the extraocular muscles of the
outcome. Bodenstein NP et al in their review mentioned eye. Organized retro-orbital mass or abscess may be rarely
appearance of black eschar on palate, nose or orbit as a present. However since the vision of the eye was lost,
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early clue to orbital involvement10. The initial symptoms of salvaging life15.
rhino-cerebral mucormycosis may be eye or facial pain and
facial numbness, followed by onset of conjunctival edema,
blurred vision and soft tissue swelling11. In case 2, extensive
Herpes Zoster was also considered a differential diagnosis
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Dhiwakar M et al in series of nine cases described perinasal
cellulitis or paraesthesia as the most frequent early clinical
sign. Periorbital edema, mucopurulent rhinorrhoea and
nasal crusting were reported as other early manifestations.
They reported that CT scan may be near normal and high
degree of suspicion must be kept in immunocompromised
patients12. Kotzamanoglou K et al in their case report
highlighted the need to differentiate fungal orbital cellulitis

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