Putting children first

The Miriam Hyman Children’s Eye Care Centre (MHCECC)* at Bhubaneswar is a world-class tertiary care pediatric centre, addressing a wide range of eye diseases in the state of Orissa (population: 40 million). Though in its infancy (set up on July 3, 2008), MHCECC has taken bold steps towards becoming a centre of excellence in pediatric eye care. It boasts of state-of-the-art equipment and offers multispecialty care to children from all sections of society, who would otherwise have no access to eye care. Plans are under way to set up an integrated pediatric eye cancer centre within MHCECC by the end of 2009, with multi-modal treatment and a fully functional pathology laboratory.

The Centre conducts school eye screening programs, partnering in a government project to screen children in schools for the visually impaired. The highly trained faculty of MHCECC participates in national and international conferences and contributes to peer reviewed journals. The Centre is working towards multipronged holistic pediatric eye care, taking eye care in eastern India to a whole new level. Here are a few stories of children who have undergone sight restoring surgery at the centre.

Tulika before
surgery with a prominent
left eye

After surgery
and one injection

The left eye looks
almost normal after
serial injections

Little Tulika was brought to the centre when she was 53 days old. Her parents had noticed a protuberance over her left eye, which was increasing in size, and were extremely worried.

A detailed examination revealed that the little one had a large mass behind her left eye, which was pushing the eyeball forward. The size of the mass and its rapid progression constituted a threat to her vision. The child underwent surgery and the mass was removed. It was found to be a benign tumour (capillary hemangioma) known to respond to steroid injections. Tulika received several steroid injections into the tumour over the next couple of months and it gradually became smaller.

Tulika is now 14 months old and fast growing into a happy and playful little girl.

Jaydeep before
surgery with an
upward displacement
of his right eye

After four months of
treatment, Jaydeep
has a near normal
appearance

Ten-year-old Jaydeep was brought to the centre with concerns of asymmetry of the face. His parents had noticed a gradual progressive upward displacement of his right eye. At the Institute, a complete medical examination including a comprehensive check up of the eye showed a mass involving the right sinus (maxillary sinus in the midface), which had invaded the orbit from below. At the Oncology Clinic the child was advised computed tomography, which was helpful in performing a biopsy from the mass. The final diagnosis was primary neuroectodermal tumour (PNET) – a rare malignancy that starts from primitive cells.

After a detailed discussion with his parents, Jaydeep was put on multi-modal therapy, involving chemotherapy, surgery and conformal stereotactic radiation therapy to achieve local and systemic control. Four months after the treatment Jaydeep resumed school and is now a healthy and active boy.

Debabrata was preparing for his class 10 examinations, but found it difficult to study as he was seeing everything double. He had visited several doctors but no one could guarantee single vision. Finally he came to LVPEI.

The doctors listened to Debabrata’s history carefully. He seemed to have developed this problem after he began using a new pair of glasses. An examination revealed that he was a hyperope, but had been using glasses with a myopic correction for over a year. This had led to excessive accommodation and, subsequently, to esotropia.

Doctors at MHCECC changed his prescription and put him on cycloplegics, hoping it would relax accommodation and restore single vision. But this did not work – he had used the wrong glasses for too long. Finally, after a normal CT scan, doctors decided to operate on him. There was no time for experimentation because exams were looming before Debabrata.

A bilateral medial rectus recession was performed with adjustable sutures; the sutures were adjusted the next day. The double vision disappeared! Debabrata was able to prepare for and take his exams.

Such complex strabismus surgeries are now commonplace at LVPEI, Bhubaneswar.