Nepalese Journal of Ophthalmology最新文献

Background: Endogenous endophthalmitis refers to the intraocular infection resulting via haematogenous spread from the distant foci. Dengue is an important health problem in India with varied ophthalmic manifestations either due to viremia, immunologic phenomenon, or haemorrhagic tendency.

Case: We report an unusual presentation of endogenous endophthalmitis as fulminant orbital cellulitis in a young adult patient having a history of dengue fever.

Observations: Young male having history of dengue fever presented with complaints of sudden pain, swelling, redness, and loss of vision in the left eye. His clinical features and radiographic examination were suggestive of orbital cellulitis with pan-ophthalmitis, which rapidly progressed to endophthalmitis.

Conclusion: This case highlights the role of orbital vessels as a possible route for occurrence of endophthalmitis in a case of orbital cellulitis.

Background: Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, opportunistic, angio-invasive, and fatal infection caused by mold fungi of the genera Rhizopus, Mucor, and Rhizomucor. The global incidence of ROCM is 0.005-1.7 per million, with a fatality rate of 46%. Early diagnosis and treatment are crucial for this disease, as a delay of one week can increase the mortality rate to 66%.

Case: A 32-year-old male, a known case of coronavirus disease 2019 (COVID-19) for the past 15 days from Janakpur, Dhanusha, Nepal presented to the emergency department of Dhulikhel Hospital with a sudden onset of blurred vision in the left eye, left-sided ocular pain, and nasal bleeding for the last three days.

Observations: The patient was suspected of post-COVID-19 mucormycosis, and a nasal swab for potassium hydroxide (KOH) mount showed hyphae in microscopy. Intravenous and retrobulbar liposomal amphotericin B were administered as medical therapy, along with surgical debridement. A multidisciplinary approach was necessary for the treatment.

Conclusion: A long-term, multimodal treatment approach involving combined antifungal drug therapy (intravenous liposomal amphotericin B and retrobulbar amphotericin B), and timely surgical debridement leads to an improvement in both short-term and long-term outcomes.

Introduction: In the sub-continent, there is a huge discrepancy between the cornea collected and the ever-increasing demand. Lack of awareness, faulty perceptions, and unwillingness to donate corneas are the major hurdles.

Objectives: To assess the level of awareness among doctors, students, and paramedics in a teaching hospital.

Materials and methods: An analytical cross-sectional, pre-tested, study design assessed the awareness, knowledge, and attitude among health care workers (medical students, nurses, doctors, and paramedics) in the context of eye donation through a administered self-administered semi-structured questionnaire.

Results: In our study, 692 (57.7%) of the respondents were aware that the ideal time for donation was within six hours of death. Our study revealed that 875 (72.9) of the respondents were willing to donate their eyes; out of these 305 (25.4%) were MBBS students and 223 (18.6%) were nursing students, (Chi-square tests, p <0.001). Six-hundred and twenty-five (52.1%) respondents knew that the nearest eye bank should be contacted if they or any of their family members wished to donate their eyes. However, only 90 (7.5%) of the respondents' family/ relatives had donated his/her eyes. A significant association between knowledge of eye donation and the age, gender, religion, or marital status and knowledge of eye donation of participants was observed.

Conclusion: The study highlights the need for creating awareness about eye donation among doctors, medical students, and paramedics, who can be an effective channel for planning, educating, and motivating the public to pledge for eye donation.

Background: Lacrimal gland adenoma is a benign tumour of the lacrimal gland mostly involving the orbital part of the gland and composed of epithelial and myoepithelial components. It involves the third and fourth decade of life as a gradual painless enlargement of the lacrimal gland.

Case: This is a case report of a 30-year-old female presenting with the forward bulging of the right eye causing the eye to be displaced medio-inferiorly over the course of one year. After careful clinical examination and MRI, a clinical diagnosis of lacrimal gland adenoma was established and was planned for right lateral orbitotomy (without marginotomy) via eyelid crease incision and transcutaneous-transseptal approach with complete excision of the tumour under general anaesthesia.

Observations: This case was presented to the out patient department with mild painful non-axial proptosis of the right eye. After clinical examination, her MRI report showed a well-defined altered signal intensity enhancing lesion on the extraconal compartment of the right orbit in the antero-supero-lateral aspect. After complete surgical removal of the mass, it was sent for histopathological analysis and it confirmed it as a pleomorphic adenoma. The patient has been following up every 6 months for 2 years and is asymptomatic.

Conclusion: Being the most prevalent lacrimal gland tumour, pleomorphic adenoma affects the unilateral lacrimal gland causing non-axial proptosis. Complete removal of mass has an excellent prognosis with complete resolution of symptoms.

Background: Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system following a viral illness or vaccination, which occurs most often in children as a monophasic event. The neurological signs typically appear days to weeks after an initial febrile infection (usually of the upper respiratory tract) or vaccine immunisation.

Case: An eight year old boy presented with painless progressive diminution of visual acuity for two days, On ophthalmic examination his visual acuity was hand movements at a close range in both the eyes. Posterior segment examination revealed bilateral optic disc swelling.

Observations: Magnetic Resonance Imaging (MRI) brain revealed multiple discrete ovoid hyperintense lesions in bilateral cerebral white matter. His contrast enhanced MRI orbit study revealed bilateral oedematous optic nerve.

Conclusion: Optic neuritis can present with different systemic conditions. Thorough ocular examinations (visual acuity, colour vision, contrast sensitivity, fundus examination) and neuroimaging should be done in all the cases. Early diagnosis and management is required for good visual prognosis.

Introduction: Orbital infections and infestations present with varying clinical presentations and incidences ranging from benign ocular condition to disseminated systemic disease. The diagnosis is often difficult initially, due to similar ocular presentations.

Materials and methods: This review was compiled using articles available on PubMed using key words like orbital infections, orbital cellulitis, orbital infestations, orbital tuberculosis, orbital fungal infections. Clinical experience in presentation and management at our centre was also included.

Results: The varied presentations, management, complications and follow-ups have been summarised in this review.

Conclusion: As the management is cause-specific, thus lies the importance of early accurate diagnosis, both clinical and radiological. This article aims to review existing literature on orbital infections and infestations for aiding in early accurate diagnosis and management.

Introduction: Branch Retinal vein occlusion is the most common retinal vascular disease after diabetic retinopathy in elderly populations.

Objectives: To describe morphological patterns of macular edema in branch retinal vein occlusion using optical coherence tomography.

Materials and methods: It is a hospital based; descriptive, cross-sectional study. All patients with macular edema secondary to branch retinal vein occlusion diagnosed by optical coherence tomography and fulfilling the inclusion criteria from 2017 July 1 to 2018 July 1 were studied.

Results: A total of 84 eyes of 84 patients were enrolled. The mean age of the patient was 68.0833 ± 11.22 years (range, 35-74 years). Forty-five (53.57%) were male. Forty-four eyes had right eye involvement. Major and macular branch retinal vein occlusion was found in 50 and 34 eyes respectively. Forty eight eyes had superior and 36 eyes had inferior branch retinal vein occlusion. Morphological patterns of macular edema were classified: cystoid macular edema, cystoid macular edema with serous retinal detachment, diffuse macular edema and diffuse macular edema with serous retinal detachment of which 68 (80.95%) had cystoid macular edema. Out of 84 eyes, 30 (35.71%) had inner and outer segment (IS/OS) junction disruption.

Conclusion: Optical coherence tomography is a safe and noninvasive technique. Serous retinal detachment and photoreceptors disruption may go unnoticed unless OCT is performed. It can measure the changes in retinal thickness and thus predict the visual outcomes in patients with macular edema.

Introduction: Central serous chorioretinopathy (CSCR) is a disease with a multifactorial aetiology.

Objectives: To evaluate the role of psychological stress and choroidal thickness in patients with CSCR.

Materials and methods: This was a hospital-based, analytical cross-sectional study, conducted at Christian Medical College, Vellore, India, from 2018 February to 2019 September, after the approval of the Institutional Review Board and Ethics Committee. Patients who satisfied the eligibility criteria of the study, were selected from the outpatient clinics of the Department of Ophthalmology. Twenty-five patients with unilateral CSCR (Group 1 - cases), and 50 age and gender-matched patients without CSCR (Group 2 - controls), randomly selected in a 1:2 ratio, were enrolled after obtaining informed consent. Psychological stress was assessed using Cohen Perceived Stress Scale (PSS-10). All patients had a Swept Source optical coherence tomography scan of the macula. Subfoveal choroidal thickness (SFCT) of both eyes of all participants was measured using a standard protocol. The data were collated and analysed, using Independent samples t-test and Chi-square/ Fisher's exact test, as appropriate, with IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA).

Results: There was a significant difference between the two groups in mean stress scores (p <0.01), as well as stress categories (p <0.01). Although there was no significant difference in the prevalence of hypertension between the two groups (p = 0.33), there was a significant difference both in the mean systolic (p <0.01) and diastolic (p <0.01) blood pressure between the two groups. We found a significant difference between mean SFCT of CSCR eyes (421+/- 78.34 μm) and control eyes (314.24 +/- 52.48 μm, p <0.01), as well as between fellow eyes (396.20 +/- 68.79 μm) and control eyes (314.24 +/- 52.48 μm, p <0.01). However, there was no significant difference in the mean SFCT of CSCR eyes and fellow eyes (p =0.24).

Conclusion: The findings reiterate the concept that the underlying pathophysiological changes leading to CSCR involve both the eyes of the patient. Psychological stress and hypertension may be factors that play an important role in the etiopathogenesis of the pachychoroid-related changes leading to CSCR. Stress relief measures, with a holistic approach to management, should be an integral part of the therapeutic strategies for CSCR.