Nepalese Journal of Ophthalmology最新文献

Introduction: Ocular Rosacea is a poly etiological chronic inflammatory disease with heterogeneous clinical manifestations. It is primarily a dermatologic disease, which often manifests in the eyes affecting eyelids, conjunctiva, and cornea. The leading role in the pathological process belongs to the disruption of regulatory mechanisms in the vascular, immune, and nervous systems. The varied manifestation can be erythematous pustular lesions on the face, chronic blepharitis, meibomian gland dysfunction, evaporative dry eye, peripheral corneal ulceration, corneal scarring, perforation, and neovascularization.

Case: We describe a rare case report of a 43-year-old male with progressive ocular manifestations of rosacea keratitis. Slit-lamp biomicroscopic examination revealed squamous blepharitis, telangiectatic vessels with obliterated meibomian glands, circumcorneal congestion, peripheral corneal perforation of 2x2 mm at 4 0 clock, shallow anterior chamber(AC) with positive seidel's in the left eye. Fundoscopy showed serous choroidal detachment(CD). Snellen's Best Corrected Visual Acuity(BCVA) was 20/240 with Intraocular pressure measured was 5 mmhg. The patient was managed with topical loteprednol, moxifloxacin, carboxymethylcellulose medications along with cyanoacrylate glue and bandage contact lens and had excellent visual acuity of 20/20 with a follow-up of 1 year.

Conclusion: Ocular rosacea perforation has been reported in chronic cases and may not always require amniotic membrane transplant, patch grafting, or keratoplasty. If managed meticulously with cyanoacrylate glue and BCL can have excellent outcomes. Eye specialists should be alerted that the key to a successful outcome is excellent control of inflammatory activity and differentiating this non-infectious keratitis from other keratitis before commencing treatment.

Introduction: Corneal squamous neoplasia is less common than that of conjunctiva and can cause diagnostic confusion.

Case: A 40-year-old male presented with gradual onset blurring of vision in left eye for 8 weeks. He had received treatment for dry eyes, then for herpetic dendritic keratitis, but without improvement. On slit-lamp examination with diffuse light, apparently the cornea looked clear with some dilated conjunctival vessels nasally. But in the retro-illumination, on the corneal surface, there was a translucent inverted "V" shaped lesion with irregular fimbricated margin. He underwent excisional biopsy of the corneal lesion and the adjacent conjunctiva. Cryotherapy of the conjunctival margin and the adjoining limbus was done. Corneal and conjunctival specimens reported intraepithelial neoplasia grade II and I respectively.There had not been any recurrence till 4 year post-operatively.

Conclusion: Corneal examination by retro-illumination aids to diagnose and demarcate corneal intraepithelial neoplasia clinically. Timely management results in good prognosis.

The South Asian Association for Regional Cooperation (SAARC) is a geopolitical union of 8 member states of South Asia, one of the rapidly transforming regions in the world. It houses 25% of the world population, with a similar rise in at-risk population for diabetes and its complications. Diabetic retinopathy (DR), is one of the major causes of blindness and visual impairment. Despite the region's dramatic demographic and economic transformation, its healthcare system is nascent enough to achieve the over-reaching recommendations by developed countries. Our review helps in tailoring the clinical care to the available resources, focusing on an integrated approach for timely detection and management of sight-threatening diabetic retinopathy (STDR). Our study also recommends urgent measures to be taken to implement diabetes registers by all care providers and take the responsibility of ensuring that patients with STDR are referred for treatment. This tailored framework helps in the screening and treatment of those with STDR in resource-constrained settings, thereby decreasing the health and economic burden in all SAARC countries.

Introduction: Ocular hypertension is a condition with elevated intraocular pressure that needs to be monitored closely to prevent glaucoma and other complications. The study aims to find out the prevalence of ocular hypertension in patients aged more than 40 years.

Materials and methods: This is a hospital based cross-sectional study conducted in a community based tertiary hospital of Nepal.

Results: Mean age of the patients was 47.53years. 62% of the patients were males and 38% were females. Mean intraocular pressure in the right eye was 15.8 mmHg and mean intraocular pressure in left eye was 16.2 mm Hg. Prevalence of ocular hypertension was 6%.

Conclusion: All patients more than 40 years of age should undergo detailed ocular examination for early detection and treatment of ocular hypertension.

Introduction: This study aims to evaluate outcomes and complications of temporary suture tarsorrhaphy (TST) in cases of impending corneal ulcer perforation.

Materials and methods: Case records of patients who underwent temporary suture tarsorrhaphy at Mechi Eye Hospital during a period of 18 months were retrospectively evaluated. All the smear positive fungal keratitis with more than 5mm infiltration involving central and/or paracentral cornea with impending corneal perforation were included. Demographic and clinical profile including - visual acuity, indication for temporary suture tarsorrhaphy, duration of signs and symptoms were noted. The outcomes were evaluated after 1 month and 3 months post tarsorrhaphy, in relation with time to epithelial healing, anatomical success rate, best corrected visual acuity, complications associated with non-healing corneal ulcer, number of temporary suture tarsorrhaphy needed and complications of TST.

Results: The study included 119 cases of smear positive fungal keratitis with mean age of 51.34 + 15.56 years. In this study, 56.30% of the patients developed epithelial healing at 2 - 4 weeks with mean duration of 23.24 + 12.09 days of temporary suture tarsorrhaphy. Out of 119 patients, the corneal ulcer healed in 84 patients (70.6%), whereas 35 (29.4%) did not heal. Among those with non-healing ulcers, 15 patients (12.6%) had to undergo evisceration. The anatomical success rate was 87.39% which was statistically significant (P = 0.001). Regarding visual outcome, in 62 patients (52.10%) BCVA improved by 2 or more lines, which was statistically significant (P<0.05) resulting in a functional success of 26.89%.

Conclusion: This study concludes that temporary suture tarsorrhaphy could be a useful option for management of corneal ulcers with impending perforation in eye centers with limited resources settings and high disease burden with good anatomical and functional outcome.

Introduction: Although cataract surgery training is considered an integral part of all ophthalmology residency programs in Nepal, there is no literature about the training patterns and its effectiveness. The objective was to study the perspectives of young ophthalmologists towards the patterns and quality of cataract surgery training in their residency programs.

Materials and methods: An anonymous web-based survey was conducted among MD Ophthalmology graduates completing their residency between January 2018 and December 2020 in Nepal.

Results: A total of 74 respondents included graduates from all 13 medical colleges under four universities/ academic bodies. All the respondents were primarily trained in Manual Small Incision Cataract Surgery technique (MSICS) with 28.4% (n=21) also having limited exposure to phacoemulsification. Overall, 62.1 % (n=46) of respondents had some exposure to wet lab training. Around 42% (n=31) had performed less than 25 cataract surgeries as a primary surgeon during residency and only 36.5 % (n=27) felt confident enough to perform cataract surgery independently after completion. More than 47 % (n=35) graded their cataract surgery training experience to be poor or below average.

Conclusions: Ophthalmology residency programs may need to reassess their surgical training methods as the majority of recently graduated ophthalmologists from Nepal feel inadequately trained in cataract surgeries.

Introduction: Joubert syndrome is an inherited disorder of rare occurrence usually presenting as developmental delay, hypotonia, hyperpnea and ataxia. The diagnosis is confirmed by characteristic findings in neuroimaging. Involvement of ocular, renal and hepatic systems can be present. Joubert syndrome presenting first to an ophthalmologist is very uncommon.

Case: A twenty-one-year female, with history of delayed milestones, infantile hemiplegia with hearing and visual impairment was referred for visual assessment. On systemic examination, ataxic gait was present. CT head showed hypoplasia of postero-inferior portion of vermis with communication between 4th ventricle and cisterna magna with variable degree of cerebellar dysgenesis. The neurological, ophthalmological and radiological findings of this patient were consistent with Joubert syndrome related disorder.

Conclusion: We hereby report a case of Joubert syndrome related disorder with ocular involvement which after correlation with neurological findings and neuroimaging led us to the diagnosis of this rare disorder. The renal and hepatic functions in these patients need to be monitored.

Introduction: This study aims to study a relatively unexplored topic about the causes and managements of early-onset ocular hypertension (OHTN) following the pars plana vitrectomy with silicone oil (PPV with SO) procedure for retinal detachment. Additionally, to explore the outcome of trabeculectomy in managing such patients.

Materials and methods: This is a retrospective exploratory pilot study. We studied 23 patients who underwent the procedure then subsequently developed ocular hypertension within a month of the procedure. The probable causes for their early-onset ocular hypertension were identified and addressed with medicine, peripheral iridotomy (PI), complete or partial silicone removal. Trabeculoplasty was done in irretractable causes. This study aimed to evaluate the causes of early onset ocular hypertension after pars plana vitrectomy with silicone oil and explore the outcome of different managements including trabeculectomy.

Results: Inflammation (n=11, 47.8%) was the most common cause of early-onset ocular hypertension. Other causes were overfilling/spilling of silicone oil in anterior chamber (n=5, 21.7%), pupillary block (n=4, 17.4%) and angle-recession glaucoma (n=2, 8.69%). Majority of the cases responded to intraocular pressure (IOP) lowering medications (n=11). Three eyes with persistently high intraocular pressure underwent trabeculectomy after which the intraocular pressure was controlled.

Conclusion: Even though prior studies have reported that trabeculectomy does not address late-onset ocular hypertension, our study shows that the procedure might be helpful in early-onset ocular hypertension. This is probably because at the time of presentation for early-onset ocular hypertension, silicone has not emulsified, which will not be the case in late-onset ocular hypertension. If a large study also shows that trabeculectomy can correct early-onset ocular hypertension, this information can guide the practices of ophthalmologists whose patients cannot afford expensive glaucoma drainage devices.

Introduction: Glaucoma is the second leading cause of blindness worldwide. Glaucoma will affect 79.6 million individuals by 2020, according to projections. Improved glaucoma screening and treatment approaches are urgently needed. The purpose of this study is to determine the clinical characteristics of glaucoma patients who visit Bharatpur Eye Hospital and aims to calculate the number of new diagnoses of glaucoma from 01 February 2020 to 15 March 2020.

Materials and methods: This is a hospital-based, cross-section study. All patients with a diagnosis of glaucoma were invited to participate. The examination findings, diagnosis, and management were all documented. A standardized questionnaire was used to collect patient knowledge and understanding of glaucoma.

Results: Among 127 patients 52.8% were newly diagnosed with glaucoma. Many patients (59.8%) were symptomatic for more than 6 months. The mean presenting intraocular pressure was 20.86 mm Hg with an SD of 11.55 mm Hg. Only 44.9% of the participants had heard about glaucoma. Many participants (65.4%) did not have knowledge of glaucoma. Among 127 participants 9.4% had a family history of glaucoma.

Conclusion: Glaucoma is a significant burden that presents challenges to ophthalmic services in Chitwan. Many people have a poor understanding of their condition and have limited access to services. There is a need to build a treatment infrastructure and raise public awareness.