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":"113 38","pages":""},"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":" 680","pages":""},"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":"84 1","pages":""},"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":"120 35","pages":""},"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":" 1084","pages":""},"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}
Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.52446
Madhu Thapa, G. B. Shrestha, Pragati Gautam, M. Sigdel
Introduction: Renal diseases are on rise globally due to increased incidence of non-communicable diseases as well as primary-kidney diseases and frequent use of nephrotoxic drugs. Only definite treatment of End-Stage-RenalDisease (ESRD) is renal transplantation. Immuno-suppressive-drugs are prescribed lifelong after renal transplantation especially steroids which can lead to various sight-threatening complications. Methods: This cross sectional, observational study included 62 eyes of 31 patients who had undergone renal transplantation, at least 3 months prior were referred from Nephrology Department. Comprehensive eye evaluation was done at B. P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS), Department of Ophthalmology, Institute of Medicine. Results: The average age of participants was 37 ±10.57 years with 77.4 % (n=24) male. Mean duration of renal transplant was 5.10 ± 3.61 years. Fifty-eight percent (n=18) had hypertensive kidney disease. Diabetes Kidney disease, recurrent UTI, CKD of unknown causes and combined case of diabetes plus hypertension were seen in 6.4% (n=2) each. Sixty percent of the patients had some kind of ocular involvement. Twenty-nine percent (n=18) had subnormal visual acuity of ≤ 6/9. Cataract was seen in 29% (n=18) of eyes followed by pinguecula (17.7%, n=11) and hypertensive-retinopathy (17.7%, n=11). Glaucoma and Diabetic-retinopathy were seen only in 6.4% (n= 4) of each eyes. There was no association seen between ocular findings with cause of renal transplant, duration of transplant and renal function status in bivariate analysis. Conclusions: Some form of ocular abnormality is commonly seen in patients of renal transplantation who are on immunosuppressive drugs. However, incidence of sight threatening complications are rare.
{"title":"Ocular Findings among the Patients of Renal Transplantation","authors":"Madhu Thapa, G. B. Shrestha, Pragati Gautam, M. Sigdel","doi":"10.3126/nepjoph.v15i1.52446","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.52446","url":null,"abstract":"Introduction: Renal diseases are on rise globally due to increased incidence of non-communicable diseases as well as primary-kidney diseases and frequent use of nephrotoxic drugs. Only definite treatment of End-Stage-RenalDisease (ESRD) is renal transplantation. Immuno-suppressive-drugs are prescribed lifelong after renal transplantation especially steroids which can lead to various sight-threatening complications. Methods: This cross sectional, observational study included 62 eyes of 31 patients who had undergone renal transplantation, at least 3 months prior were referred from Nephrology Department. Comprehensive eye evaluation was done at B. P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS), Department of Ophthalmology, Institute of Medicine. Results: The average age of participants was 37 ±10.57 years with 77.4 % (n=24) male. Mean duration of renal transplant was 5.10 ± 3.61 years. Fifty-eight percent (n=18) had hypertensive kidney disease. Diabetes Kidney disease, recurrent UTI, CKD of unknown causes and combined case of diabetes plus hypertension were seen in 6.4% (n=2) each. Sixty percent of the patients had some kind of ocular involvement. Twenty-nine percent (n=18) had subnormal visual acuity of ≤ 6/9. Cataract was seen in 29% (n=18) of eyes followed by pinguecula (17.7%, n=11) and hypertensive-retinopathy (17.7%, n=11). Glaucoma and Diabetic-retinopathy were seen only in 6.4% (n= 4) of each eyes. There was no association seen between ocular findings with cause of renal transplant, duration of transplant and renal function status in bivariate analysis. Conclusions: Some form of ocular abnormality is commonly seen in patients of renal transplantation who are on immunosuppressive drugs. However, incidence of sight threatening complications are rare.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"17 19","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139130239","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.v15i1.50357
R. Rana, L. Bajracharya, Reeta Gurung, Radhika Upreti, Manish Poudel, Pradeep Banjara, S. Thapa
Introduction: Paediatric keratoplasty is rarely performed surgery with high risk of graft failure. Developing countries have not benefited due to lack of sufficient facilities and trained surgeons. Objectives: The objectives of the study were to analyze the indications and its outcome in terms of vision and graft survival. Materials and methods: This retrospective chart review used electronic medical records from January 2017 to December 2019 of all consecutive patients aged upto18 years or below that underwent paediatric keratoplasty after ethical approval at Tilganga Institute of Ophthalmology. Outcome was defined as anatomical or visual success and graft clarity. Different demographic and surgical parameters were studied among 59 eyes of 48 patients. Results: Mean age of recipient was 12.23± 3.81 years. Majority 37 (52.5%) had unilateral grafts with keratoconus being the most common 24 (40.6%) acquired non-traumatic indication. Mean post-operative best corrected visual acuity 0.6 Logmar was significantly (p <0.001) low as compared to preoperative 1.3 Logmar. Overall graft survival rate was 47 (78%) at one-year follow-up; keratoconus accounting for 24 (100%). Major factors in contributing for graft failure were rejection, infection, and glaucoma. Conclusion: A good outcome in terms of anatomical and visual success was achieved in our study. Keratoconus has an excellent graft survival. Visual rehabilitation by cycloplegic refraction should be done to prevent amblyopia. Enhancing the training of surgeons and addressing challenges faced in a paediatric population will help decrease corneal blindness among paediatric patients in the future.
{"title":"Indication and Outcome of Paediatric Keratoplasty at a Tertiary Referral Eye Hospital in Nepal","authors":"R. Rana, L. Bajracharya, Reeta Gurung, Radhika Upreti, Manish Poudel, Pradeep Banjara, S. Thapa","doi":"10.3126/nepjoph.v15i1.50357","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.50357","url":null,"abstract":"Introduction: Paediatric keratoplasty is rarely performed surgery with high risk of graft failure. Developing countries have not benefited due to lack of sufficient facilities and trained surgeons. Objectives: The objectives of the study were to analyze the indications and its outcome in terms of vision and graft survival. Materials and methods: This retrospective chart review used electronic medical records from January 2017 to December 2019 of all consecutive patients aged upto18 years or below that underwent paediatric keratoplasty after ethical approval at Tilganga Institute of Ophthalmology. Outcome was defined as anatomical or visual success and graft clarity. Different demographic and surgical parameters were studied among 59 eyes of 48 patients. Results: Mean age of recipient was 12.23± 3.81 years. Majority 37 (52.5%) had unilateral grafts with keratoconus being the most common 24 (40.6%) acquired non-traumatic indication. Mean post-operative best corrected visual acuity 0.6 Logmar was significantly (p <0.001) low as compared to preoperative 1.3 Logmar. Overall graft survival rate was 47 (78%) at one-year follow-up; keratoconus accounting for 24 (100%). Major factors in contributing for graft failure were rejection, infection, and glaucoma. Conclusion: A good outcome in terms of anatomical and visual success was achieved in our study. Keratoconus has an excellent graft survival. Visual rehabilitation by cycloplegic refraction should be done to prevent amblyopia. Enhancing the training of surgeons and addressing challenges faced in a paediatric population will help decrease corneal blindness among paediatric patients in the future.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"117 5","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139133107","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.v15i1.59413
Arjun Shrestha, Pranita Upadhyaya, Madan P. Upadhyay
Not available.
不详。
{"title":"Developing Artificial Intelligence Model for Prediction of Diabetic Retinopathy and Delivering in a real-world Local Context: BP Eye Foundation’s Perspective","authors":"Arjun Shrestha, Pranita Upadhyaya, Madan P. Upadhyay","doi":"10.3126/nepjoph.v15i1.59413","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.59413","url":null,"abstract":"Not available.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"78 22","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139131919","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.v15i1.47629
Samiksha Bhattarai, P. Lavaju, B. Badhu, Sangeeta Shah, Santosh Chaudhary, Robin Maskey, Ashesh Koirala
Introduction: Diabetes leads to an alteration in retinal nerve fiber layer (RNFL) thickness and macular thickness which can easily be detected with optical coherence tomography (OCT). Objectives: This study was done to compare the RNFL and macular thickness between diabetic patients without retinopathy and non-diabetic patients so that it would be useful in the early detection of retinal changes if present. The correlation between the RNFL and macular thickness with metabolic blood parameters of diabetic subjects was also studied. Materials and methods: This is an observational, cross-sectional, hospital-based study including 120 subjects who were further divided into two groups. Group A consisted of 60 diabetic patients without retinopathy and group B consisted of 60 non-diabetic patients. The blood parameters were recorded and the RNFL thickness and macular thickness were compared between the two groups after evaluation by OCT. Results: The average central macular thickness was found to be more in group A but was statistically insignificant (p=0.29). Macular thickness in the superior quadrant was significantly higher among group A when compared with group B (p=0.01). Whereas RNFL thickness difference between the two groups was statistically insignificant (p=0.53). Blood urea showed significant positive correlation (r=0.269) with central macular thickness (p=0.03). Conclusion: Our study showed that diabetic patients without retinopathy could have increased macular thickness in the superior quadrant when compared with normal people whereas RNFL thickness may not alter. The blood urea levels of the diabetic patients can provide us clues regarding possible retinal changes.
导言：糖尿病会导致视网膜神经纤维层（RNFL）厚度和黄斑厚度发生变化，而光学相干断层扫描（OCT）很容易检测到这一变化。研究目的本研究旨在比较无视网膜病变的糖尿病患者和非糖尿病患者的视网膜神经纤维层和黄斑厚度，以便及早发现视网膜病变。此外，还研究了 RNFL 和黄斑厚度与糖尿病患者血液代谢参数之间的相关性。材料和方法：这是一项以医院为基础的横断面观察性研究，包括 120 名受试者，并将他们分为两组。A 组包括 60 名无视网膜病变的糖尿病患者，B 组包括 60 名非糖尿病患者。研究人员记录了两组患者的血液参数，并通过 OCT 评估比较了两组患者的 RNFL 厚度和黄斑厚度。结果发现 A 组的黄斑中心平均厚度更大，但在统计学上并不显著（P=0.29）。与 B 组相比，A 组上象限的黄斑厚度明显更高（P=0.01）。两组的 RNFL 厚度差异无统计学意义（P=0.53）。血尿素与黄斑中心厚度呈显著正相关（r=0.269）（p=0.03）。结论我们的研究表明，与正常人相比，无视网膜病变的糖尿病患者上象限黄斑厚度可能会增加，而 RNFL 厚度可能不会改变。糖尿病患者的血尿素水平可为我们提供视网膜可能发生变化的线索。
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Pub Date : 2023-12-31DOI: 10.3126/nepjoph.v15i1.52436
Anil Parajuli, I. Paudyal, P. Joshi, S. Thapa
Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. Objectives: To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. Materials and methods: We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. Results: There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P <0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p <0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Conclusion: Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.
{"title":"Surgical Outcomes of Ahmed Glaucoma Valve and Aurolab Aqueous Drainage Implant in Nepalese Eyes: Comparison in the First Year","authors":"Anil Parajuli, I. Paudyal, P. Joshi, S. Thapa","doi":"10.3126/nepjoph.v15i1.52436","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.52436","url":null,"abstract":"Introduction: Glaucoma is the leading cause of irreversible blindness worldwide. Though trabeculectomy still remains the surgical modality of choice for the management of glaucoma, the outcome of glaucoma drainage devices (GDDs) too has been encouraging in recent years. Objectives: To compare the surgical outcomes of Ahmed glaucoma valve (AGV) and Aurolab aqueous drainage implant (AADI) in cases of refractory glaucoma in Nepalese eyes. Materials and methods: We retrospectively studied the charts of the patients with refractory glaucoma who had undergone GDD implantation at Tilganga Institute of Ophthalmology (TIO), Kathmandu, Nepal. Depending on which GDD was implanted, the eyes of the patients were divided into: AGV group and AADI group. The outcome measures of the study were intraocular pressure (IOP), requirement of antiglaucoma medications (AGMs), surgical success and complications. Results: There were 24 eyes of 23 patients in AGV group and 31 eyes of 30 patients in AADI group with a median (quartiles) follow-up of 12 (12,12) months. In the final visit, IOP and AGMs were both significantly lower than the baseline in both the groups (P <0.001). The median IOP in mmHg and AGMs were both significantly lower in the AADI group compared to AGV group in the final visit, p <0.001 and p=0.002, respectively. The overall success was similar in both the groups: AGV (n=22, 91.67%) and AADI (n=29, 93.55%), p=1.0. However, complete success was significantly more in AADI group (n=16, 51.61%) compared to AGV group (n=6, 25%), p=0.046. Complications and their rates were comparable between the two groups (p=0.4). Conclusion: Both AGV and AADI safely and effectively reduced the IOP and the number of AGMs in cases of refractory glaucoma in Nepalese eyes.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":" 843","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139136658","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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