Nepalese Journal of Ophthalmology最新文献

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.

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.