Nepalese Journal of Ophthalmology最新文献

Introduction: This study aimed to describe the occurrence of bilateral neuroretinitis and retinal vasculitis in an immunocompetent female with disseminated tuberculosis.

Case description: A 25 year old female diagnosed with disseminated tuberculosis presented with sudden painful loss of vision bilaterally. On examination she was found to have bilateral neuroretinitis and retinal periphlebitis involving the posterior pole. She was prescribed systemic steroids in addition to the anti-tuberculous therapy that she was receiving. The fundus lesions gradually resolved over four months with modest improvement in visual acuity. There were no recurrences in the follow up period of 14 months.

Conclusions: Ocular involvement in the form of neuroretinitis with concomitant retinal vasculitis can occur in patients with disseminated tuberculosis. Addition of systemic steroids to anti-tuberculous therapy leads to anatomical resolution with improvement in visual acuity.

Introduction: Laser-assisted in situ Keratomileusis (LASIK) is the most commonly performed refractive surgical procedure. The amount of tissue ablated in LASIK affects the safety and long-term outcome. The objective of this study was to compare the percent tissue altered (PTA) in topography guided (TG) and wavefront optimized (WFO) LASIK using Zeiss MEL 80 excimer laser.

Materials and methods: This retrospective observational study was conducted at a tertiary eye center. Patients with moderate myopia who underwent LASIK between June 2016 and January 2019 were divided into two groups (Group I: TG LASIK, 69 eyes; Group II: WFO LASIK, 70 eyes). The groups were compared for preoperative parameters [spherical equivalent (SE), keratometry and pachymetry], intraoperative parameters [ablation depth (AD), PTA and residual stromal bed thickness (RSBT)] and postoperative parameters (vision, SE).

Results: Among preoperative parameters, SE and keratometry were similar while thinnest pachymetry was significantly less in group I. Among the intraoperative parameters, PTA (P < 0.01) and AD (P < 0.01) were significantly less in group I while RSBT (P = 0.54) was not significantly different. Postoperatively at 6 months, 92.75% (64) eyes in group I and 90% (63) eyes in group II had visual acuity of 6/6 or better (P = 0.57). 98.55% (68) and 97.14% (68) eyes in group I and group II respectively had SE refraction within ± 0.5 dioptres.

Conclusion: TG LASIK induces less tissue alteration for given refractive error with similar visual outcome as compared to WFO LASIK which makes TG apparently safer and is the preferred technique for borderline thin corneas.

Introduction: We describe the microbiological profile of postoperative endophthalmitis from northern India and analyse the pattern of antibiotic sensitivity which may have changed due to development of resistance secondary to overuse of antimicrobial drugs.

Materials and methods: This is a retrospective study of postoperative endophthalmitis from January 2011 to December 2017 in a tertiary eye hospital of northern India. Any patient developing endophthalmitis within one year of any intraocular procedure was included in the study. According to severity, treatment with a trial of intravitreal antibiotic injections or core vitrectomy was decided. Ocular samples were collected which were either anterior chamber tap or vitreous biopsy and sent for microbiological examination. The samples were stained with Gram's and KOH stain and cultured on chocolate agar, blood agar, brain heart infusion broth and Sabouraud dextrose agar.

Results: A total of 545 patients of postoperative endophthalmitis were analysed which showed a male predilection (60.5%) with maximum patients between the age group 50-69 years. 292 patients (53.5%) were culture negative and 253 patients (46.4%) were culture positive. Most common organism identified was Staphylococcus in 73 patients followed by Pseudomonas in 48 patients. Staphylococcus species was most sensitive to vancomycin (97%) followed by amikacin (91%) followed by gentamicin and moxifloxacin (88% each). Pseudomonas was the second most common isolate which showed maximum sensitivity to imipenem (82%) followed by ciprofloxacin(60%). Polymicrobial infection was noted in 23 patients. The most common fungal isolate was aspergillus in 11 patients, followed by fusarium in 10 patients.

Conclusion: Our study shows that gram positive bacteria are the most common organisms in postoperative endophthalmitis and are most sensitive to vancomycin, followed by gram negative bacteria which show increased sensitivity with imipenem than commonly used antibiotic - ceftazidime.

Introduction: Primary acquired nasolacrimal duct obstruction is a common ophthalmic condition and has conventionally been managed by external dacryocystorhinostomy. However this procedure is time consuming and involves making mucosal flaps. The aim of this study was to compare the surgical outcome in Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C versus conventional external dacryocystorhinostomy.

Materials and methods: This is a retrospective non-randomized study of surgical outcome in patients of primary acquired nasolacrimal duct obstruction who underwent an Arrugas bone trephine assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C (group A) versus those who underwent conventional external dacryocystorhinostomy (group B) in a teaching hospital in North India. Patients with previously failed dacryocystorhinostomy, lacrimal fistula, canalicular and common canalicular obstruction were excluded. Success was defined as patent syringing at the end of one year. Surgical time was calculated from skin incision to skin suturing.

Results: There was complete resolution of epiphora with patent syringing in 43 out of 52 patients in group A, while in group B, 47 out of 55 patients had complete resolution of epiphora with patent syringing at the end of one year (p= 0.77). Mean surgical time was significantly lower in Group A than in Group B (p=<.05). Scarring and closure of the ostium was the most common cause of failure in both groups (Group A, n=5, 9.6%; Group B, n= 3, 5.45%).

Conclusion: Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C is a viable alternative to conventional external dacryocystorhinostomy with comparable success rate and shorter surgical time and a faster learning curve.

Introduction: Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature.

Case: Our case describes the occurrence of an upper eyelid mass in a 62-year-old female which was found to have an associated demodex infestation.

Conclusion: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.

Introduction: The main purpose of this survey was to find out what technique for bevacizumab injection is practiced by ophthalmologists in Nepal and to evaluate which is the best technique of drug dispensing and what possible hindrances are there in following it.

Materials and methods: This was an online survey using google forms.

Results: There were a total of 34 participants in the survey. Most of the participants (58.8%) followed the same vial, multiple prick, multiple days method for giving intravitreal bevacizumab.. Majority of participants said they thought that aliquoting the drug and using it same day would be the best technique to prevent post injection endophthalmitis. Cost and unsuitability for small hospitals were the main factor preventing surgeons from practicing the best method.

Conclusion: Risk of endophthalmitis can be reduced by following proper drug dispensing techniques. Aliquoting bevacizumab in smaller syringes under aseptic conditions can reduce the risk of endophthalmitis.

Introduction: Glaucoma is one of the major causes of irreversible blindness. In Nepal, the most common type of Glaucoma seen is Primary Open Angle Glaucoma. There are many risk factors associated with Primary Open Angle Glaucoma. The main objective of the study was to compare ocular biometric parameters in patients diagnosed with Primary Open Angle Glaucoma and age matched controls.

Material and methods: This is a hospital based cross sectional study done at Mechi Eye Hospital. The study included 137 cases of Primary Open Angle Glaucoma and 75 normal individuals as control. Axial length (AL), anterior chamber depth (ACD), Keratometry 'K' value and Central Corneal Thickness (CCT) were measured. Mann - Whitney U test was used for statistical analysis.

Results: Mean age in Primary Open Angle Glaucoma group was (55.25 ± 10.16 years) and in the control group was (60.96 ± 10.91 years). Axial length in the Primary Open Angle Glaucoma group (23.16 ±1.19 mm) was deeper as compared to the control group (22.69 ±0.89 mm), the difference was statistically significant (p<0.001). Anterior chamber depth (ACD) was statistically deeper in the Primary Open Angle Glaucoma group (3.05 ±0.51 mm) as compared to the control group (2.86 ±0.46 mm), (p<0.01). Central corneal thickness (CCT) was thinner in the Primary Open Angle Glaucoma group (519.5 ±36.25 um) as compared to the control group (525.40 ±37.77 um) but the difference was not found to be statistically significant (p<0.19). K value in Primary Open Angle Glaucoma (7.54 ±0.41mm) was higher than age-matched controls (7.58 ± 0.33mm) but the difference was not statistically significant (p<0.79).

Conclusion: Patients with Primary Open Angle Glaucoma had longer Axial length (AL) and deeper Anterior chamber depth (ACD) as compared to normal individuals.

Introduction: Systemic blood pressure, by far, is one of the most important factors that can have an effect on intraocular pressure. We have compared the intraocular pressure (IOP) among patients with systemic hypertension and those with normal blood pressure.

Materials and methods: A hospital based case control study was conducted from March 2017 to March 2018 in the Ophthalmology outpatient department at Dhulikhel Hospital. A total of 100 patients with hypertension were included in the case group (hypertensive group) and 100 cases with no systemic or ocular disease were included in the control group (normotensive group). Mean intraocular pressures were calculated and compared between the two groups.

Results: Mean age of patients was 49.03 years in hypertensive group and 47.53 years in normotensive group. Mean IOP of the right eye in those with hypertension was 16.10 mmHg and in the left eye was 15.8 mmHg. Similarly mean IOP of the right eye in the normotensive group was 15.8 mmHg and the left eye was 16.2 mmHg. The difference between mean IOP of hypertensive and normotensive individuals was not statistically significant (p > 0.05). The prevalence of ocular hypertension was found to be 7.5%.

Conclusion: There was no statistically significant difference in IOP between hypertensive and normotensive individuals. However, a statistically significant difference in IOP was noted between 'hypertensive with controlled blood pressure' and 'hypertensive with uncontrolled BP' indicating that high blood pressure may be associated with high IOP.