Nepalese Journal of Ophthalmology最新文献

Introduction: Iridofundal colobomas, being developmental defects, are known to be accompanied by several ocular anomalies but an association with vitreous hemorrhage and an intraocular mass has not been reported earlier.

Case: We report a case of an 18 years old subject having iridofundal coloboma in both eyes and an association of vitreous hemorrhage and an intraocular mass in the left eye. The diagnosis was confirmed with a detailed ocular examination, fundus fluorescein angiography, swept-source optical coherence tomography and ultrasonography. The laser barrage of coloboma caused a regression in the size of the intraocular mass and prevented recurrence of vitreous hemorrhage over one and half years of follow-up.

Conclusion: The source of vitreous hemorrhage in this subject is unclear though some anomalous vessels in relation to the supero-nasal mass, optic disc and coloboma of the left eye might have caused it. The laser barrage of coloboma obscured these anomalous vessels resulting in the regression of the intraocular mass.

Introduction: Hypertensive retinopathy is a common complication in patients with hypertension. This study aims to assess the prevalence, associated factors and awareness of hypertensive retinopathy among an elderly population with hypertension in Bhaktapur, Nepal.

Materials and methods: This is a population-based, cross-sectional study conducted from 2013 to 2015 in Bhaktapur district, Nepal. The sample size was 2100 subjects aged 60 years and above. From this sample, all diagnosed patients with hypertension were analyzed. A detailed history was obtained, and an ocular examination was performed.

Results: Information was complete for 1860 (88.57%) subjects. The age of the study population ranged from 60 to 95 years with the mean age of 69.64±7.31 years. Hypertension was found in 643 subjects (34.61%), of which 224 (12.04%) were newly diagnosed cases. Among the subjects with hypertension, hypertensive retinopathy was found in 81 cases (12.6%). Hypertensive retinopathy was more frequent in the age group 70-79 years (15.23%), males (13.25%), illiterates (13.56%), diabetics (16.49%), and body mass index (BMI) ≥25 kg/m2 (14%). None of the factors was found to be statistically significant. Among the study participants, awareness regarding the effect of hypertension on eye, retina and vision was found to be 13.84%, 8.4%, and 11.98% respectively.

Conclusion: Prevalence of hypertension and hypertensive retinopathy among an elderly population of 60 years and above in Bhaktapur district, Nepal were similar to other countries. Hypertensive retinopathy was higher among males, illiterates, diabetes and BMI> 25kg/m2. Awareness of hypertensive retinopathy was 8.4% among hypertensive subjects. Emphasis should be directed toward improving awareness campaigns.

Introduction: Cortical visual impairment (CVI) in children is a retro chiasmal visual tract disorder where there is with an impairment in the visual acuity and/or functionality of vision-guided task, including motor planning in the presence of normal ocular findings or minimal ocular morbidity. The study was conducted to assess the knowledge about CVI among ophthalmologists practicing in Nepal.

Materials and methods: This was a cross sectional study. Data collection was done by administering a preformed, validated questionnaire that was sent via email to all the ophthalmologists registered under the Nepal Ophthalmic Society. The email mentioned the aim of the study along with the questionnaire.

Results: A total of 146 (37.82%) ophthalmologists responded to the questionnaire. Forty four percent of the participants were general ophthalmologists, 28% were pediatric ophthalmologists and 67% were ophthalmologists from other subspecialty. The median age of participants was 37.6 years. Most of the ophthalmologist had a good knowledge about the cause, common risk factors, clinical risk factors, management and prognosis of CVI. However only 29.5% of participants were aware of the investigation of choice for diagnosing CVI and 31.7% were aware of the leading causes of visual impairment in the developed countries. The study also established that the knowledge score was higher in pediatric ophthalmologists than the general ophthalmologist and ophthalmologists from other specialties.

Conclusion: Most of the ophthalmologists had a good knowledge about the cause, common risk factors, clinical features, management and prognosis of CVI. However only a limited number of participants were aware of the investigation of choice for diagnosing CVI and the leading causes of visual impairment in the developed countries. Majority of the participants rarely examined patients with CVI which does not correlate with the high prevalence of perinatal hypoxia, the commonest cause of CVI, in our country.

Introduction: Chorioretinitis sclopetaria (CS) is a rare consequence of ocular injury. Its association with open globe injury (OGI) and retinal detachment (RD) is controversial. This study evaluates patterns of chorioretinitis sclopetaria and its association with open globe injury and retinal detachment.

Case: This is an electronic review of records of a tertiary eye care institute of south India with descriptive analysis of six cases. Cases where fundus findings of chorioretinitis sclopetaria were available were included. Information regarding mode of injury, visual outcomes, follow up and causes of poor visual outcomes were obtained. Presence of open globe injury, retinal detachment, vitreous hemorrhage (VH) and orbital foreign body (FB) was also noted. Ultrasound scans of the eyeball were reviewed for presence of signs of chorioretinitis sclopetaria.

Observations: All the injured patients were male (age range 23-52 years). Bullet and blast injuries were the modes of injury. The duration since injury to the last follow up ranged from 0.25 to 12 years. The final visual acuity was <20/200 in 3/6 cases. Open globe injury and retinal detachment was noted in one case each, while 3/5 cases had orbital foreign body. Extensive facial and neuro-surgery were required in 2/6 cases. Sonography showed signs of chorioretinitis sclopetaria in 2/3 cases where scans were available for review.

Conclusions: Though manifestations of chorioretinitis sclopetaria evolve with time with visual improvement, final visual acuity is generally poor. Cases of chorioretinitis sclopetaria may have accompanying retinal detachment or open globe injury. Sonography should be evaluated with a high degree of suspicion for chorioretinitis sclopetaria in typical cases.

Introduction: Retinitis Pigmentosa (RP) is a group of diffuse retinal degenerative diseases predominantly affecting the rod and cone photoreceptors. The prevalence of retinitis pigmentosa seen in literature is approximately 1:4000. Retinitis Pigmentosa is one of the the most common causes of blindness in the age group of 20 to 40 years. The objective of this study was to determine the profile of retinitis pigmentosa in Terai and Nepal-India border region considering patients seeking care at a Tertiary level Eye Hospital in the terai region (southern part) of Nepal.

Materials and methods: A hospital-based, retrospective study was carried out at R. M. Kedia Eye Hospital. A total of 385 (83 males and 107 females from Nepal and 109 males and 86 females from India) diagnosed patients of Retinitis Pigmentosa were included in the study. Data was collected over a period of eleven years from 2008-2018.

Results: Out of 385 diagnosed Retinitis Pigmentosa patients, 192 (49.87%) were male and 193 (50.13%) were female with slightly female predominance. The prevalence of RP seen in our study was 0.03%. About 51% of the patients visited here were from India and nearby border areas/ villages which cover most of the rural areas of India. In this study it was found that 49.34% of the RP cases were from Nepal, of which 43.63% of cases were from Hindu community and 5.71% from Muslim community and about 50.66% cases of RP were from India, of which 37.67% from Hindu and 12.98% from Muslim community. The peak age of presentation of RP was at 30-39 years (29.09%), followed by 20-29 years (26.75%). The common marriage pattern of consanguinity was found in Muslim community in between the first cousins. In this study the hospital record did not show any evaluation for the syndromic disease in the hospital record, though RP is usually non syndromic and there are literatures where many syndromic forms have been identified.

Conclusion: The prevalence of RP seen in the study was 0.03% (A total of 1101299 sample population of which 385 patients had RP). Since RP is an inherited disease and is one of the non-treatable causes of blindness which runs in the families, a role of counseling to reduce consanguineous marriages should be brought forward to reduce the disease process.

Introduction: Corneal foreign bodies are one of the commonest forms of ocular trauma, the majority of which occur due to occupational exposure. The aim of this study was to study the profile of patients with corneal foreign bodies.

Materials and methods: A hospital based prospective study was conducted among 60 patients presenting to the ophthalmology outpatient department in Dhulikhel Hospital-Kathmandu University Hospital (DH-KUH) over a time span of 6 months. Demographic data of patients, clinical characteristics of foreign bodies and associated complications were noted.

Results: Most of the patients were males (n=55) belonging to the 21-30 age group (n=24). Majority of them were workers in metal industries (n=26). Welding and cutting metal were implicated as the most common mode of injury (n=53).

Conclusion: By virtue of this study, we identified the high risks associated with sustaining this form of ocular trauma. The incidence and hence the prevalence of corneal foreign body can be gradually levelled down if we aware the people about the associated complications and advise them to use protective eye wears (PEW).

Introduction: As the number of people with diabetes mellitus is increasing because of urbanization and change in dietary habits and sedentary lifestyle, the number of diabetic retinopathy is also expected to increase in future. [1] [sa2] We aimed to find out the prevalence of diabetic retinopathy and associated risk factors among diabetic patients in the tertiary eye hospital.

Materials and methods: This is the observational cross-sectional study enrolling 420 diabetic patients visiting the multispecialty tertiary eye hospital between March 2020 and February 2021. Anthropometry measurement, laboratory risk profiles and blood pressure were recorded Results: The prevalence of any diabetic retinopathy, proliferative diabetic retinopathy, and diabetic macular edema were 30.96 %, 6.19 %, and 5.95 % respectively. The duration of DM (p=0.001), hypertension (p=0.04), high SBP (p=0.023), abdominal obesity (p=0.015), high LDL(p=0.011) cholesterol, low HDL cholesterol(p=0.012), and creatinine (p=0.001) were associated with DR in our study.

Conclusion: A holistic approach should target to control the modifiable risk factors like blood sugar, blood pressure, lipid profile, kidney function, and obesity to prevent DR. Anthropometric assessment of waist to height and waist circumference should be included in the holistic health promotion strategy in Nepal as BMI may not be risk factors for DR in Nepalese people.

Introduction: The aim of reconstruction of a contracted socket is to retain a satisfactory prosthesis. Simple procedures to modify the socket architecture as first line options could avoid multiple staged procedures, increased surgical time, harvesting tissues or use of allografts. The objective of this study was to evaluate the outcome of modifying the socket architecture by making conjunctival relaxing incisions leaving it bare to re-epithelialize and compare it to dermis-fat graft.

Materials and methods: A retrospective review of all socket reconstruction surgeries in our hospital over a period of 10 years (July 2009 to June 2019) was done. The two procedures which were compared were dermis-fat graft (DFG) and conjunctival relaxing incisions (CRI) without a graft. In the latter, the split conjunctiva was left bare under a conformer and temporary tarsorrhaphy. The conjunctiva was allowed to re-epithelialize under cover of topical antibiotic and steroid.

Results: The patients included had a mean age of 24 years (n=8) in the DFG group and 36 years (n=10) in the CRI group. The most common cause of anophthalmic socket was enucleation for tumour and evisceration for trauma in the two groups, respectively. Six patients (75%) in the DFG group and six (60%) in the CRI group achieved good prosthesis retention (P = 0.51). None had post-operative infection.

Conclusion: Transverse conjunctival relaxing incisions with tissue stretching can be a safe first line option to rehabilitate a contracted socket.

Introduction: Macular corneal dystrophy (MCD) is a rare autosomal recessive stromal dystrophy. The prevalence of inherited diseases varies in different communities. It is not commonly observed in Nepal.

Case: A 14-year male presented with bilateral gradual and painless blurred vision with photophobia of three years duration. Cornea of both eyes showed focal grayish opacities in anterior and mid stroma with intervening stromal haze. There was no history of consanguinity in the family. Anterior segment ocular coherence tomography showed thinning of cornea and deposits in corneal stroma. Macular corneal dystrophy was the clinical diagnosis and the patient underwent deep anterior lamellar keratoplasty in the right eye. Histopathological examination and histochemical staining with Alcian Blue supported the diagnosis.

Conclusion: Significant improvement in vision was observed in the operated eye. MCD may be present in communities without evidence of consanguinity. It can cause visual impairment at an early age. Timely intervention improves vision and quality of life.

Introduction: Recently, the Indian subcontinent has been hard hit by the second wave of COVID-19. Along with it, the region has become a hot spot for mucormycosis infection in patients with COVID-19. The aim of this paper is to provide a scientific overview on the status of mucormycosis in pre-COVID-19 era and on how COVID-19 could have directly or indirectly expose the hidden burden of mucormycosis globally.

Materials and methods: This paper is structured as a narrative review and is based on relevant published literature on both COVID-19 and mucormycosis.

Conclusion: Mucormycosis in the pre-COVID-19 era was almost a neglected entity. It was because the risk factors for both - More severe COVID-19 infections and Mucormycosis are almost similar - COVID-19 might have helped to expose the true magnitude of the mucormycosis and flagging it as a major public health concern requiring a revisit by medical science.