Nepalese Journal of Ophthalmology最新文献

Introduction: This retrospective, non-randomized, observational study was conducted at ASG Eye Hospital, Kathmandu to evaluate the outcome of phacoemulsification without anti-Vascular Endothelial Growth Factor (VEGF) in patients with treatment naïve diabetic retinopathy.

Materials and methods: Records of all patients who underwent phacoemulsification without Bevacizumab in treatment of naïve patients with any grade of non-proliferative Diabetic Retinopathy (NPDR) were seen. Pre-operative and post-operative visual acuity along with central macular thickness (CMT) was compared.

Results: The study comprised 32 eyes of 20 patients with treatment naïve non-proliferative Diabetic Retinopathy who underwent phacoemulsification. Twelve were men and eight were women with an average age of 69.2 years (range 55 years to 83 years). The average preoperative central macular thickness as measured on optical coherence tomography was 254.63± 20.25 microns and 1-month postoperative central macular thickness was 254.72± 19.96 microns; the study did not find any significant difference (p-value 0.918). The average difference in the central macular thickness between the 1-month postoperative and preoperative values was 0.09 microns.

Conclusion: Uneventful phacoemulsification in eyes with treatment naïve diabetic retinopathy does not cause an increase in central macular thickness after surgery and thus anti-Vascular Endothelial Growth Factor as an adjunct is not mandatory.

Introduction: Infantile capillary haemangiomas (IHs) are common, benign tumours that are self -limiting and generally found in the head and neck region.

Case: We present a case of a three month old female baby who presented with a left upper eyelid capillary haemangioma because of which she could not lift the upper lid subjecting her to a high risk of stimulus- deprivation amblyopia. Treatment was provided in the form of an intralesional Triamcinolone acetate injection (40 mg/ml) under general anaesthesia, along with oral Propranolol (1 mg/kg body in 2 divided doses for the first two days, followed by 2 mg/kg in 2 divided doses for ten days (continued upto four months) and topical Timolol (0.5%) lid massage twice a day upto a period of six months.

Observation: No adverse effects were reported and a marked reduction in size of the tumor was observed thereby providing an immediate relief to the child.

Conclusion: Hence a combination therapy using intralesional steroids, along with oral propranolol and topical timolol over the lesion has proven to be very effective in providing early response.

Introduction: Tuberculosis remains a major public health problem in Nepal and anti-tubercular drugs used for the treatment of pulmonary and extrapulmonary tuberculosis can be associated with ocular toxicity. This prospective study aimed to evaluate the incidence of ocular toxicity among patients receiving anti-tubercular therapy and to assess the change in visual functions and ocular imaging before and after use of anti-tubercular therapy.

Materials and methods: A total of 89 eyes of 45 TB patients taking anti-tubercular therapy were enrolled. Detailed history and examination including best-corrected visual acuity (BCVA), colour vision (Farnsworth D-15t), contrast sensitivity (Pelli-Robson chart), Goldman visual field analysis and spectral domain optical coherence tomography for retinal nerve fibre layer (RNFL) analysis were assessed at baseline and at 6 months after starting anti-tubercular therapy. Visual evoked potential (VEP) was performed in suspected cases.

Results: The mean age of the patients was 29.13±14.00 years and 62.2% were males. The mean weight of the subjects was 54.37±10.36 kg, mean daily dosage of ethambutol was 17.91±1.74 mg/day/kg and mean administration duration was 2.71±1.54 months. The incidence of ocular toxicity was 2.24%. Bilateral retrobulbar optic neuropathy occurred in a 27-year female of 55 kg receiving ethambutol (20 mg/kg/day) for 6 months for Pott's spine. Her best-corrected visual acuity in both eyes was reduced to 6/36 from 6/6 and developed non-specific color vision defect, decreased contrast sensitivity, bilateral cecocentral visual field defect and mean decrease in retinal nerve fibre layer thickness compared to the baseline data. In rest cases, a statistically significant decrease in mean retinal nerve fibre layer thickness in both eyes suggested the evidence of subclinical toxicity.

Conclusion: Though less common, ethambutol toxicity can occur in patients under anti-tubercular therapy in the form of retrobulbar optic neuritis. Decreased contrast sensitivity and thinning in the mean retinal nerve fibre layer thickness can be the indicator of subclinical toxicity.

Introduction: Vitamin A deficiency leads to a wide spectrum of ocular manifestations ranging from conjunctival xerosis to corneal ulceration and perforation. Penetrating keratoplasty along with vitamin A supplementation can save the eye and useful vision.

Case: A 10-year-old boy presented with decreased vision in both eyes for 3 months. Slit-lamp examination with diffuse light revealed bilateral corneal thinning with iris prolapse at inferior aspect of cornea. He underwent therapeutic penetrating keratoplasty in both eyes. Vitamin A supplementation was given as per national protocol. Till 1 year postoperatively visual acuity in RE was 6/18 and LE was pre-phthisical.

Conclusion: Vitamin A deficiency is potentially a sight threatening condition, which may lead to keratomalacia and corneal perforation if neglected. Timely management with Vitamin A supplementation and penetrating keratoplasty can save the eye and vision.

Introduction: The research aimed to study the natural course of serous macular detachment SRD) in patients with pregnancy induced hypertension (PIH), and document fundus changes, OCT findings and visual outcome.

Materials and methods: This is a prospective observational study. Admitted patients underwent ocular screening, and detailed dilated indirect ophthalmoscopy. Those with serous macular detachment were further evaluated with OCT; characteristics of OCT analysed and recorded. All eyes were followed up till macular resolution was noted.

Results: Out of 4950 cases, 22 patients (38 eyes) had serous macular detachment. Mean central macular thickness (CMT) was 512.29 (SD 242.074). RPE irregularity (31.6%),subretinal hyperreflective dots (26.3%) and subretinal membranes (23.7%) were more commonly seen OCT features in these eyes. The difference between mean vision and mean central macular thickness at different intervals was statistically significant : F(3, 111)=65.514, p - 0.001; F(3, 111)=47.331, p - 0.001 respectively. All eyes had resolution of retinal detachment with full visual recovery following delivery. However, 10 pregnancies had foetal mortality.

Conclusion: The incidence of ocular affection in pregnancy induced hypertension is 1-2%. Retinal detachment in such cases have good visual potential following termination of pregnancy. However, the cases had a high incidence of foetal demise. Therefore, early emphasis on early detection of ocular involvement in pregnancy induced hypertension and timely intervention is focused on to prevent foetal demise.

Introduction: Unilateral uveo-meningeoenchephalitic syndrome is a relatively rare entity. Our case highlights the importance of keeping this entity in mind when a unilateral picture suggestive of Vogt Koyanagi Harada syndrome crops up.

Case: A 34-year-old male came with chief complaints of blurring of vision in the right eye since two days with a prodrome of intense headache and redness in the right eye. On examination, the vision in the right eye was counting fingers close to face and 20/20 in the left eye. Clinical examination suggested unilateral uveo-meningeoenchephalitic syndrome which was confirmed on multimodal imaging.

Observations: This case highlights the fact that though uveo-meningeoenchephalitic syndrome is bilateral, by definition; the initial presentation may still be unilateral and a prompt diagnosis and treatment can prevent the involvement of the other eye.

Conclusion: Any case presenting with signs of symptoms suggestive of Vogt Koyanagi Harada should be treated as Vogt Koyanagi Harada even though the initial presentation may be unilateral. A prompt diagnosis and early treatment will ensure that the other eye does not get involved. Early Vogt Koyanagi Harada may just present with choroidal hyperpermeability and multiple septate pockets of SRF without any vitreous cells or anterior segment inflammation.

Introduction: Many studies have shown that eye health services in Nepal are still far behind in reaching schools. Therefore, the aim of this study is to examine the teacher's self-efficacy for the incorporation of eye health promotion activities.

Materials and methods: A cross-sectional study design was applied with a self-administrated questionnaire. A total of 292 teachers were randomly selected for this study.

Results: Male (153.38) older-aged and Dalit ethnic group (159.81) teachers, as well as teachers who had participated (146.85) in the program, had higher self-efficacy to conduct school eye health-promoting activities than non-participants in schools. But, teaching experience is not determined to get self-efficacy for testing of visual acuity. Teachers with higher qualifications are found to be skillful.

Conclusion: The school's eye health program has not been superseded by any relevant legislation. As a result, it's critical to concentrate on provisions that may be included in the school curriculum.