Nepalese Journal of Ophthalmology最新文献

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.

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.

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.

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.