Demographics and Awareness of Diabetic Retinopathy among Diabetic Patients Attending Department of Ophthalmology at Dhulikhel Hospital.

Background Diabetes mellitus is considered as a major public health concern globally. Poor management of diabetes may lead to several serious complications including endstage renal disease, diabetic retinopathy, diabetic neuropathy, and cardiovascular complications. Among them diabetic retinopathy is one of the leading causes of visual impairment and blindness in Nepal. Objective To assess the demographics and level of awareness among individuals with diabetes about diabetic retinopathy during their visit to Department of Ophthalmology at Dhulikhel Hospital. Method A descriptive cross-sectional study was conducted involving all consecutive cases of diabetes mellitus who attended eye clinic with the principal investigator and co-investigator from March 2021 to August 2021. Detailed demographics of the participants, their level of awareness regarding diabetic retinopathy and associated complications were documented. This was followed by a detailed ocular examination intending to screen for the presence of features of diabetic retinopathy. Result A total of 260 patients with a mean age of 54 years ± 12.20 (range of 24 - 85 years) were included. The male to female ratio was 2.2:1. Among them, 65.4% of the patients had diabetes mellitus for less than 5 years duration. Diabetic retinopathy was found in 18.46% of the cases. Awareness of diabetic ocular complications was significantly higher among literate population (p = 0.054), among those who have positive family history of diabetes mellitus (p = 0.529) and those who had undergone prior fundus evaluation (p = 0.000). Conclusion From result of this study, we can emphasize that there is a necessity for health education in order to increase the awareness and knowledge about diabetic retinopathy to lower the burden of sight threatening complications related with the issue.

Clinical Characteristics of Cataract Patients and Outcome of Cataract Surgery in Tertiary Care Hospital in Central Nepal.

Background Cataract remains the leading cause of avoidable blindness in low-income countries such as Nepal. Despite the availability of surgical interventions for cataract in leading institutions, still a large number of patients from remote areas delay or have difficulty in getting treatment, present late or with complications. Objective To determine the clinical characteristics and visual outcome of patients undergoing cataract surgery in Tertiary Care Hospital in Central Nepal. Method We retrospectively reviewed the medical records of 138 patients who underwent cataract surgery at a tertiary care hospital from January 2018 to September 2022. R version 4.0.3 was used for the data analysis. Categorical variables are presented as frequency (percentages) and the numerical ones are presented as mean (standard deviation). Result During follow-up visits between one to three weeks, 91.9% out of 135 patients had normal/near normal presenting visual acuity and with best correction it was 96.9% out of 131 patients. About 1.6% out of 124 operated eyes still had moderate visual impairment after best correction when they visited for follow-up at 12 weeks. Conclusion The study findings underline the ongoing gap in increasing access to cataract treatment, given the large proportion of individuals who still presented extremely late.

Retinal Haemorrhage in Newborns in Tertiary Care Hospital.

Background Retinal haemorrhage in new-born is a clinically common neonatal fundus condition. Although, it usually does not affect the development of visual function, entities like macular haemorrhages may lead to amblyopia causing deterioration of visual function. Such scenario leads to downgrade in quality of life of the affected child. Objective To explore the underlying clinical factors associated with retinal haemorrhage in term new-borns. Method A cross sectional study was conducted involving 136 term neonates admitted in the neonatal intensive care unit of Dhulikhel Hospital. Fundus examination was performed within 2 weeks of delivery. Retinal haemorrhage was graded according to their location in three retinal zones. Result Out of 136 cases examined, 44 (32.35%) of the cases had one of the eyes with retinal haemorrhage. Where grade 1 retinal haemorrhage was accounted in majority of the cases. Birth weight, gestational age, mode of delivery, poor Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) Score in 1 and 5 minutes, birth asphyxia, neonatal sepsis and heavy work in antenatal period had statistically significant correlation with occurrence of retinal haemorrhage. Conclusion Our results suggest that spontaneous vaginal delivery, larger birth weight, higher gestational age, birth asphyxia, low Appearance, Pulse, Grimace, Activity, and Respiration score, are risk factors for occurrence of neonatal retinal haemorrhage. It is recommended that in neonates with above high-risk factors should undergo targeted fundus screening for early identification and needful interventions.

Pattern of Corneal Diseases in Paediatric Age Group at a Tertiary Eye Care Center in Nepal.

OBJECTIVE: It is to study the pattern of corneal diseases (including injuries) in paediatric population in a tertiary eye care center. MATERIALS AND METHODS: A descriptive, cross sectional study was carried out in a tertiary eye care center which included 176 cases. RESULTS: Out of 176 cases studied, 6 cases (3.4%) presented with congenital causes, 4 cases (2.27%) were of dystrophy and ectasia, 63 cases (35.79%) had infective origin, 17 cases (9.65%) had inflammatory cause, 9 cases (5.11%) had systemic association and 77 cases (43.75%) had traumatic causes. CONCLUSION: Trauma was noted to be the most important cause for corneal diseases in paediatric population followed by infective conditions. Viral keratitis was found to be the most common type of corneal infection in the paediatric age group.

Ocular injuries in the people's uprising of April 2006 in Kathmandu, Nepal.

INTRODUCTION: In April 2006, the people of Nepal organised mass demonstrations demanding the restoration of democracy in the country. The ocular injuries that resulted during the riots that ensued, their pattern and the visual outcome of the injured have not yet been reported. OBJECTIVE: To study the demographic profile, type, severity and the visual outcome of ocular injuries that occurred during the 2006 people's uprising in Nepal. SUBJECTS AND METHODS: This was a retrospective interventional series of cases involving 29 subjects. The main outcome measures were demography, laterality of injury, type of injury and the visual status before and after the trauma. RESULTS: The age of the victims ranged from 14 to 32 years. Among the victims with eye injuries, 27 (93.1 %) were males, who were unemployed youth, students and construction workers. The left eye was injured more frequently than the right. Non-lethal bullets and explosive tear gas were the commonest agents of the major ocular injuries. The main types of injuries requiring hospitalization were closed globe injuries in eight victims and open globe in six. Surgical intervention was required in 57.2 % (n = 29) of the cases. The visual outcome was poor in cases of open globe injury with posterior segment involvement. CONCLUSION: Non-lethal bullets and explosive tear gases can cause significant visual impairment. Severe open globe injury with a retained intra-ocular foreign body is associated with significant visual loss.

Changing trends in idiopathic retinal vasculitis in a tertiary eye care centre of Nepal over a ten-year period.

OBJECTIVES: To study the demographic profile, clinical presentations, management and visual outcome of retinal vasculitis in a tertiary eye care center of Nepal MATERIALS AND METHODS: A retrospective, record based study of retinal vasculitis cases in the retina clinic of a tertiary care centre in Nepal from January 2009 to January 2011 was carried out. Results of the study were compared to those from the study conducted in a similar set- up between 1998 and 2000. RESULTS: Sixty-nine eyes of 51 affected patients were evaluated in the study. The male/female ratio was 2.64:1 vs 19:1 a decade ago (p=0.0027). The mean age of the patients was 33.53 ± 12.29 years in the present study. Bilateral ocular involvement was present in 18 cases (35.3%) vs 56.14% in the past decade (p=0044).The common symptoms were dimness of vision (29.4%), floaters (25.5 %) and flashes of light (3.92%). Seventy-one eyes (69.6%) had the best corrected visual acuity of 6/18 or better. Four eyes (3.92 %) had no light perception. Vascular sheathing was the most common finding (32.35%), followed by vitritis (30.39%). Corticosteroids were primarily used to manage retinal vasculitis (39.21%). No association of retinal vasculitis with tuberculosis was found. CONCLUSION: The demographic pattern and clinical presentation of idiopathic retinal vasculitis has changed over a decade period in Nepal.

Malignant transformation of kissing nevus- a rare entity.

BACKGROUND: Kissing nevus is a congenital nevus in adjacent parts of the eyelids. Malignant transformation of kissing or divided nevi of the eyelids is rarely described. OBJECTIVE: To report a very rare case of malignant transformation of kissing nevus with ocular and extraocular spread. CASE: A 57- year- old man with 6/6 visual acuity in both eyes presented with a kissing nevus present since birth in right upper and lower eyelids which had a slow growth phase. The upper lid in the area of the nevus was thickened with a 20x12x15 mm black pigmented crusted hemorrhagic nodular lesions. The lower lid had a 6 mm black pigmented ulcerated lesion over the pre-existing nevus in the lateral third of the lid with full thickness infiltration. Another 5x4 mm pigmented lesion over the lower medial lid margin with a thickness of about 3 mm extended to the conjunctival side of the lower lid. Right sided pre-auricular and sub-maxillary nodes were palpable. A biopsy of tissue samples from the eyelid and pre-auricular nodes were consistent with malignant melanoma. CONCLUSION: Malignant transformation of kissing nevus is rare. It can spread to the conjunctiva,pre-auricular and sub-mandibular lymphnodes.

Nd: Yag laser treatment for sub-hyaloid hemorrhage in childhood acute leukemia.

INTRODUCTION: Sub-hyaloid haemorrhage is common in acute leukemia. OBJECTIVE: To investigate the effects of Nd: YAG Laser hyaloidotomy in 11 eyes of 8 patients with pre-macular haemorrhage in acute childhood leukemia. MATERIALS AND METHODS: Premacular sub-hyaloid haemorrhage is one of the leading causes of visual disability in children with acute leukemia. Eleven eyes of 8 patients attending Kanti Children Hospital and BP Koirala Lions Centre for Ophthalmic Studies from January 2006 to July 2007 with premacular subhyaloid haemorrhage were included in the study and treated with Nd: YAG Laser. The haemorrhage originated from acute myeloid leukemia (AML) in 4 cases (6 eyes) and acute lymphoblastic leukemia (ALL) in 4 cases (5 eyes). RESULTS: Drainage of premacular sub-hyaloid haemorrhage into the vitreous cavity within 3 months succeeded in 9 eyes out of 11 eyes treated. One eye had a dense clotted haemorrhage and the other had a re-bleed. Overall visual improvement was equal in both AML and ALL cases. No obvious epiretinal membrane, retinal breaks and tractional retinal detachment occurred in any eye. CONCLUSION: Nd: Yag laser hyaloidotomy is a relatively safe, simple and alternative treatment for eyes with a dense premacular sub-hyaloid haemorrhage in acute childhood leukemia. The risks and benefits have to be weighed in randomized clinical trials to establish Nd: YAG hyaloidotomy treatment as a routine procedure in leukemic children.

The conjunctival impression cytology between the diagnosed cases of dry eye and normal individuals.

BACKGROUND: The dry eye or tear film dysfunction is a common ophthalmic syndrome. OBJECTIVE: To compare the results of conjunctival impression cytology between dry eye patients and normal individuals. SUBJECTS AND METHODS: A case control study including consecutive cases of dry eye syndrome was carried out. Individuals without dry eye were taken as control. Impression of conjunctiva with cellulose acetate filter paper was taken from inferonasal bulbar conjunctiva and was stained with Periodic Acid- Schiff (PAS) and counter-stained with haematoxylin and eosin. MAIN OUTCOME MEASURE: goblet cell density. RESULTS: There was a female preponderance in dry eye disease. Of 114 dry eye cases, 49.2% eyes showed decreased or absent goblet cell density. In 72 normal individuals 73.7% eyes showed normal goblet cell density and 26.3% of eyes showed decreased or absent goblet cells (p less than 0.001). The tear break-up time (TBUT) test was significantly more likely to be less than 10 seconds in cases as compared to the controls ( OR = 19.36, 95% CI = 7.56 - 52.52). Similarly, the goblet cell density was likely to be significantly reduced in cases with dry eye syndrome (OR= 2.25, 95% CI = 1.26 - 4.02, p = 0.003). CONCLUSION: Goblet cell density significantly reduces in dry eye syndrome. The impression cytology is a useful test for the diagnosis of dry eye syndrome.

Etiology of vitreous hemorrhage in a tertiary eye care center in Nepal.

INTRODUCTION: Vitreous hemorrhage is one of the most common differential diagnoses of sudden painless decrease in vision. OBJECTIVE: To find out the etiology of vitreous hemorrhage in cases of vitreous hemorrhage at a tertiary eye centre in Nepal. MATERIALS AND METHODS: This was a hospital-based cross-sectional study done over a period of one-and-a-half years. One hundred and one subjects with vitreous hemorrhage were evaluated in detail to establish the etiology. STATISTICS: The mean value and standard deviation were calculated. The data were analyzed using microsoft excel and SPSS 11.5 program. RESULTS: A total of 122 eyes of 101 patients were evaluated. The mean age was 41.90 (± 21.50) years with a range of 2 months to 84 years. Male were 73 %. Bilateral involvement was found in 20.8 %. Proliferative diabetic retinopathy, retinal vasculitis, branch retinal vein occlusion, rhegmatogenous retinal detachment together with ocular trauma constituted the etilogoy of vitreous hemorrhage in more than 75 % of patients. CONCLUSION: Proliferative diabetic retinopathy, retinal vasculitis and branch retinal vein occlusion are the most common causes of vitreous hemorrhage in adults whereas in children trauma is the commonest cause.

Anatomical and functional outcomes of surgery of rhegmatogenous retinal detachment.

INTRODUCTION: Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition. OBJECTIVE: To evaluate the anatomical and functional outcome of surgery of RRD. MATERIALS AND METHODS: A prospective study of interventional case series was designed including 50 consecutive patients with RRD in a tertiary level eye center in Kathmandu. The patients underwent scleral buckling (SB) or pars plana vitrectomy (PPV) according to the proliferative vitreo-retinopathy (PVR) changes. All the patients had at least 3 months of follow-up. The anatomical and physiological outcome measures were primary retinal reattachment and improvement in visual acuity respectively. The surgery was considered successful when there was attachment of retina after the first surgery. RESULTS: The mean age of these patients at the time of presentation was 46.24 ± 19.82 years. Of 50, sixty-six percent of the patients underwent SB and 34 % underwent PPV. Primary surgical success rate was 88 %. While comparing the initial best corrected visual acuity (BCVA) with the final, 72% had an improvement, 12 % unchanged and 16 % had a deteriorated visual acuity. CONCLUSION: The visual acuity improves and the anatomical success rate is high in the majority of the patients after surgery for rhegmatogenous retinal detachment.

The factors associated with age related macular degeneration and quality of life of the patients in a tertiary-level ophthalmic center in Kathmandu.

INTRODUCTION: age-related macular degeneration (ARMD) is a leading cause of blindness in the elderly population. OBJECTIVE: to frame a profile of patients withARMD and find out the factors associated with it MATERIALS AND METHODS: a cross-sectional study was carried out including a total of 75 patients with ARMD presenting to the out-patient department of a tertiary level ophthalmic center in Kathmandu. The data pertaining to their demography, ocular and systemic history and the findings of clinical examination and laboratory investigations were analyzed. The quality of life was assessed based on their dependability on the others for daily activity. RESULTS: mean age of presentation of ARMD was 73 years +/- 7.93. Of the total, 44 were male and 31 female. Smoking was significantly associated with ARMD (p<0.01). 47 of the subjects had a sedentary lifestyle and 28 a non-sedentary lifestyle. Sedentary life style was significantly associated with ARMD (p=0.028). 48 subjects were hypertensive. Systemic hypertension was significantly associated with ARMD (p = 0.015). 45 had dry ARMD, 21 had wet ARMD and 9 ofthemhad a mixed variety. Thirteen out of the 75 study subjects were leading a normal life while 45 of them had some limitation (self-care only) and 17 of them were dependent on the others for their daily activity. The quality of life was not significantly different between dry and wet ARMD (p = 0.40). CONCLUSION: sedentary life style, smoking and hypertension are the modifiable factors that are associated with ARMD. A significant number of people with the ARMD have a compromised quality of life.

Association between diabetic retinopathy and serum lipoproteins level.

INTRODUCTION: diabetic retinopathy is the leading cause of blindness of working-age patients in the urban areas. OBJECTIVE: to find out the association between diabetic retinopathy and serum lipoproteins in patients with diabetes mellitus MATERIALS AND METHODS: a community-based cross-sectional study involving 100 subjects with type II diabetes living in the cities of Kathmandu, Bhaktapur and Lalitpur of Nepal was carried out using a purposive sampling method. The retinopathy was classified according to the modified Airlie House classification of diabetic retinopathy. The patients with systolic hypertension were excluded. The blood sugar level was assessed by using glycosylated hemoglobin. The fasting serum lipoproteins were assessed by photometric enzymatic methods. STATISTICS: the SPSS version 10.0 software was used. The p value of <0.05 was considered significant. RESULTS: the majority (n=91) of the patients were in the age group 31-60 years with the mean of 48.2 +/- 9.5. The mean duration of diabetes mellitus in the patients with no-diabetic-retinopathy was 4 +/- 3.4 years and that in those with the retinopathy was 6.4 +/- 4years, (p =0.006). The mean glycosylated hemoglobin level for no-diabetic-retinopathy group was 6.9 1.1%, whereas for the diabetic retinopathy group, it was 7.7 +/- 1.5% (p = 0.004). The mean values of serum lipoproteins when taken together were slightly higher in the diabetic retinopathy group than in the group with no-diabetic-retinopathy. The serum triglyceride value was higher in the group with diabetic retinopathy than in the group with no retinopathy. Serum triglyceride had a low degree of positive correlation with HbA lc value. CONCLUSION: there is no significant association between the serum lipoprotein levels and diabetic retinopathy in patients with type II diabetes mellitus. Serum triglyceride level has a low degree of positive correlation with HbA lc value.

Alport syndrome.

Alport syndrome is an oculo-renal syndrome characterized by a triad of clinical findings consisting of hemorrhagic nephritis, sensorineural hearing loss and characteristic ocular findings. We report a young male patient who presented with painless diminution of vision associated with hearing loss. The importance of ophthalmic evaluation for suspecting the disease is highlighted.

Retinal vasculitis.

Retinal vasculitis is an idiopathic inflammatory venous occlusion primarily affecting the peripheral retina of otherwise healthy young adults. Eales' disease is recognized as primary vasculitis of unknown etiology occurring in young adults. This article aims at the overall review of the etiopathogenesis, clinical presentations, pathology, management and prognosis of retinal vasculitis.

Terson's syndrome.

Terson's syndrome is rarely encountered in ophthalmic practice. The ophthalmologists should be acquainted with the clinical features and methods of diagnosis of this syndrome. Here we report a middle-aged lady with altered sensorium, visual impairment and headache who was diagnosed as having Terson's syndrome after fundoscopy and spinal tap. It was managed conservatively.

Association of primary glaucomas with retinal vein occlusion.

AIMS AND OBJECTIVES: To determine the association of Primary glaucoma with retinal vein occlusion. METHODOLOGY: A prospective cross-sectional study was carried out in B.P. Koirala Lions Centre for Ophthalmic Studies from April 2002-July 2003. All diagnosed cases of retinal vein occlusion were evaluated in detail for the presence of primary glaucoma. Detailed history was taken. Best corrected visual acuity was recorded, slit-lamp evaluation of anterior segment was performed, intraocular pressure was assessed with the help of applanation tonometer, gonioscopy was done and fundus evaluation was done under full mydriasis. RESULTS: Out of 50 patients, 19 (38%) were central retinal vein occlusion and 31(62%) were branch retinal vein occlusion. Majority of the retinal vein occlusion patients were in the age group of (61-70 years) 12 out of 50 patients (24%). There were 12 patients of primary glaucoma in 50 patients of retinal vein occlusion. Out of which 11 patients had primary open angle glaucoma and 1 patient had primary angle closure glaucoma. CONCLUSION: This study shows association of primary glaucoma as a risk factor of retinal vein occlusion. Evaluation of retinal vein occlusion patients for primary glaucoma would be worthwhile for early detection and prevention of blindness.

Association of systemic diseases with retinal vein occlusive disease.

Retinal vein occlusion (RVO) is the second commonest vascular disease of the eye, second only to Diabetic Retinopathy. The association of the retinal vein occlusion with other systemic disease likes hypertension, diabetes mellitus and others has been well documented. With the increase in persons being affected from these disorders, patients with retinal vein obstruction are also increasing. Hence, a study was designed to evaluate all cases of RVO to find out its association with systemic disorders. A total of 100 patients (106 eyes) were enrolled in the study. Out of which, 66 cases reported to have Brach Retinal Vein Occlusion (BRVO) and rest 34 cases with Central Retinal Vein Occlusion (CRVO). Among the associated systemic diseases, hypertension and diabetes mellitus accounted for 84% cases. Isolated hypertension (54%) was most commonly seen followed by diabetes mellitus (8%). The prevalence of BRVO was almost twice as compared to CRVO. The high association of various systemic disorder especially Hypertension and diabetes further supports the need of early and periodic eye examination for those suffering from these disorders.

Serum level of low-density lipoprotein cholesterol in hypertensive retinopathy.

Increased serum level of low-density lipoprotein is associated with coronary artery disease. There are, however, no reports on whether the same is true in hypertensive retinopathy. A cross-sectional comparative study was carried out to evaluate the serum level status of low-density lipoprotein in hypertensive retinopathy, including 30 randomly selected subjects with hypertensive retinopathy; age and gender matched 26 hypertensives without fundus changes. Serum low-density lipoprotein cholesterol (LDL-C) levels were assessed in all subjects. Results showed statistically significant (p < 0.0196) higher serum levels of LDL-C in hypertensive patients with retinopathy (mean +/- SD = 2.45 +/- 1.76 mmol/l, SE = 0.33 and 95% CI = 1.79-3.11 vs mean +/- SD = 1.6 +/- 0.4 mmol/l, SE = 0.08 and 95% CI = 1.44-1.76). An increased serum level of LDL-C is associated with hypertensive retinopathy.

An unusual presentation of giant cell tumour (osteoclastoma).

The number of well-documented true giant cell tumours arising in any of the craniofacial bones is small, but they do exist. A 19 year old female, Ms. KS, presented with complain of progressive enlargement of facial bones especially jaw bones, then orbit symmetrically since the age of 7. There was bilateral gross enlargement of mandible, maxilla, orbital walls, causing displacement of eye medially and upwards. The visual acuity of both eyes were 6/36 and 6/18 with best correction. Extra ocular movements were restricted because of bony growth and conjunctiva over inferior fornix were keratinized due to exposure. Fine needle aspiration (FNAC) from the side of bony growth showed plenty of osteoclasts with multinucleated giant cells. The level of serum alkaline phosphatase were highly increased. She underwent orbitotomy and a part of tissue was sent for biopsy which revealed multiples of mononucleargiant cells and tumour cells.