Nepalese Journal of Ophthalmology最新文献

Introduction: Seasonal hyperacute panuveitis (SHAPU) is still a dilemma in the field of ophthalmology. Every alternate odd year from September until January, children usually present with unilateral painless red eyes if not treated in a timely manner, rapidly progressing to phthisis bulbi.

Case: Case was also diagnosed as a case of seasonal hyperacute panuveitis.

Observations: However, during the treatment, the patient developed spontaneous scleral necrosis, which has not been reported to date.

Conclusion: Seasonal hyperacute panuveitis may have different clinical presentation, therefore cases of seasonal hyperacute panuveitis should be monitored and evaluated properly before initiating treatment.

Introduction: Acute retinal necrosis (ARN) is a rapidly progressive, necrotizing herpetic infection, commonly leading to retinal detachment with significant visual morbidity. Most common causative agent belong to the herpesvirus family. It commonly occurs in healthy immunocompetent individuals. Early diagnosis of disease is important in order to start the treatment timely. Systemic antivirals and intravitreal antiviral therapy along with steroids are the main stay of treatment. Our study is a retrospective study of 5 years. We studied the patient demographics, presenting features, treatment outcome and complications of acute retinal necrosis in a tertiary care center in Nepal.

Objective: Methodology: A total of 14 eyes of 13 patients were included in the study. This study is a hospital based retrospective study done in the Uveitis and Vitreoretinal department of a tertiary eye care center. Records of all patients diagnosed with Acute Retinal Necrosis between May 2013 to May 2018 were included in this study. Hospital data of these subjects including patient demographics, presenting symptoms, clinical signs, treatment received and treatment outcome were noted and analysed.

Result: The mean age of the patients was 45.1 years ± 14.9 years. Sixty-nine were males and 92.3% had bilateral involvement. The mean duration of onset of symptoms was 22.4 days ± 19.5. The most common presenting symptom was decreased vision (78.6%). Among the 13 patients 10 received intravenous acyclovir, 1 received intravenous ganciclovir and 2 patients received oral acyclovir for initial systemic therapy.

Conclusion: The most common complication was cataract followed by retinal detachment.

Introduction: Meibomian gland dysfunction (MGD) is usually treated with conservative methods. Adjunct therapy with oral Doxycycline has played a vital role in its treatment. Recently Azithromycin has also been introduced as a newer agent.

Objective: To compare the efficacy, safety and compliance of oral azithromycin with doxycycline over one year period in patients with Meibomian gland dysfunction (MGD).

Methodology: A randomised comparative clinical trial was performed among 284 subjects (age >35 years) with MGD. They were randomly divided into two groups A and B. Along with standard conservative management, Group A received oral 9-day azithromycin (500 mg for 3 consecutive days for 3 consecutive weeks) and group B received 14 days doxycycline (200 mg/day). A score comprising seven symptoms and seven signs (primary outcome) was recorded before and at first and second follow up after treatment and further analyzed.

Result: The mean symptoms and signs treated by Azithromycin group was lesser as compared to Doxycycline group in the first follow up (p <0.001). However it was statistically insignificant at second follow-up (p=0.043). The group taking azithromycin had a much better overall response (p = 0.006). Gastrointestinal symptoms were the major side effects encountered, the group taking doxycycline experienced significantly more side effects (p ≤0.001).

Conclusion: Both antibiotics were effective and safe for treating persistent MGD, but azithromycin was more effective. It required a lower dose, worked faster, and had a shorter treatment duration compared to doxycycline.

Background: Asymmetric visual field defects with a high cup-to-disc ratio resembling glaucomatous damage can be the only clinical features of a pituitary macroadenoma with apoplexy, posing diagnostic challenges.

Case: A 39-year-old man presented with a history of gradual onset, progressive visual obscuration in the right visual field for one month without any other accompanying neurological symptoms. On examination, his intraocular pressure (IOP) was 16 mmHg in both eyes. Posterior segment examination revealed a cup to-disc ratio (CDR) of 0.8 in the right and 0.7 in the left eye, with concentric neuroretinal rim thinning and mild temporal disc pallor. These findings led to the diagnosis and treatment of normal tension glaucoma (NTG) elsewhere. Visual field examination showed field defects featuring a junctional scotoma. The MRI scan of the brain revealed a well-defined mass lesion situated in the sella suggestive of pituitary macroadenoma with possible apoplexy confirmed later through histopathological examination. The neurosurgery team successfully removed the tumor through the endoscopic endonasal trans-sphenoidal approach and the patient reported significant improvement in vision and visual field defects.

Observations: In our case, visual signs and symptoms were the only presenting features, caused by pituitary macroadenoma with apoplexy, which can be a potentially life-threatening condition. Although pituitary apoplexy is an acute condition with numerous neurological signs and symptoms, visual symptoms with high CDR and neuroretinal rim thinning with mild temporal disc pallor were the only features seen in our case, posing a diagnostic challenge. There were no associated systemic manifestations. However, the patient had a favorable outcome because of prompt diagnosis and multidisciplinary management.

Conclusion: The spectrum of clinical manifestations of pituitary macroadenoma with apoplexy should encompass a gradual onset, progressive asymmetric visual field defect with temporal disc pallor to facilitate timely diagnosis and effective management.

Introduction: Pterygium is a common and benign condition that warrants surgical removal for ocular and cosmetic reasons. Pterygium excision with conjunctival autograft is frequently performed surgery in Nepal.

Objective: This study is aimed to find out the recurrence and satisfaction following surgery.

Methodology: This was a descriptive cross-sectional study conducted from August to October 2021 at a tertiary hospital in Bhaktapur. All the patients who had undergone pterygium surgery with conjunctival autograft surgery for primary pterygium from January 2018 to December 2019 and completed at least 6 months of follow-up were included. We reviewed records for surgery, complications, and recurrence from Medical Records. We also interviewed patients by phone for satisfaction related to symptomatic and cosmetic relief. The descriptive statistics were reported as frequency, mean, and standard deviation. The satisfaction score was measured on a 5-point Likert scale.

Result: Among 142 patients, the mean age was 46.70±11.25 years, and 28.17% were males. 7.74% had complications and graft edema was the most common. The recurrence rate after surgery was 5.63%. The recurrence was higher among males and under 40 years patients. More than one-third of the patients reported they had surgery for symptomatic relief. The study showed high satisfaction scores for both symptomatic relief and cosmetic appearance, with scores of 3.62±0.93 and 3.87±0.96, respectively, on a 5-point Likert scale.

Conclusion: Pterygium surgery with conjunctival autograft is safe surgery with minimal complications. Along with symptomatic relief, cosmetic satisfaction can be considered a measure of successful surgical outcome in pterygium surgery.

Introduction: Cycloplegic agents are the most common method used for accommodation relaxation in accommodative spasm cases. However, concerns have arisen about the possibility of rebound effects following the cessation of cycloplegic treatment. This case reports demonstrates a clinical approach for managing accommodative spasm, utilizing the modified Borish's delayed subjective technique and vision therapy. Additionally, also evaluates the patient's clinical status after six months of cessation of therapy. Case Report 1: A 9-year-old female presented with a headache and blurred vision. Her presenting visual acuity was 1/60 in each eye and variable myopia reached up to -6.00 diopters spherical. Cycloplegic refraction showed a low hyperopia and improvement in visual acuity to 6/9 in each eye. This confirmed the diagnosis as accommodative spasm and was referred to a vision therapy clinic for further management. Case Report 2: A 13-year-old female presented with 6/36 visual acuity in both eyes and variable myopic refractive error but cycloplegic refraction revealed low hyperopia and improvement in visual acuity. Then, she was referred to optometry and vision therapy clinic.

Conclusion: A modified Borish's delay subjective technique can be applied to instantaneous relief of accommodative spasm. Vision therapy can be useful in restoring normal accommodative and vergence functions. Sustained improvement in visual function and stability of accommodation is obtained after six months of cessation of vision therapy.

Introduction: Strabismus is a complex problem of eye alignment, binocularity, and cosmetics that affect vision and quality of life. Strabismus surgery helps to establish binocular fusion, expand the field of binocular vision, eliminate diplopia, correct a compensatory head posture, and improve cosmetic appearance. The outcomes of horizontal strabismus surgery range from 56.3-86.5%. It depends on different factors such as the type of strabismus, accurate measurement of pre-operative deviation, age at which strabismus surgery was performed for the first time, type of strabismus surgery, postoperative alignment, and binocularity. Regrettably, there is insufficient data regarding the prevalence of strabismus and the outcomes of surgical interventions in Nepal. This study addresses the outcome of strabismus surgery and the factors influencing surgical success conducted at a tertiary hospital.

Objective: To evaluate the outcome of horizontal strabismus surgery and factors influencing surgical success.

Methodology: The medical records of 206 patients who had undergone their first horizontal strabismus surgery at Tilganga Institute of Ophthalmology (TIO) from 2017 to 2020 were reviewed retrospectively. Those who completed a follow-up period for at least 3 months were included. Patients with restrictive, paralytic, and vertical strabismus were excluded from the study. The success of the surgery was defined by achieving an eye deviation of less than 10 prism diopters (PD) six weeks post-surgery. The influencing factors for surgical success (diagnosis, age group, visual acuity, binocular function, and pre-operative angle of deviations) were analyzed.

Result: Complete data of 194 patients with follow-up periods of 6 weeks to 3 months were retrieved from the electronic medical record. The majority 116(59.8%) of the patients were between 6-18 years >18-53years 40.2% (78) with male to female ratio of 0.96:1. Majority of the participants had exotropia 124(63.9%) and mean pre-operative angle of deviation was 48.9±14.7PD (Range 10- 90). A good motor alignment (total success rate) was 44.3 %( 86); the success rate for esotropia was 36(41.9%) and for exotropia was 50(58.1%). Both fusion and stereopsis were significantly improved after surgery (P<0.001). The patient who had a smaller deviation in the preoperative period had good surgical success in the postoperative period.(P <0.001). The type of deviation, age, gender, pre-operative amblyopia, and binocular vision were not related to the surgical success.

Conclusion: In cases of horizontal concomitant strabismus, the preoperative amount of deviation is the paramount factor influencing surgical success. Notably, surgical success is low in patients with large preoperative deviation.

Introduction: Intermittent proptosis is a transitory position-dependent protrusion of one or both eyeballs beyond orbit. The common causes of proptosis in young females are tumors, inflammation, trauma, thyroid eye disease and vascular lesions. The case report highlights the importance of imaging in prone position.

Case: We report a rare case of a 24-year-old female who recently developed intermittent proptosis while bending forwards. The patient was evaluated clinically. Ultrasonography B scan, Computerised axial tomography (CT), Magnetic resonance imaging (MRI) were advised to rule out orbital varices, arteriovenous aneurysm, or any organic lesion. Probable diagnosis of venolymphatic malformation was made.

Conclusion: An intertwined approach was carried out with Ophthalmologist and Radiologist to arrive at the final diagnosis highlighting the importance of imaging in prone position.

Introduction: Macular edema (ME) secondary to retinal vein occlusion (RVO) is a leading cause for visual impairment.

Objective: To identify the systemic biomarkers that influence the anatomical and functional outcomes of a single injection of intravitreal bevacizumab (IVB) for RVO related macular edema ME.

Methodology: A prospective interventional study was conducted on patients with treatment naïve RVO induced ME, from November 2019 to April 2021 after ethical approval. All participants underwent a complete systemic evaluation consisting of blood pressure measurement, blood sugar, glycosylated hemoglobin, hemoglobin, total and differential cell counts, lipid profile and renal function tests at baseline. IVB was administered for RVO induced ME. Anatomical outcome was measured as change in macular thickness from baseline to one month after treatment on optical coherence tomography and functional outcomes were improvement in visual acuity.

Result: Median best corrected visual acuity improved from 0.56±0.39 to 0.4±0.4 LogMAR (p <0.001) with significant reduction in mean central retina thickness (CRT) from 609.9±216.5 μ to 337.6±168.2 μ (p <0.001) at one month. On evaluating systemic parameters, longer duration of hypertension (r = -0.2795, p = 0.037), and those with higher eosinophil count (r = -0.2595, p = 0.025) were less likely to have a reduction in CRT. Higher HDL levels (r = 0.2505, p = 0.031) and better RBC counts (r = 0.2732, p = 0.016) were more likely to be predictive of a better reduction of CRT.

Conclusion: Patients with RVO related ME can experience visual improvement and reduction in edema at initiation of treatment. Systemic biomarkers correlating to those for cardiovascular morbidity influence outcomes of ME. Optimum management of these modifiable systemic biomarkers can enhance treatment outcomes.