Nepalese Journal of Ophthalmology最新文献

Background: Aetiology for non-closure of full-thickness macular hole (FTMH) becomes crucial in determining the method of effective mode of intervention. Association of epiretinal proliferation (ERP) along with full-thickness macular hole (FTMH) have shown poorer anatomic and visual outcomes after surgical intervention. Various surgical techniques have been described in literature for treatment of persistent MH.

Case: We report a A 60-year-old female patient with FTMH secondary to branched retinal vein occlusion (BRVO) initially associated with ERP.

Observations: She was successfully managed by treating with combination of intravitreal injection of off label bevacizumab (Avastin) (1.25 mg/0.05 ml) and pure gas of SF6 (1 cc) under topical anaesthesia after an initial surgical intervention.

Conclusion: Presence of ERP in retinal vein occlusion cases needs closer and frequent follow up. IVB can be used as an adjunct in treating secondary MH.

Introduction: Accurate refractive error assessment is the first and the most important step of ocular examination. A reliable screening method of refractive status is important for early detection and prevention of blinding complications of uncorrected refractive error.

Objectives: To evaluate the comparability of astigmatism measured by an auto-refractometer (URk-800F) with the measurements of the gold standard anterior segment optical coherence tomography (AS-OCT).

Materials and methods: This cross-sectional observational study was conducted in a tertiary eye centre in Kathmandu from February 2023 to June 2023. A total of 100 patients with best corrected visual acuity of ≥ 20/20, spherical refractive error with cylindrical error of more than and equal to -0.75 and no pathology detected on slit lamp examination were taken by consecutive sampling method. Ethical approval was taken for the study. The data were entered into Microsoft Excel and analysed using Bland-Altman analysis.

Results: The mean cylindrical power and axis was -2.33 D and 88 degrees for the right eye and -2.32 D and 122 degrees for the left eye respectively, as measured by MS-39 AS-OCT. For URK 800-F Auto-refracto Keratometer, the mean cylindrical power and axis was -2.31 D and 89 degrees for the right eye and -2.27 D and 124 degrees for the left eye.

Conclusion: The findings of this study conclude that an auto-refractometer can be used as an effective tool for identification of spherical refractive error as well as measurement of accurate cylindrical power and cylindrical axis in low resource primary care settings.

Introduction: Many ocular or systemic conditions can cause weakening of the zonules, leading to subluxation or complete dislocation of lens into the anterior chamber or vitreous cavity.

Objectives: To evaluate the outcome of surgery in cases with subluxated and dislocated lens.

Materials and methods: Retrospective chart review of all cases with subluxated and dislocated lens who underwent surgery in a one-year period from 2019 January to 2019 December was conducted. Demographic profile, systemic comorbidities, initial and final best corrected visual acuity (BCVA), surgical procedure were recorded along with all the intraoperative and post-operative complications.

Results: A total of 62 eyes of 60 patients with mean age of 50.18 ± 15.18 years (18 to 87 years) were included with the modal duration of presentation of one week. Among these, trauma was found to be the most common etiology. Subluxation was present in 55 eyes and seven eyes had dislocation. Intracapsular Cataract Extraction (ICCE) was performed in 41 while 21 underwent Extracapsular Cataract Extraction (ECCE); and surgical intervention elicited a statistically significant (p < 0.05) improvement in the visual acuity. The BCVA was statistically better among the pseudophakic patient. Most common complication encountered intraoperatively was vitreous loss and post operatively was significant corneal edema.

Conclusion: Cataract extraction in cases with subluxated and dislocated lens due to different etiology results in the improvement in the visual acuity of the patient. In cases where ECCE cannot be performed, ICCE also results in comparable visual improvement.

Background: Bilateral optic neuritis following enteric fever is a rare condition requiring early evaluation by an ophthalmologist and prompt treatment for visual rehabilitation.

Case: A 31-year-old female diagnosed with enteric fever presented to the Neuro-ophthalmology department with sudden painful loss of vision in both eyes for 10 days.

Observations: Her Best Corrected Visual Acuity (BCVA) was counting fingers close to face in left eye and 6/18 in right eye. Posterior segment examination showed blurring of disc margin on both eyes. On Magnetic Resonance Imaging (MRI) of brain and orbit there was mild thickening of retro-orbital portions of both optic nerves. She was started on steroid therapy which resulted in marked improvement of vision in both eyes.

Conclusion: Optic neuritis following enteric fever is a rare entity and requires early diagnosis with prompt treatment for improvement of visual acuity and prevention of visual impairment.

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.