Nepalese Journal of Ophthalmology最新文献

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: 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.

Introduction: Ethambutol is an antibiotic used as a first line drug in the treatment of tuberculosis and a vision threatening side effect of EMB is ethambutol-induced optic neuropathy (EON). The aim of the study is to create awareness about the potentiality of ethambutol to cause ethambutol-induced optic neuropathy, careful monitoring of dose and patient education.

Materials and methods: A retrospective observational study of 14 patients whose complete Anti- tubercular treatment records could be retrieved were included. Epidemiological data including age, sex, systemic illness were recorded. Duration between optic nerve toxicity , usage of ethambutol and the drug dosage were noted. Best corrected visual acuity, anterior segment examination including pupils, extraocular movements, colour vision, central fields and fundus examination were evaluated. The patients were followed up at one and three month intervals.

Results: Associated systemic illness was found to be a confounding factor for the development of ethambutol-induced optic neuropathy. 57% of patients had diabetes mellitus followed by hypertension (14.2%), renal disease (7.1%). The average daily dose of Ethambutol ingested was 1078.5 mg (21 mg/kg) and this high dose could have been the primary cause for development of ethambutol-induced optic neuropathy. Vision ranged from total blindness to mild visual impairment and poor recovery of vision was noted even after discontinuing ethambutol.

Conclusion: Only a minority of patients showed improvement in visual function following discontinuation of ethambutol and the toxicity was found to be dose-dependent. Patients with comorbidities like renal impairment and diabetes mellitus appeared to be at greater risk. Ophthalmological examination before commencing treatment and periodic evaluation thereafter is mandatory.

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: This study aimed to analyse the clinical retinal examination findings and undilated Optomap ultrawide field retinal imaging for the detection of proliferative diabetic retinopathy (DR) as compared to the fluorescein angiography (FA).

Materials and methods: In this retrospective cross-sectional study, five hundred and twenty-three patients diagnosed with diabetic retinopathy on dilated retinal examination underwent fluorescein angiography and undilated Optomap imaging. Fluorescein angiography and undilated Optomap images were graded by masked graders and the diagnosis was labelled either as proliferative diabetic retinopathy or non-proliferative diabetic retinopathy. Sensitivity and specificity was calculated comparing the diagnosis obtained from the dilated retinal examination and the undilated Optomap images against the fluorescein angiography image findings.

Results: Gradable quality fluorescein angiography and undilated Optomap images with a clinical diagnosis mentioned in the medical record for that particular visit were available in 980 (right eye - 656; 67%; left eye - 324; 33%) eyes of 496 patients. There were 332 (67%) males and 164 (33%) females with a mean age of 60.3 ± 9.51 years (range: 32 - 81 years). Sensitivity of clinical examination and undilated Optomap images in accurately identifying proliferative diabetic retinopathy was 63.5% and 43.5% respectively. Specificity of clinical examination and undilated Optomap images in accurately identifying proliferative diabetic retinopathy was 88.5% and 76.2% respectively. On comparison of the undilated Optomap imaging findings against the clinical examination findings, the sensitivity and specificity were 47.7% and 75.1% respectively.

Conclusion: Both clinical fundus evaluation and undilated Optomap imaging were relatively inferior to fluorescein angiography in the detection of proliferative diabetic retinopathy, which hence remains the choice of imaging modality giving scope for wider application.

Introduction: Glaucoma is one of the common causes of blindness worldwide, and the leading cause of irreversible blindness .The overall prevalence of glaucoma in Nepal is 1.9%. Though poorly understood, primary open angle glaucoma (POAG) is believed to have a genetic or familial component that may occur through polygenic or multifactorial transmission. First-degree relatives of POAG patients have 4-16% risk of developing POAG. Given the circumstances and the prevalence of POAG in first degree relatives of POAG patients, screening the first degree relative/s accompanying the patient to the hospital can be a cost effective and viable tool for glaucoma screening that will not add any extra cost of travel and accommodation.

Materials and methods: The authors performed a hospital-based cross-sectional study at a tertiary eye hospital in Nepal. All first-degree family members of POAG patients who accompanied them to the glaucoma clinic underwent a full ophthalmic examination.The optic disc was evaluated and intraocular pressure (IOP) was measured. POAG and glaucoma suspect were defined as per ISGEO classification.

Results: Sixty one first degree relatives of 54 glaucoma patients were examined. The mean age was 30.67 years (±12.71). Fifty five(90.2%) of 61 of accompanying first degree relatives were off springs, 6 (9.8%) were siblings. Five out of 61 (8.2%) were diagnosed as glaucoma and started on anti-glaucoma medication. Fourteen participants (23%) were glaucoma suspects. Forty two (68.9%) of the participants had no sign of glaucoma.

Conclusion: Ocular examination of the first-degree relatives accompanying POAG patients helped to identify a remarkable number of individuals with glaucoma and thus might be used as an effective and viable tool for screening glaucoma in a hospital setting. Awareness regarding glaucoma is very low even among the first degree relatives of glaucoma patients.

Introduction: Endoscopic Endonasal Dacryocystorhinostomy (EENDCR) is effective, safe and less time consuming procedure and scar free to manage patients with epiphora. Traditionally, EENDCR is performed under general anesthesia. Limited general anesthesia facility in our country has made EENDCR surgery limited to the hospitals with GA facilities. EENDCR surgery under local or assisted local anesthesia could be an alternative solution. The aim of the study was to study the pain tolerability of the patient undergoing EENDCR under local anesthesia (LA) or assisted local anesthesia (ALA). To the best of our knowledge, there is a lack of similar studies in Nepal.

Materials and methods: This was a prospective, nonrandomized, interventional study done at a tertiary eye care center. After sample collection the study was aimed to evaluate the pain tolerability of patients undergoing EENDCR under LA or ALA. The case collection and the surgery were done by a single surgeon from 2018 Jan- 2019 April and followed for 6 to 24 months. All consecutive cases were enrolled in the study. Informed consent was obtained from all the patients. Inclusion criteria included chronic dacryocystitis with NLDO (Nasolacrimal duct obstruction), lacrimal sac mucocele and lacrimal sac pyocele. Previously failed DCR surgery was not included in the study. Total of 100 patients of EENDCR with a tube who completed a minimum 6 months follow up postoperatively were included in the study. Verbal rating scale (VRS) was used to report response to pain during different steps of surgery.

Results: There were 100 patients within the age range of 13-41 years of age. One hundred and six EENDCR were performed on 100 patients. Eighty-seven patients were adult (19-41) years and 13 patients were of pediatrics age group (13-18) years. There were 74 female and 26 male patients. Thirty-seven were RE (right eye), 57 were LE (Left eye) and 6 were BL (bilateral). Duration of illness was less than 6 months in 9 patients and more than 6 months in 91 patients. Ninety-two eyes were operated under LA and fourteen eyes of 11 patients asked for sedation in addition to local anesthesia (ALA). Patients reported pain during the creation of the bony ostium with Keryson's rounger (24 eyes, VRS 3-4) and while using the drill (19 eyes, VRS 5-6). On pain scoring, there was no pain (0-2) in patients who underwent EENDCR under ALA. Pain scoring in patients who underwent EENDCR under LA showed no pain (0-2) in 51.08%, mild pain (3-4) in 26.08%, and moderate pain (5-6) in 20.65%. Duration of surgery ranged from 15 to 45 minutes. Duration of follow up was 6- 24 months. There was a 96.2% success rate in this study.

Conclusion: EENDCR can be done under LA or ALA depending on the indication and demand of the patient.

Introduction: The study aimed to assess the outcome of the modified wheeler technique with lower eyelid retractor plication for the correction of Involutional (senile) entropion among the study patients Materials and methods: A retrospective case series study was conducted in two tertiary eye hospitals of Bangladesh from 1 July to 31 December, 2020. This study included all patients undergoing modified wheeler technique with inferior lid retractor plication and followed up to at least one year and six months between 01 January 2015 to 31 December, 2019. All patients were suffering from senile entropion of the lower eyelid. All surgeries were performed by a single surgeon and the study sample size was selected purposively. Patients were operated by the modification of modified wheeler technique for the correction of lower eyelid entropion in this study. The outcome of the surgical techniques was assessed at regular intervals on each follow up.

Results: Thirty eyes of thirty patients were evaluated. Success rate was 100% in the 18 months follow up time with no recurrence in any. Ecchymosis, skin scarring and/or minimal pain were observed as post-operative complications.

Conclusion: The modified wheeler technique with inferior eyelid retractor plication is the definitive and permanent procedure for the correction of involutional entropion with minimal or no recurrence.