Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.49142
Sumit Pandey, R. Kharel Sitaula, Sagun Narayan Joshi
Introduction: The release of inflammatory mediators in the anterior chamber can lead to the structural alteration of the corneal and uveal tissue. Objectives: To compare the changes in Central Corneal Thickness (CCT), corrected Intraocular Pressure (cIOP) and Iridocorneal Angle (ICA) in unilateral acute anterior uveitis (AAU) before and after treatment. Materials and methods: The study was a hospital based comparative study conducted between July 2018 to June 2019. Newly diagnosed, untreated unilateral Acute Anterior Uveitis (AAU) adult cases above 16 years were included in the study. Ethical clearance was obtained from the Institutional Review Committee of Institute of Medicine. Eighty-two unilateral AAU cases (Total 164 eyes including 82 unaffected were analyzed) underwent Goldmann applanation tonometry (GAT) and corneal topography at presentation and three weeks after treatment. The cIOP was calculated by the Ehlers formula. Results: The mean CCT of affected eyes was greater (563.84±51.49μm) compared to unaffected eyes (535.99±31.48μm) before treatment (p=0.001) and was reduced (533.2±25.71μm) after treatment (p=0.01). There was no significant difference in IOP, cIOP, and ICA between the affected eyes (14.45±6.89mmHg, 13.14±7.14mmHg and 48.78±7.94°) and the unaffected eyes (14.02±2.36mmHg, 14.4±3.09mmHg, and 49.80°±8.21°) before treatment. There was no difference in IOP (14.04±2.76mmHg) and ICA (49.21°±6.72°) after treatment, however, there was a significant increase (p=0.01) in the cIOP (14.95±2.93mmHg). Conclusion: In the study, CCT of affected eyes was greater compared to unaffected eyes and reduced after treatment. There was no difference in cIOP and ICA in case eyes compared to control before treatment. However, cIOP increased after treatment.
{"title":"Changes in Central Corneal Thickness, Corrected Intraocular Pressure, and Iridocorneal Angle in Unilateral Acute Anterior Uveitis","authors":"Sumit Pandey, R. Kharel Sitaula, Sagun Narayan Joshi","doi":"10.3126/nepjoph.v15i1.49142","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49142","url":null,"abstract":"Introduction: The release of inflammatory mediators in the anterior chamber can lead to the structural alteration of the corneal and uveal tissue. Objectives: To compare the changes in Central Corneal Thickness (CCT), corrected Intraocular Pressure (cIOP) and Iridocorneal Angle (ICA) in unilateral acute anterior uveitis (AAU) before and after treatment. Materials and methods: The study was a hospital based comparative study conducted between July 2018 to June 2019. Newly diagnosed, untreated unilateral Acute Anterior Uveitis (AAU) adult cases above 16 years were included in the study. Ethical clearance was obtained from the Institutional Review Committee of Institute of Medicine. Eighty-two unilateral AAU cases (Total 164 eyes including 82 unaffected were analyzed) underwent Goldmann applanation tonometry (GAT) and corneal topography at presentation and three weeks after treatment. The cIOP was calculated by the Ehlers formula. Results: The mean CCT of affected eyes was greater (563.84±51.49μm) compared to unaffected eyes (535.99±31.48μm) before treatment (p=0.001) and was reduced (533.2±25.71μm) after treatment (p=0.01). There was no significant difference in IOP, cIOP, and ICA between the affected eyes (14.45±6.89mmHg, 13.14±7.14mmHg and 48.78±7.94°) and the unaffected eyes (14.02±2.36mmHg, 14.4±3.09mmHg, and 49.80°±8.21°) before treatment. There was no difference in IOP (14.04±2.76mmHg) and ICA (49.21°±6.72°) after treatment, however, there was a significant increase (p=0.01) in the cIOP (14.95±2.93mmHg). Conclusion: In the study, CCT of affected eyes was greater compared to unaffected eyes and reduced after treatment. There was no difference in cIOP and ICA in case eyes compared to control before treatment. However, cIOP increased after treatment.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.40632
L. Bajracharya
Introduction: Corneal opacity is an important cause of blindness in developing countries. Objectives: This study analyzes optical keratoplasty performed for corneal opacity due to infective keratitis. Materials and methods: This is a retrospective study of all consecutive cases of optical keratoplasty performed between 2011 and 2014 (four-year period) for healed infective keratitis. Cases with less than two months’ followup were excluded during outcome evaluation. Comparison was made between keratoplasty for Microbial and Viral (herpetic) Scar. Results: Ninety-three eyes of 93 patients were enrolled. Fifty-nine (63.4%) were male. Average age of patients was 38.9±19.5 years. Average donor endothelial cell count was 2713±434.5 cells/mm2. Fifty-four (58%) corneal scars were due to microbial keratitis and others were herpetic. Eighty-five (91.4%) had undergone penetrating keratoplasty. Eighty-eight (94.6%) cases were included for outcome analysis. Average follow-up duration was 37±27.5 months. Fifty-two (59%) had clear graft at their last visit. Twenty-three (26.1%) grafts had endothelial failure and 13 (14.7%) grafts failed due to late onset keratitis. Twenty-five (28.4%) had vision of ≥6/18. Rejection occurred in 24(27.2%) and glaucoma in 11(12.5%). Post-operatively viral keratitis in the graft occurred significantly more inViral Scar Group (38.6%, n=15) than in Microbial Scar Group (5.5%, n=3). But there was no significant difference in graft clarity, rejection, vision and secondary glaucoma between the two Groups. Conclusion: Outcome of keratoplasty for post-infectious scars was found fairly satisfactory. Although occurrence of viral keratitis was higher in case of keratoplasty done for Viral Scars, the final result was similar to that of microbial scar.
{"title":"Outcome of Optical Keratoplasty for Corneal Scar due to Infective Keratitis","authors":"L. Bajracharya","doi":"10.3126/nepjoph.v15i1.40632","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.40632","url":null,"abstract":"Introduction: Corneal opacity is an important cause of blindness in developing countries. Objectives: This study analyzes optical keratoplasty performed for corneal opacity due to infective keratitis. Materials and methods: This is a retrospective study of all consecutive cases of optical keratoplasty performed between 2011 and 2014 (four-year period) for healed infective keratitis. Cases with less than two months’ followup were excluded during outcome evaluation. Comparison was made between keratoplasty for Microbial and Viral (herpetic) Scar. Results: Ninety-three eyes of 93 patients were enrolled. Fifty-nine (63.4%) were male. Average age of patients was 38.9±19.5 years. Average donor endothelial cell count was 2713±434.5 cells/mm2. Fifty-four (58%) corneal scars were due to microbial keratitis and others were herpetic. Eighty-five (91.4%) had undergone penetrating keratoplasty. Eighty-eight (94.6%) cases were included for outcome analysis. Average follow-up duration was 37±27.5 months. Fifty-two (59%) had clear graft at their last visit. Twenty-three (26.1%) grafts had endothelial failure and 13 (14.7%) grafts failed due to late onset keratitis. Twenty-five (28.4%) had vision of ≥6/18. Rejection occurred in 24(27.2%) and glaucoma in 11(12.5%). Post-operatively viral keratitis in the graft occurred significantly more inViral Scar Group (38.6%, n=15) than in Microbial Scar Group (5.5%, n=3). But there was no significant difference in graft clarity, rejection, vision and secondary glaucoma between the two Groups. Conclusion: Outcome of keratoplasty for post-infectious scars was found fairly satisfactory. Although occurrence of viral keratitis was higher in case of keratoplasty done for Viral Scars, the final result was similar to that of microbial scar.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.49459
Mohan Karki, Y. Roka, A. Thapa, N. Bhattarai, S. R. Pandey
Background: We present a case of proptosis with headache, decrease in vision and orbital pain where patient underwent sphenoid-orbital decompression, and excision of mass, resulting in significant improvement in her vision with complete resolution of proptosis, headache and orbital pain. This study was done to diagnose and evaluate clinical outcome of hyperostotic sphenoid wing meningioma with orbital involvement after surgery. Case: A 40 year-female presented with severe headache, right eye swelling, periorbital pain and decreasing in vision for two years, and right eye proptosis more severe for three months. Observations: She underwent right frontotemporal craniotomy with removal of hyperostotic sphenoid wing and excision of meningioma after magnetic resonance imaging demonstrated a right sphenoid wing meningioma extending orbital and middle cranial fossa. She had improvement of her symptoms post-operatively. Conclusion: Surgical decompression of orbit with total resection of meningioma and sphenoid wing hyperostosis can result in significant improvement in the vision and proptosis.
{"title":"Hyperostotic Sphenoid Wing Meningioma with Proptosis: A Rare Case Report with Literature Review","authors":"Mohan Karki, Y. Roka, A. Thapa, N. Bhattarai, S. R. Pandey","doi":"10.3126/nepjoph.v15i1.49459","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49459","url":null,"abstract":"Background: We present a case of proptosis with headache, decrease in vision and orbital pain where patient underwent sphenoid-orbital decompression, and excision of mass, resulting in significant improvement in her vision with complete resolution of proptosis, headache and orbital pain. This study was done to diagnose and evaluate clinical outcome of hyperostotic sphenoid wing meningioma with orbital involvement after surgery. Case: A 40 year-female presented with severe headache, right eye swelling, periorbital pain and decreasing in vision for two years, and right eye proptosis more severe for three months. Observations: She underwent right frontotemporal craniotomy with removal of hyperostotic sphenoid wing and excision of meningioma after magnetic resonance imaging demonstrated a right sphenoid wing meningioma extending orbital and middle cranial fossa. She had improvement of her symptoms post-operatively. Conclusion: Surgical decompression of orbit with total resection of meningioma and sphenoid wing hyperostosis can result in significant improvement in the vision and proptosis.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Myopia is emerging as a public health emergency worldwide. Low dose atropine has been proven to be safe and efficacious in halting the progression of myopia. Objectives: Aim of this study was to evaluate safety and efficacy of low dose atropine in Nepalese children with progressive myopia. Materials and methods: It is a prospective non randomized interventional study. Children with myopia progression of >0.5D in the last six months with baseline myopia of -1.5 to -8 Diopter and astigmatism of 3 D or less were prescribed 0.01% atropine daily at bedtime for two years. Demography including age, gender, race, and examinations including anterior and posterior segment, axial length, near point of accommodation and near vision were recorded in all the children. Ocular and systemic side effects were documented. Results: A total of 200 children were enrolled in the study. Mean age was 11.9±2.97 years with 41% female. Baseline mean axial length was 24.47±1 and mean spherical equivalent was 3.69±1.33. Average increase in axial length was 0.18(±0.02), 0.17(±0.02), and 0.19(±0.04) mm in six months, one year, and two years respectively. The increase in spherical equivalence was 0.2 (±0.01), 0.3(±0.02), and 0.3(±0.02)) diopter in six months, one year, and two years respectively. The myopia progression was found more in the Mongolian race compared to the Aryan race. No ocular or systemic side effects were documented. Conclusion: Topical low dose atropine appears to be safe and efficacious in halting the progression of myopia in a cohort of Nepalese children. Further randomized control trial on various doses of atropine are recommended.
{"title":"Safety and Efficacy of Low Dose Atropine in Nepalese Children with Progressive Myopia","authors":"Srijana Adhikari, Namrata Gupta, Birendra Mahat, Manish Poudel, Rojeeta Parajuli, Ang Jangmu Lama, Richa Poudel","doi":"10.3126/nepjoph.v15i1.49076","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49076","url":null,"abstract":"Introduction: Myopia is emerging as a public health emergency worldwide. Low dose atropine has been proven to be safe and efficacious in halting the progression of myopia. Objectives: Aim of this study was to evaluate safety and efficacy of low dose atropine in Nepalese children with progressive myopia. Materials and methods: It is a prospective non randomized interventional study. Children with myopia progression of >0.5D in the last six months with baseline myopia of -1.5 to -8 Diopter and astigmatism of 3 D or less were prescribed 0.01% atropine daily at bedtime for two years. Demography including age, gender, race, and examinations including anterior and posterior segment, axial length, near point of accommodation and near vision were recorded in all the children. Ocular and systemic side effects were documented. Results: A total of 200 children were enrolled in the study. Mean age was 11.9±2.97 years with 41% female. Baseline mean axial length was 24.47±1 and mean spherical equivalent was 3.69±1.33. Average increase in axial length was 0.18(±0.02), 0.17(±0.02), and 0.19(±0.04) mm in six months, one year, and two years respectively. The increase in spherical equivalence was 0.2 (±0.01), 0.3(±0.02), and 0.3(±0.02)) diopter in six months, one year, and two years respectively. The myopia progression was found more in the Mongolian race compared to the Aryan race. No ocular or systemic side effects were documented. Conclusion: Topical low dose atropine appears to be safe and efficacious in halting the progression of myopia in a cohort of Nepalese children. Further randomized control trial on various doses of atropine are recommended.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.49617
Rakshya Basnet, Sanjay Kumar Singh
Background: Radius–Maumenee syndrome (RMS) is a rare idiopathic condition characterized by the enlargement of episcleral vessels and an elevation in intraocular pressure (IOP) leading to secondary glaucoma. Case: In this report, we present a case of RMS in 23-year-old male who experienced redness in Right Eye (RE) and intermittent headaches for a duration of 10 years. The patient exhibited a best corrected visual acuity of 6/6 in both eyes. Observations: During slit lamp biomicroscopy, episcleral venous engorgement was observed in both eyes. Tonometry measured 28 mmHg in the RE and 14 mmHg in Left Eye (LE). In fundus photographs of RE and LE, there was evident cup asymmetry, along with retinal nerve fiber layer defects in superotemporal and inferotemporal regions of the right eye. Optical coherence tomography (OCT) Optic Nerve Head with hood report of RE showed loss of double hump pattern with asymmetric and severe retinal nerve fiber layer thinning in superior and inferior quadrant. Visual field testing of RE showed superior and inferior arcuate scotoma. Brain and orbit magnetic resonance angiography (MRI Angiogram) revealed no abnormal voids indicating cavernous fistula or other orbital lesions. The presence of secondary open angle glaucoma with episcleral venous engorgement and negative test results for other potential conditions led to the diagnosis of RMS in the patient. The patient is now under combination therapy with aqueous suppressants and uveoscleral outflow increasing drugs. Conclusion: This case serves as a reminder to ophthalmologists about potential association of glaucoma if there’s enlargement of episcleral vessels in eyes without inflammation.
{"title":"Radius-Maumenee Syndrome, A Rare Entity: A Case Report","authors":"Rakshya Basnet, Sanjay Kumar Singh","doi":"10.3126/nepjoph.v15i1.49617","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49617","url":null,"abstract":"Background: Radius–Maumenee syndrome (RMS) is a rare idiopathic condition characterized by the enlargement of episcleral vessels and an elevation in intraocular pressure (IOP) leading to secondary glaucoma. Case: In this report, we present a case of RMS in 23-year-old male who experienced redness in Right Eye (RE) and intermittent headaches for a duration of 10 years. The patient exhibited a best corrected visual acuity of 6/6 in both eyes. Observations: During slit lamp biomicroscopy, episcleral venous engorgement was observed in both eyes. Tonometry measured 28 mmHg in the RE and 14 mmHg in Left Eye (LE). In fundus photographs of RE and LE, there was evident cup asymmetry, along with retinal nerve fiber layer defects in superotemporal and inferotemporal regions of the right eye. Optical coherence tomography (OCT) Optic Nerve Head with hood report of RE showed loss of double hump pattern with asymmetric and severe retinal nerve fiber layer thinning in superior and inferior quadrant. Visual field testing of RE showed superior and inferior arcuate scotoma. Brain and orbit magnetic resonance angiography (MRI Angiogram) revealed no abnormal voids indicating cavernous fistula or other orbital lesions. The presence of secondary open angle glaucoma with episcleral venous engorgement and negative test results for other potential conditions led to the diagnosis of RMS in the patient. The patient is now under combination therapy with aqueous suppressants and uveoscleral outflow increasing drugs. Conclusion: This case serves as a reminder to ophthalmologists about potential association of glaucoma if there’s enlargement of episcleral vessels in eyes without inflammation.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139130751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Ophthalmological examination is an important aspect of the neurological assessment in a patient with traumatic brain injury. However, significant periorbital swelling can make direct visualization of the pupils difficult. Ultrasonic examination can be a valuable bedside tool when direct visualization fails. Case: A case of a seven-year female child who had presented with a history traumatic brain injury is reported here. Observations: The periorbital swelling prevented the direct visualization of the eyes. Bedside evaluation with a multipurpose ultrasound (USG) was used to monitor the pupillary diameter (PD) and the consensual pupillary light reflex (PLR) at regular intervals. The PD was measured in the B-mode while the PLR was monitored in M-mode of the USG. The optic nerve sheath diameter (ONSD) was also monitored as a correlate of intracranial pressure (ICP). Conclusion: Ophthalmic evaluation of PD and PLR can be easily and objectively done on the bedside using USG especially in cases where the direct visualization of the pupils is difficult due to injuries and swelling of the periorbital tissues. Furthermore, ONSD measurements can also be done to monitor the changes in the ICP.
背景：眼科检查是脑外伤患者神经评估的一个重要方面。 然而，眶周明显肿胀会使直接观察瞳孔变得困难。当无法直接观察瞳孔时，超声波检查是一种非常有价值的床旁工具。病例：这里报告的是一例 7 岁女性儿童的脑外伤病例。观察结果眶周肿胀阻碍了眼睛的直接观察。使用多功能超声波（USG）进行床旁评估，定期监测瞳孔直径（PD）和瞳孔光反射（PLR）。瞳孔直径通过 B 模式测量，而瞳孔对光反射则通过 USG 的 M 模式监测。还监测了视神经鞘直径（ONSD），作为颅内压（ICP）的相关指标。结论使用 USG 可以在床边轻松、客观地对 PD 和 PLR 进行眼科评估，尤其是在由于眶周组织受伤和肿胀而难以直接观察瞳孔的情况下。此外，还可以通过测量 ONSD 来监测 ICP 的变化。
{"title":"Use of Bedside Ultrasound for Ophthalmic Evaluation in a Case of Traumatic Brain Injury: A Case Report","authors":"BIPIN KARKI, Ninadini Shrestha, Ashru Neupane, Hony Kc, P. Shrestha, Santosh Acharya","doi":"10.3126/nepjoph.v15i1.27187","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.27187","url":null,"abstract":"Background: Ophthalmological examination is an important aspect of the neurological assessment in a patient with traumatic brain injury. However, significant periorbital swelling can make direct visualization of the pupils difficult. Ultrasonic examination can be a valuable bedside tool when direct visualization fails. Case: A case of a seven-year female child who had presented with a history traumatic brain injury is reported here. Observations: The periorbital swelling prevented the direct visualization of the eyes. Bedside evaluation with a multipurpose ultrasound (USG) was used to monitor the pupillary diameter (PD) and the consensual pupillary light reflex (PLR) at regular intervals. The PD was measured in the B-mode while the PLR was monitored in M-mode of the USG. The optic nerve sheath diameter (ONSD) was also monitored as a correlate of intracranial pressure (ICP). Conclusion: Ophthalmic evaluation of PD and PLR can be easily and objectively done on the bedside using USG especially in cases where the direct visualization of the pupils is difficult due to injuries and swelling of the periorbital tissues. Furthermore, ONSD measurements can also be done to monitor the changes in the ICP.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139133499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.50086
S. Parajuli, Sadhana Sharma, R. Shrestha, S. Chapagain
Introduction: Cataract surgery is an invasive procedure that causes mechanical and inflammatory insult to the eye. Objectives: The objective was to study the changes in central corneal thickness (CCT) which is an indirect indicator of corneal endothelial dysfunction and the changes in macular thickness following uncomplicated small incision cataract surgery (SICS) Materials and methods: This was a prospective observational study with a before-and-after design conducted in Reiyukai Eiko Masunaga eye hospital, Banepa, Kavrepalanchok, Nepal. SICS was performed on 68 eyes of 62 patients. Change in CCT and central macular thickness (CMT) from baseline was observed post-surgery on the first day, one week, and six weeks. Results: There were 27 (43.5%) females and 35 males (56.5%) in the study. Mean age was 58.26 ±10 years. This difference of visual acuity between pre and post-operative state was statistically significant. The first post-operative day (POD) and first week post-operative CCT values when compared with preoperative CCT values were statistically significant. However, post-operative CCT values at six weeks were similar to preoperative values. Also, the differences at day one, first week and six weeks post-operative CMT values when compared with preoperative CMT values were statistically significant. Conclusion: This study revealed that there is a significant rise in CCT after SICS which gradually tends to normalize at six weeks. Similarly there is a gradual rise in CMT after SICS persisting even at six weeks. These changes were subtle and there was a marked improvement of visual acuity at six weeks after SICS.
{"title":"Changes in Central Corneal Thickness and Central Macular Thickness following Uncomplicated Small-incision Cataract Surgery","authors":"S. Parajuli, Sadhana Sharma, R. Shrestha, S. Chapagain","doi":"10.3126/nepjoph.v15i1.50086","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.50086","url":null,"abstract":"Introduction: Cataract surgery is an invasive procedure that causes mechanical and inflammatory insult to the eye. Objectives: The objective was to study the changes in central corneal thickness (CCT) which is an indirect indicator of corneal endothelial dysfunction and the changes in macular thickness following uncomplicated small incision cataract surgery (SICS) Materials and methods: This was a prospective observational study with a before-and-after design conducted in Reiyukai Eiko Masunaga eye hospital, Banepa, Kavrepalanchok, Nepal. SICS was performed on 68 eyes of 62 patients. Change in CCT and central macular thickness (CMT) from baseline was observed post-surgery on the first day, one week, and six weeks. Results: There were 27 (43.5%) females and 35 males (56.5%) in the study. Mean age was 58.26 ±10 years. This difference of visual acuity between pre and post-operative state was statistically significant. The first post-operative day (POD) and first week post-operative CCT values when compared with preoperative CCT values were statistically significant. However, post-operative CCT values at six weeks were similar to preoperative values. Also, the differences at day one, first week and six weeks post-operative CMT values when compared with preoperative CMT values were statistically significant. Conclusion: This study revealed that there is a significant rise in CCT after SICS which gradually tends to normalize at six weeks. Similarly there is a gradual rise in CMT after SICS persisting even at six weeks. These changes were subtle and there was a marked improvement of visual acuity at six weeks after SICS.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139136615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.51624
P. Sodhi, S. Baindur, Anu Sharma, Nasiq Hasan
Background: An idiopathic full-thickness parafoveal hole (PFH) in the absence of trauma or intraocular surgery is a rare finding. Case: A 60-year-female who did not gain good vision following an uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye (RE) consulted a retina specialist, one year after her cataract surgery. There was no history of trauma, radiation exposure, reduced scotopic vision, or any other intraocular surgery. Her personal and family history were unremarkable for any systemic or ocular diseases. Routine blood investigations, an electrocardiogram, and a detailed ocular examination were done. Observation: She had the best corrected visual acuity (BCVA) of LogMAR 1.0 (20/200; 6/60) in the right eye. The right eye had an axial length (AL) of 23.50 mm and an intraocular lens power of 21.0 dioptres. The ultrawide field fundus examination saw parafoveal chorio-retinal atrophy without significant peripheral myopic degeneration. On optical coherence tomography (OCT), a central foveal thickness of 138 microns with foveal scarring was noticed. There was a full-thickness parafoveal hole between the fovea and optic disc having a height of 198 microns; base diameter of 240 microns; arm lengths of 203 microns and 206 microns; and a minimum linear dimension of 42 microns. The optical coherence tomography angiography scan showed a reduced vessel density in the superficial and deep retina; and increased visibility of choroidal vessels in outer retina chorio-capillaries, chorio-capillaries, and choroid slab at the parafoveal hole The ultrasound B scan was anechoic and there was no posterior vitreous detachment (PVD). Conclusion: The axial length, intraocular lens power and fundus examination did not indicate pathological myopia. As there was no preceding posterior vitreous detachment or retinal surgery, the underlying retinochoroidal atrophy most probably caused the full-thickness parafoveal hole.
{"title":"A Case of Full Thickness Parafoveal Hole Associated with Chorio-Retinal Atrophy","authors":"P. Sodhi, S. Baindur, Anu Sharma, Nasiq Hasan","doi":"10.3126/nepjoph.v15i1.51624","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.51624","url":null,"abstract":"Background: An idiopathic full-thickness parafoveal hole (PFH) in the absence of trauma or intraocular surgery is a rare finding. Case: A 60-year-female who did not gain good vision following an uneventful phacoemulsification with intraocular lens (IOL) implantation in the right eye (RE) consulted a retina specialist, one year after her cataract surgery. There was no history of trauma, radiation exposure, reduced scotopic vision, or any other intraocular surgery. Her personal and family history were unremarkable for any systemic or ocular diseases. Routine blood investigations, an electrocardiogram, and a detailed ocular examination were done. Observation: She had the best corrected visual acuity (BCVA) of LogMAR 1.0 (20/200; 6/60) in the right eye. The right eye had an axial length (AL) of 23.50 mm and an intraocular lens power of 21.0 dioptres. The ultrawide field fundus examination saw parafoveal chorio-retinal atrophy without significant peripheral myopic degeneration. On optical coherence tomography (OCT), a central foveal thickness of 138 microns with foveal scarring was noticed. There was a full-thickness parafoveal hole between the fovea and optic disc having a height of 198 microns; base diameter of 240 microns; arm lengths of 203 microns and 206 microns; and a minimum linear dimension of 42 microns. The optical coherence tomography angiography scan showed a reduced vessel density in the superficial and deep retina; and increased visibility of choroidal vessels in outer retina chorio-capillaries, chorio-capillaries, and choroid slab at the parafoveal hole The ultrasound B scan was anechoic and there was no posterior vitreous detachment (PVD). Conclusion: The axial length, intraocular lens power and fundus examination did not indicate pathological myopia. As there was no preceding posterior vitreous detachment or retinal surgery, the underlying retinochoroidal atrophy most probably caused the full-thickness parafoveal hole.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.54803
Jyoti Sapkota, L. Bajracharya, Reeta Gurung, R. Rana
Introduction: Graft failure is a common complication following keratoplasty requiring repeat keratoplasty (re-KP). Objectives: To determine the indications and outcome of repeat keratoplasty at a tertiary eye care centre in Nepal. Materials and methods: This was a retrospective study of 78 patients who underwent re-KP for graft failure in Tilganga Institute of Ophthalmology from Jan 2015 to Dec 2020. Indications for the primary keratoplasty, causes of graft failure and outcomes of re-KP in terms of vision acuity, graft clarity and secondary glaucoma were evaluated. Cases of regraft with less than one-year follow-up period were excluded. Results: A total of 78 re-KPs had been performed in 78 patients during the study period. Seventy eyes had undergone single corneal regraft and 8 eyes had undergone multiple (second or third) regraft surgery. Most common indication of primary keratoplasty was infectious keratitis (n=36; 46.2%). On follow up, 36 eyes (46.2%) were clear at the last visit, of which 31 eyes were single regraft cases and 5 were of multiple regraft cases. Most common cause of graft failure was graft infection (n=34; 43.6%) followed by corneal scarring (n=12; 15.4%). Of 42 eyes with failed regrafts, recurrence of the preoperative infection was commonest cause (n=15, 35.7%) followed by secondary glaucoma (n=11; 26.2%). Of 36 eyes with clear regraft, only 4 eyes (11.11%) achieved best corrected vision of ≥6/18 and remaining 32 eyes had BCVA <6/18 due to associated cataract, secondary glaucoma and high astigmatism. Conclusion: The most common cause for re-KP includes graft infection followed by secondary glaucoma. Outcomes of corneal regrafts in the form of graft clarity and visual acuity are suboptimal.
{"title":"Indications and Outcomes of Repeat Keratoplasty for Graft Failure at a Tertiary Eye Care Center in Nepal","authors":"Jyoti Sapkota, L. Bajracharya, Reeta Gurung, R. Rana","doi":"10.3126/nepjoph.v15i1.54803","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.54803","url":null,"abstract":"Introduction: Graft failure is a common complication following keratoplasty requiring repeat keratoplasty (re-KP). Objectives: To determine the indications and outcome of repeat keratoplasty at a tertiary eye care centre in Nepal. Materials and methods: This was a retrospective study of 78 patients who underwent re-KP for graft failure in Tilganga Institute of Ophthalmology from Jan 2015 to Dec 2020. Indications for the primary keratoplasty, causes of graft failure and outcomes of re-KP in terms of vision acuity, graft clarity and secondary glaucoma were evaluated. Cases of regraft with less than one-year follow-up period were excluded. Results: A total of 78 re-KPs had been performed in 78 patients during the study period. Seventy eyes had undergone single corneal regraft and 8 eyes had undergone multiple (second or third) regraft surgery. Most common indication of primary keratoplasty was infectious keratitis (n=36; 46.2%). On follow up, 36 eyes (46.2%) were clear at the last visit, of which 31 eyes were single regraft cases and 5 were of multiple regraft cases. Most common cause of graft failure was graft infection (n=34; 43.6%) followed by corneal scarring (n=12; 15.4%). Of 42 eyes with failed regrafts, recurrence of the preoperative infection was commonest cause (n=15, 35.7%) followed by secondary glaucoma (n=11; 26.2%). Of 36 eyes with clear regraft, only 4 eyes (11.11%) achieved best corrected vision of ≥6/18 and remaining 32 eyes had BCVA <6/18 due to associated cataract, secondary glaucoma and high astigmatism. Conclusion: The most common cause for re-KP includes graft infection followed by secondary glaucoma. Outcomes of corneal regrafts in the form of graft clarity and visual acuity are suboptimal.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.46909
Prasansa Shakya, S. Parajuli, Sadhana Sharma
Introduction: Meibomian gland dysfunction (MGD) frequently leads to ocular surface disease, yet its impact on patients’ overall health is often overlooked. With increase in sedentary lifestyle, decreased physical activities and exposure to the digital world people have been facing increasing incidence of dyslipidemia. Objectives: To investigate the association between serum lipid profile with severity of meibomian gland dysfunction. Materials and methods: This was an observational, analytical, cross-sectional study carried out in the department of Ophthalmology of Shree Birendra hospital from January 2019 to January 2020. Oxford grading scale was used to grade the severity of MGD as none (grade 0), mild (grade I and II), moderate (grade III), and severe (grade IV and V). Serum lipid profile was obtained from all patients with MGD and analysis was carried out. Results: Among 100 patients in this study majority of the participants were from the age group 61-70 (n, 40%) among whom 54 (54%) were females and 46 (46%) were males. Statistically significant association was noted between increase in total cholesterol, LDL, and TG levels with severity of MGD. However no significant association was found between HDL and the stage of MGD. Conclusion: This study demonstrated that patients with increasing severity of meibomian gland dysfunction had greater abnormalities in their serum lipid profiles with respect to total cholesterol, LDL and triglycerides
{"title":"Association of Meibomian Gland Dysfunction with Serum Lipid Profile: A Hospital-based Cross-sectional study","authors":"Prasansa Shakya, S. Parajuli, Sadhana Sharma","doi":"10.3126/nepjoph.v15i1.46909","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.46909","url":null,"abstract":"Introduction: Meibomian gland dysfunction (MGD) frequently leads to ocular surface disease, yet its impact on patients’ overall health is often overlooked. With increase in sedentary lifestyle, decreased physical activities and exposure to the digital world people have been facing increasing incidence of dyslipidemia. Objectives: To investigate the association between serum lipid profile with severity of meibomian gland dysfunction. Materials and methods: This was an observational, analytical, cross-sectional study carried out in the department of Ophthalmology of Shree Birendra hospital from January 2019 to January 2020. Oxford grading scale was used to grade the severity of MGD as none (grade 0), mild (grade I and II), moderate (grade III), and severe (grade IV and V). Serum lipid profile was obtained from all patients with MGD and analysis was carried out. Results: Among 100 patients in this study majority of the participants were from the age group 61-70 (n, 40%) among whom 54 (54%) were females and 46 (46%) were males. Statistically significant association was noted between increase in total cholesterol, LDL, and TG levels with severity of MGD. However no significant association was found between HDL and the stage of MGD. Conclusion: This study demonstrated that patients with increasing severity of meibomian gland dysfunction had greater abnormalities in their serum lipid profiles with respect to total cholesterol, LDL and triglycerides","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139136533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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