Nepalese Journal of Ophthalmology最新文献

Introduction: Major cause of irreversible blindness is glaucoma which is increasing as a significant global health problem. Knowledge of glaucoma burden and its clinical characteristics in this region is essential.

Materials and methods: This was a cross-sectional hospital -based study conducted at Glaucoma unit in CHEERS Hospital, Bhaktapur from August 2015 to July 2019. Patients' demographic profile, along with comprehensive eye examination findings were reviewed from the records. Data analysis was done with IBM SPSS version 24 and was presented in mean (±SD), frequency and proportions and a chi- square test was applied. P value < 0.05 was considered statistically significant.

Results: Total of 310 glaucoma cases were included in this study. The mean age presentation was 61.89±14.4 years, and the majority of patients (52.9%) were in the age group 60-79 years. Most patients had primary open angle glaucoma (171, 55.2%) followed by primary angle closure glaucoma (92, 29.7%).

Conclusion: Primary open angle glaucoma is the most common form of glaucoma. The proportion of glaucoma increased with increasing age (> 40 years). Provision of screening programs targeting persons with risk factors and opportunistic eye examinations would be beneficial in detection of glaucoma.

Introduction: Mycotic scleral abscess after pars plana vitrectomy (PPV) is a rare entity and a scleral abscess caused by Aspergillus flavus following PPV has not been reported in the literature. We describe the clinical presentation, complication and management outcome in a patient, who developed a mycotic scleral abscess at the infusion port site after 20 gauge pars plana vitrectomy.

Case: Two weeks after pars plana vitrectomy, a patient presented with a scleral abscess at the site of infusion port. He was a known diabetic, had a history of pulmonary tuberculosis and was using steroid eye drop at the time of presentation. Surgical debridement of the abscess was performed and he was treated with topical and systemic antifungal drugs. After three days of incubation, Sabouraud dextrose agar identified growth of Aspergillus flavus. After showing initial resolution, at 4 weeks follow up, the scleral abscess was noted to have progressed to involve the adjacent cornea. Corneoscleral patch graft was performed and treatment with topical and systemic antifungal was continued, which led to complete resolution of the corneoscleral abscess with corneal opacity and scar formation, over a period of eight weeks.

Conclusion: Scleral abscess is a rare complication after pars plana vitrectomy and requires early and appropriate treatment to decrease the ocular morbidity. Dissemination of the infection to involve the cornea can be managed with corneo scleral patch graft and appropriate antifungal medications to salvage the eye.

Introduction: The eye hospitals of low-income countries including Nepal are not equipped with imaging modalities including CT scan, UBM and Pentacam but most of them have ophthalmic ultrasound. We evaluate the utility of routine ultrasound for proper localization and confirmation of the intra-lenticular foreign body along with detection of the status of the posterior capsule using immersion technique.

Case: Four consecutive cases with intra-lenticular foreign bodies presenting to the vitreo-retina department of Lumbini Eye Institute were included in the study. Ultrasound immersion technique was used to detect the ILFB along with x-ray. Planned ILFB removal with phacoemulsification or lens aspiration and foldable IOL implantation as a single-stage procedure was done in all the patients. They were followed up to 3 months after the surgery.

Observations: Intra-lenticular location of IOFB was confirmed by ultrasound immersion technique in all 4 eyes. Intactness of the posterior capsule was also detected preoperatively in all 4 eyes. ILFBs were removed with Utrata's capsulorrhexis forcep in all cases following capsulorrhexis. Phacoemulsification was performed to remove cataract in 2 cases whereas lens aspiration with Simcoe canula was performed in other two cases. Single piece acrylic foldable intraocular lens was implanted in all cases. Posterior capsule was intact in all 4 cases intra-operatively. Features of siderosis were observed in one case. Mild postoperative uveitis was seen in all cases and was controlled with topical steroids. Best corrected visual acuity at the last examination was 6/9 or better in all cases.

Conclusions: Ultrasound immersion technique is very useful tool in management of intra-lenticular foreign body at least in low resource setting. Phacoemulsification /lens aspiration with ILFB removal and IOL implantation provides good visual outcome in these eyes.

Introduction: Hypotrichosis with juvenile macular dystrophy (HJMD) is an autosomal recessive disease with progressive macular degeneration leading to blindness in the first three decades of life along with hypotrichosis.

Case: We herein report a case of a five year old boy with hypotrichosis with juvenile macular dystrophy diagnosed with multi-modal imaging which was later confirmed by genetic testing by whole genome sequencing.

Observations: Fundus examination of both eyes revealed symmetrical hypopigmentation in peripapillary retinal pigment epithelium (RPE) involving posterior pole and surrounded by a mottled hyperpigmented border. Fundus autofluorescence showed central hypo autofluorescence with surrounding hyper autofluorescence corresponding to RPE atrophy and a faint hypo autofluorescence at the junction of normal retina. SD-OCT showed segmental outer retinal and choriocapillaris atrophy temporal to fovea with interdigitation zone and ellipsoid zone loss and RPE irregularities with hyperreflective subretinal deposits at the fovea. Electroretinogram showed normal waves but a slight reduction of b wave amplitude in both eyes. He had sparse scalp-hair.

Conclusion: Children with reduced vision not falling into a typical macular degeneration should be examined systemically and may just have sparse scalp hair and still have a genetic disease. A regular follow-up should be emphasized in view of progressive nature of the disease.

Introduction: Virtual Reality technology helps in creating virtual environments for evaluation of visual performance of low vision individuals with holistic experience. The purpose of this study was to develop a virtual reality (VR) platform for the objective assessment of functional vision in patients with low vision in two categories, central and peripheral vision loss .

Materials and methods: Focus group discussions (FGD) were organized to understand the difficulties faced on a day to day basis by patients with low vision. Based on the results of the focus group discussions, a virtual bank scenario incorporating specific visual tasks was developed. A pilot study was conducted which involved people with normal vision; low vision Patients secondary to central field loss (CFL) and peripheral field loss (PFL). Each subject completed all the tasks in the objective assessment; the data obtained from the assessment were further analyzed to understand the pattern.

Results: Comparing the three groups, there was a significant difference in distance (central field loss was lowest) and near visual angle, and three visual search tasks (peripheral field loss was lowest). In assessing the time taken, peripheral field loss group was again found to take the most time to complete tasks.

Conclusion: Based on a newly developed virtual reality platform, assessment of functional vision of specially abled persons could be tested and was inferior to that of normal sighted persons. in a close to realistic environment. Multiple visual tasks were performed in the virtual environment and the visual performance was compared among all three groups of participants. Participants were matched for age and gender. Irrespective of the nature of tasks, visual performance of the normal group seemed significantly better than people with CFL and PFL.

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.