Nepalese Journal of Ophthalmology最新文献

Introduction: The principal route of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) is respiratory droplets. Reverse transcription-polymerase chain reaction (RT-PCR) test of throat swabs, nasopharyngeal swabs, sputum, endotracheal aspirates and bronchoalveolar lavage is the diagnostic test of severe acute respiratory syndrome coronavirus-2. Since the epithelium of the conjunctiva contains angiotensin-converting enzyme-2 receptors, the presence of the severe acute respiratory syndrome coronavirus-2 in conjunctival secretion can be expected. The present study is designed to detect severe acute respiratory syndrome coronavirus-2 from conjunctival secretions and the prevalence of conjunctivitis in laboratory-confirmed CoronaVirus disease-19 (COVID-19) patients.

Materials and methods: This is a prospective observational study carried out in a tertiary care hospital in western Odisha, India from September 2020 to November 2020 during the first wave of CoronaVirus disease-19. One hundred and thirteen laboratory-confirmed CoronaVirus disease-19 positive patients either by reverse transcription-polymerase chain reaction or Rapid antigen test (RAT) from nasopharyngeal swabs were included. Conjunctival swabs were collected from all these patients with proper precautionary measures and sent for reverse transcription-polymerase chain reaction test. Any signs of conjunctivitis at any stage of the illness were observed in all the patients.

Results: Out of 113 samples, reverse transcription-polymerase chain reaction test of the conjunctival swab was found to be positive in three patients (2.65%). The mean cycle threshold (CT) value of these three swabs was 27.16. No signs of conjunctivitis were found in any of these patients. Diabetes and hypertension were associated comorbidities in one patient.

Conclusion: The absence of conjunctivitis despite the presence of virus in the conjunctival swab gives a message to the ophthalmologists to take precautionary measures during a routine eye examination.

This is the case series of three patients of infectious crystalline keratopathy (ICK) presented to us after undergoing penetrating keratoplasty between 2010 to 2020. The lesions showed classical crystalline patterns and clinical diagnosis was made. The patients were treated by broad spectrum antibiotics till the complete resolution of the lesions. The cases highlight the clinical features, diagnosis and management of this rare and resistant disease.

Background: Descemet stripping automated endothelial keratoplasty (DSAEK) is performed for corneal endothelial pathology. It had gained popularity over penetrating keratoplasty (PK) because of better outcome.

Methods: Retrospective data was collected from records of patients who underwent DSAEK from 2005 to 2019. Demography, indications and post-operative complications of DSAEK were analyzed. Outcome was measured in terms of graft clarity and vision.

Results: 93 eyes of 86 patients had undergone DSAEK in the study period of 15 years. Average age of the patients was 61.0 years. 55.9% were female. The common indications for DSAEK were cataract surgery related bullous keratopathy (n=47, 50.5%), Fuchs dystrophy (n=22, 23.6%) and failed graft (n=11, 11.8%). 8.6% of surgeries had graft detachment and 5.3% had pupillary block in the early post-operative period. Outcome analysis was done for cases (n=80) which had follow-up duration of at least 2 months (range: 2 months to 11 years; average: 28.5 months).Endothelial rejection occurred in 8 cases (10.0%), 5 of which regained graft clarity after treatment. At the last follow-up visit, 23.8% (n=19) of grafts had failed, which was mostly due to endothelial failure (n=16); 3 grafts failed due to infective keratitis. 42.5% (n=34) acquired best corrected vision of 6/18 or better. The average astigmatic error was 1.6 Diopter Cylinder by refraction.

Conclusion: DSAEK showed good outcome with our results comparable to other studies. It had replaced traditional PK in our institute for endothelial dysfunction. Surgeons in the country should be encouraged and trained to do the procedure.

Introduction: Glaucoma can cause vision loss by damaging the optic nerve and increased intraocular pressure is one of the primary risk factors.

Materials and methods: This was a hospital based, prospective, comparative, single masked (observer masked) study conducted on patients attending glaucoma department of Nepal Eye Hospital within a period of 1 year from February 2020 to January 2021. The sample size was 50. Specially designed proforma was used to collect the patient. Patients falling are divided in group A and group B randomly, patients using latanoprost were placed in group A and patients using bimatoprost were placed in group B. The examination procedure included history taking, Snellen visual acuity, refraction, gonioscopy, IOP measurement, slit lamp biomicroscopy and fundoscopy with 90 diopter lens.

Results: Among fifty patients 33 (66%) were males and 17 (34 %) were females, 35 (70%) belonged to urban and 15 (30%) from rural population. Maximum number of patients were in the age group of 16-30 years i.e. 15 (30%), second highest group was 61-75 years of age group i.e. 14 (28%) , 11 i.e. 22% of patients were of 46-60 years of age group. Nine (18%) of patients were 31-45 years of age group and 1 i.e. 2% was above 75 years of age. Twenty percent presented with hypertension, 14 % with diabetes mellitus and 66 % with no systemic history. Ten percent had family history of glaucoma and 90% patients had no family history . Twenty-eight percent of patients had a family history of smoking and 72 % had no history. The mean IOP of group A (0.005% latanoprost) patients initially before the start of the treatment was 27.16 mm Hg, at sixth month IOP was 17.24 mm Hg, mean difference was 9.92 mm Hg and p value was < 0.001. The mean IOP of group B (0.03% bimatoprost) patients initially before the start of the treatment was 26.88 mm Hg , at the sixth month the IOP was 15.88 mm Hg , and the mean difference was 11.00 mm Hg and p value was < 0.001. There was a significant difference in IOP at first visit and 6 months in both groups, p<0.001. (The t-test is used.) However, the mean difference of group B, 11.00, is greater than group A, 9.92.

Conclusion: Male gender, increasing age, urban population, hypertension, diabetes mellitus, and high intraocular pressure were the most prevalent risk factors. The most important factor is early detection of signs and symptoms and measurement of diurnal intraocular pressure.

Introduction: This is a multicenter, randomized, interventional, double masked study aimed to compare safety and efficacy of cyclosporine (0.05% versus 0.09%) in dry eye disease.

Materials and methods: Random allocation of patients (n=450) was done in two groups by parallel assignment (1:1). Group1(n=225) received CAs 0.05% drops twice daily, and group 2 (n=225) received CAs 0.09% drops twice daily for 3 months. Primary outcomes were changes from baseline in Lissamine green staining score, Nelson grade on conjunctival impression cytology and tear film osmolarity. Secondary outcomes were changes in dry eye symptom score. Schirmer's test scores, changes in corneal fluorescein staining and changes in tear film break up time.

Results: Within the groups, there was a significant improvement (ANOVA, P<0.05) in tear film osmolarity, lissamine green staining score, dry eye symptom score, corneal fluorescein staining and Schirmer test scores over 3 months of intervention. However, the difference in Nelson Grade, goblet cell density, and tear film break-up time was not statistically significant. Between the groups, there was a significantly better improvement in tear film osmolarity (ANOVA, P<0.001), Lissamine green staining score (ANOVA, P=0.002), corneal fluorescein staining (ANOVA, P=0.011), dry eye symptoms (ANOVA, P=0.040) and Schirmer test scores (ANOVA, P=0.001) with CAs 0.09%. However, the improvement in Nelson grade, tear film break-up time was not significantly different between the two groups. The overall patient's comfort was significantly better over time in patients on CAs 0.05% (ANOVA, P<0.001).

Conclusion: Increasing strength of CAs better improves corneal staining, tear production, tear film osmolarity but not conjunctival morphology and tear film stability.

Introduction: Tuberculosis of the orbit is a unilateral entity commonly involving the bony wall, periosteum or soft tissue in left orbit. It is a rarity.

Case: A fifty seven years old female presented with a localised mass near inferior orbital margin. Owing to its small size and superficial location in orbit, there was no soft tissue displacement or motility disturbance.

Observations: Dissection revealed a localised firm mass attached to periorbita covering the orbital floor. The mass was excised and on histopathological analysis it was found to be composed of multiple granulomas containing abundant Giant cells. Considering such a picture at cellular level, ELISA for tuberculosis was done. Values were suggestive of recent infection. The patient was put on antitubercular multidrug regimen for six months one week after excision of mass, with a follow up of four years, having no recurrence till date.

Conclusion: Though orbital tuberculosis is much more common in childhood, it should always be considered in the differential diagnosis of orbital mass in adults also. At times, even in an otherwise healthy individual, tuberculosis might be diagnosed because of an orbital mass. Ophthalmologists should have a high index of suspicion since orbital tuberculosis has been underdiagnosed in the past.

Introduction: Dry eye is one of the frequently encountered ophthalmological disorders. Following the pandemic of Coronavirus disease 2019, use of masks and electronic devices has taken an upraise globally. These factors are one of the causes for dry eye disease. This study emphasises dry eye symptoms among lecturers working in medical colleges of Nepal.

Materials and methods: This was a descriptive cross sectional study conducted among 217 lecturers working in various medical colleges in Nepal. Dry eye evaluation was done using the Ocular Surface Disease Index (OSDI) questionnaire. Analysis of data was using Microsoft Excel 2016 and IBM Statistical Package for Social Sciences (SPSS) version 26.0.

Results: One fourth (25.80%) of 217 participants experienced symptoms of dry eye disease.

Conclusion: Increasing use of mask and laptop during this pandemic era has shown to cause mild dry eye symptoms in lecturers working in medical colleges of Nepal. Proper care and precaution needs to be practised in order to minimise dry eye symptoms and its consequences.

Introduction: Ankyloblepharon is a partial or complete fusion of eyelids by webs of skin. It may be congenital or acquired. Herein we report a rare case of acquired bilateral ankyloblepharon that developed after purulent membranous conjunctivitis. We will also discuss its unique surgical management which has not been reported previously in the literature.

Case: A 21 year old male presented with complaints of narrowing of eyes for the last six months following an attack of acute purulent membranous conjunctivitis. Surgical excision of the adhesions was done. We used conjunctival autograft to cover the raw area left after excision as a new modality of treatment. The graft was successfully taken up and no recurrence of adhesions was found at 1 year follow up.

Observations: Various modalities of treatment for ankyloblepharon have been reported which includes excision of tissue and suturing and amniotic graft. Here we have used conjunctival autograft on the raw area after excision of adhesions and the result obtained was good.

Conclusion: To the best of our knowledge this is the first and a rare case of acquired ankyloblepharon in a young male following a single episode of purulent membranous conjunctivitis. Conjunctival autograft can be successfully used to cover the raw areas left after excision of adhesions.

Introduction: Diabetic retinopathy (DR) is one of the leading causes of blindness in patients between 20 and 60 years of age which can be prevented by early detection of diabetic retinopathy. The duration of diabetes is probably the strongest predictor for development and progression of retinopathy. Optical Coherence Tomography (OCT) is a recent advance in imaging which is sensitive in early detection of small changes in macular thickness.

Materials and methods: This hospital based cross-sectional study was done at a tertiary referral center in Kathmandu, Nepal where 364 eyes of 182 patients (182 eyes in 91 patients in each group diabetes without retinopathy group and nondiabetic group) were evaluated. Thickness of the macula was determined by using Spectral Domain Optical Coherence Tomography (SD- OCT) and compared between diabetic patients without clinical retinopathy and nondiabetic patients.

Results: The mean CMT as measured by Spectral Domain Optical Coherence Tomography in diabetic patients was 236.29±40.31 µm whereas it was 244.25±30.51 µm in non-diabetic cases. The mean central macular thickness of diabetic patients with duration of diabetes less than 1 year, 1-5 years, 6-10 years, 11-15 years and more than 15 years were 217.19±42.22, 233.49±45.69, 248.5±31.37, 250.89±21.62 and 240.75±11.26 respectively.

Conclusions: This study concluded that in diabetic patients there was an initial decrease in central macular thickness which gradually increased with increasing duration of diabetes mellitus. Examination of macular thickness could be a useful modality to evaluate progression of disease before appearance of other clinical signs of diabetic retinopathy.

Introduction: HLA-B27-associated anterior uveitis is the most common identifiable cause of anterior uveitis in adults worldwide. It is associated with significant ocular morbidity in young patients due to its typically recurrent attacks of inflammation and vision-threatening ocular complications.

Materials and methods: This review was compiled using articles identified by searching on PubMed with all relevant keywords such as HLA B27, HLA B27 uveitis, spondyloarthritis, Ankylosing spondylitis, HLA B27 systemic associations.

Results: We summarize the current knowledge on the HLA B27 associated uveitis epidemiology, genetics, clinical profile, systemic associations, laboratory investigations, complications and management.

Conclusion: HLA-B27-associated uveitis is a commonly encountered entity in the uveitic clinic. Its management must be in coordination with a rheumatologist. Early and appropriately intense treatment is essential for optimal visual prognosis.