Examining the association between perceived stigma, its correlates, and restrictions in participation among persons with disabilities in Nepal: a cross-sectional study.

BACKGROUND: Disability stigma in low- and middle-income countries is one of the most persistent and complex barriers limiting persons with disabilities (PwDs) from enjoying their rights and opportunities. Perceived stigma among PwDs and its impact on participation restriction is rarely assessed in Nepal. OBJECTIVE: This study aimed to measure the extent of perceived stigma by PwDs, identify its relationships with specific demographic factors, and assess the impact on social participation. METHODS: A cross-sectional survey was conducted between May and July 2022 among PwDs in Nepal, with a sample of 371. The Explanatory Model Interview Catalog (EMIC) stigma scale and P-scale suitable for people affected by stigmatized conditions were used, and the generated scores were analyzed. One-way ANOVA was performed to determine group differences for sociodemographic variables, and linear regression and correlational analysis were used to identify their association and measure the strength and direction of the relationship. RESULTS: The mean stigma score was 16.9 (SD 13.8). 42% of respondents scored higher than the mean. The scores differed significantly by disability type, caste and ethnicity, education, occupation, and household wealth. Over 56% reported participation restriction, and 38% had severe/extreme restriction. Approximately 65% of participants with intellectual disabilities, 53% with multiple disabilities, and 48.5% of persons with severe or profound disabilities experienced severe or extreme restrictions. Perceived stigma had a positive correlation with Disability type (r = 0.17, P < 0.01) and negative correlations with Severity of disability (r= -0.15, P < 0.05), and Household wealth (r= -0.15, P < 0.01). Education was inversely associated with both stigma (r= -0.24, P < 0.01), and participation restriction (ß= -9.34, P < 0.01). However, there was no association between stigma and participation restriction (ß= -0.10, P > 0.05). CONCLUSION: All participants exhibited stigma in general; however, the severity varied based on disability type, level of education, and sociocultural circumstances. A large proportion of participants reported facing a high degree of restrictions in participation; however, no association was detected between perceived stigma and participation restriction. A significant negative linear correlation was observed between education and participation restriction. Stigma reduction programs focusing on education and empowerment would be especially important for overcoming internalized stigma and increasing the participation of PwDs.

The role of small incision suture-less cataract surgery in the developed world.

PURPOSE OF REVIEW: Manual small incision cataract surgery (MSICS) has recently gone through much refinement and fine tuning. It is often taken as an alternate option for phacoemulsification, especially in developing country. This review will present some insight on its applications especially for developed nations. The role of MSCIS in tackling complex cataracts with stony hard nucleus is fairly established. The role of training residents with MSCIS has certain advantages though debatable. RECENT FINDINGS: MSCIS is much faster and cost-effective surgical technique often possible in suboptimal condition and avoids the capital and maintenance cost of phacoemulsification. The visual outcome and postoperative complications in both phacoemulsification and MSCIS are comparable. Slightly greater astigmatism in MSICS can be lessened with a slight modification of surgical technique. The successful application of MSCIS in large public health programmes has successfully helped to increase the cataract surgical rate and quality. It is the technique of choice for blindness control programme in developing country. SUMMARY: MSICS is established as safe and cost-effective procedure in developing country with results as good as phaoemulsification. Although it may not be the best option for developed nations, it is a valuable skill especially for surgical conversion and to deal with complex and advance cataract cases. Hence, it should be a part of resident training programme in developed world and it should be in the armamentarium of every cataract surgeon.

Health literacy of common ocular diseases in Nepal.

BACKGROUND: Poor health literacy is often a key cause of lack of or delayed uptake of health care services. The aim of this study was to assess the health literacy of common ocular diseases, namely cataract, glaucoma, night blindness, trachoma and diabetic retinopathy in Nepal. METHODS: A cross sectional study of 1741 participants randomly selected from non-triaged attendants in the outpatient queue at Tilganga Institute of Ophthalmology, a semi urban general population of Bhaktapur district of Kathmandu Valley and patients attending rural outreach clinics. Participants responded to trained enumerators using verbally administered, semi structured questionnaires on their awareness and knowledge of cataract, glaucoma, diabetic retinopathy, night blindness, and trachoma. RESULTS: The awareness of cataract across the entire sample was 49.6%, night blindness was 48.3%, diabetic retinopathy was 29%, glaucoma was 21.3% and trachoma was 6.1%. Patients presenting to rural outreach clinics had poorer awareness of cataract, glaucoma, diabetic retinopathy, night blindness and trachoma compared to those from a semi-urban community and an urban eye hospital (p<0.05), Old age was directly associated with poorer awareness of cataract, glaucoma, night blindness, trachoma and diabetic retinopathy (p<0.05). Female gender was associated with lower awareness of cataract, glaucoma, night blindness and trachoma (p<0.05). Literacy was associated with greater awareness of cataract, glaucoma, diabetic retinopathy, night blindness and trachoma (p<0.05). Higher education was significantly associated with greater awareness of cataract, night blindness and trachoma (p<0.05). Multivariate analysis found that the awareness of common ocular diseases was significantly associated with level of education (p<0.05). Similarly, awareness of cataract, glaucoma, trachoma and night blindness was associated with female gender (p<0.05) whereas awareness of cataract, night blindness, trachoma and diabetic retinopathy was associated with age (p<0.05) but the awareness glaucoma and diabetic retinopathy was associated with camps. CONCLUSIONS: Low awareness of common ocular conditions is associated with factors such as female gender, old age, lower levels of education and rural habitation. A would be successful health promotion programs should specifically target health determinants to promote health literacy and to ensure timely utilization of eye care services.

Femtosecond laser-assisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor.

PURPOSE: To describe endokeratophakia in which a small incision lenticule extraction (SMILE) lenticule from a myopic patient is implanted into a recipient eye through a small incision to correct hyperopia. METHODS: A 23-year-old aphakic woman presented following cataract surgery to remove a childhood congenital cataract with hyperopia of +12.00 -1.50 × 155, corrected distance visual acuity of counting fingers, and exotropia. A SMILE procedure using the VisuMax femto-second laser (Carl Zeiss Meditec, Jena, Germany) was performed on a donor patient with high myopia and the extracted lenticule was stored (power -10.50 diopter sphere, optical zone 5.75 mm, central lenticule thickness 127 µm). In the recipient eye, a pocket lamellar incision was created using the VisuMax SMILE software. The upper interface was separated and the donor lenticule was inserted through the small incision. RESULTS: One year postoperatively, retinoscopy refraction was +7.50 -3.00 × 150, a spherical equivalent refraction reduction of 5.25 diopters. Mean keratometric power increased by 2.91 diopters. The posterior surface elevation changed significantly with a central bulge into the anterior chamber. Central corneal thickness by Pentacam (Oculus Optikgeräte, Wetzlar, Germany) increased by 121 µm. Central lenticule thickness was 130 µm and central epithelial thickness was 43 µm measured by RTVue OCT (Optovue Inc., Fremont, CA). The cornea remained clear over the 1-year postoperative period. CONCLUSIONS: Endokeratophakia appears to be a viable procedure for correcting hyperopia on the cornea by implantation of an extracted myopic SMILE lenticule from a donor patient. However, posterior surface changes and epithelial remodeling resulted in only 50% of the intended correction. No adverse side effects were observed following implantation of donor tissue for 1 year.

Indications and Outcomes of Repeat Keratoplasty for Graft Failure at a Tertiary Eye Care Center in Nepal.

INTRODUCTION: Graft failure is a common complication following keratoplasty requiring repeat keratoplasty (re-KP). OBJECTIVES: To determine the indications and outcome of repeat keratoplasty at a tertiary eye care centre in Nepal. MATERIALS AND METHODS: This was a retrospective study of 78 patients who underwent re-KP for graft failure in Tilganga Institute of Ophthalmology from Jan 2015 to Dec 2020. Indications for the primary keratoplasty, causes of graft failure and outcomes of re-KP in terms of vision acuity, graft clarity and secondary glaucoma were evaluated. Cases of regraft with less than one-year follow-up period were excluded. RESULTS: A total of 78 re-KPs had been performed in 78 patients during the study period. Seventy eyes had undergone single corneal regraft and 8 eyes had undergone multiple (second or third) regraft surgery. Most common indication of primary keratoplasty was infectious keratitis (n=36; 46.2%). On follow up, 36 eyes (46.2%) were clear at the last visit, of which 31 eyes were single regraft cases and 5 were of multiple regraft cases. Most common cause of graft failure was graft infection (n=34; 43.6%) followed by corneal scarring (n=12; 15.4%). Of 42 eyes with failed regrafts, recurrence of the preoperative infection was commonest cause (n=15, 35.7%) followed by secondary glaucoma (n=11; 26.2%). Of 36 eyes with clear regraft, only 4 eyes (11.11%) achieved best corrected vision of ≥6/18 and remaining 32 eyes had BCVA <6/18 due to associated cataract, secondary glaucoma and high astigmatism. CONCLUSION: The most common cause for re-KP includes graft infection followed by secondary glaucoma. Outcomes of corneal regrafts in the form of graft clarity and visual acuity are suboptimal.

Indication and Outcome of Paediatric Keratoplasty at a Tertiary Referral Eye Hospital in Nepal.

INTRODUCTION: Paediatric keratoplasty is rarely performed surgery with high risk of graft failure. Developing countries have not benefited due to lack of sufficient facilities and trained surgeons. OBJECTIVES: The objectives of the study were to analyze the indications and its outcome in terms of vision and graft survival. MATERIALS AND METHODS: This retrospective chart review used electronic medical records from January 2017 to December 2019 of all consecutive patients aged upto18 years or below that underwent paediatric keratoplasty after ethical approval at Tilganga Institute of Ophthalmology. Outcome was defined as anatomical or visual success and graft clarity. Different demographic and surgical parameters were studied among 59 eyes of 48 patients. RESULTS: Mean age of recipient was 12.23± 3.81 years. Majority 37 (52.5%) had unilateral grafts with keratoconus being the most common 24 (40.6%) acquired non-traumatic indication. Mean post-operative best corrected visual acuity 0.6 Logmar was significantly (p <0.001) low as compared to preoperative 1.3 Logmar. Overall graft survival rate was 47 (78%) at one-year follow-up; keratoconus accounting for 24 (100%). Major factors in contributing for graft failure were rejection, infection, and glaucoma. CONCLUSION: A good outcome in terms of anatomical and visual success was achieved in our study. Keratoconus has an excellent graft survival. Visual rehabilitation by cycloplegic refraction should be done to prevent amblyopia. Enhancing the training of surgeons and addressing challenges faced in a paediatric population will help decrease corneal blindness among paediatric patients in the future.

A population-based survey of the prevalence and types of glaucoma in Nepal: the Bhaktapur Glaucoma Study.

OBJECTIVE: To determine the prevalence and types of glaucoma in a Nepalese population. DESIGN: Cross-sectional, population-based survey. PARTICIPANTS: A total of 4800 subjects aged 40 years or older from the Bhaktapur district of Kathmandu valley. METHODS: Subjects aged 40 years or older were selected using a cluster sampling procedure and door-to-door enumeration for a population-based, cross-sectional study. All subjects underwent a detailed ocular examination at the base hospital, which included logarithm of minimal angle of resolution visual acuity, refraction, applanation tonometry, gonioscopy, Lens Opacities Classification System II cataract grading, retinal examination, and Swedish Interactive Thresholding Algorithm standard perimetry when indicated. MAIN OUTCOME MEASURES: Diagnosis of glaucoma was based on criteria described by the International Society for Geographic and Epidemiological Ophthalmology. RESULTS: A total of 4003 subjects underwent a comprehensive eye examination (response rate 83.4%), and complete data were available in 3991 subjects. The mean intraocular pressure was 13.3 mmHg (97.5th and 99.5th percentiles, 18 and 20 mmHg, respectively), and the mean vertical cup-to-disc ratio was 0.26 (97.5th and 99.5th percentiles, 0.6 and 0.8 mmHg, respectively). There were 75 subjects with glaucoma, an age- and sex-standardized prevalence of 1.80 (95% confidence interval [CI], 1.68-1.92). Age- and sex-standardized prevalence was 1.24% (95% CI, 1.14-1.34) for primary open-angle glaucoma (POAG), 0.39% (95% CI, 0.34-0.45) for primary angle-closure glaucoma (PACG), and 0.15% (95% CI, 0.07-0.36) for secondary glaucoma. The prevalence of glaucoma increased with an increase in age with no significant difference in gender. Primary angle-closure glaucoma was 3 times more common in women. Nine eyes were blind, and 2 subjects were bilaterally blind from glaucoma. CONCLUSIONS: The overall prevalence of glaucoma was 1.9%. Of all glaucoma cases, POAG accounted for 68%, PACG accounted for 22.67%, and secondary glaucoma accounted for 9.33%. Among the subjects with POAG, 96.08% had not been previously diagnosed.

Demography, indications and outcome of descemet stripping automated endothelial keratoplasty in Nepal.

BACKGROUND: Descemet stripping automated endothelial keratoplasty (DSAEK) is performed for corneal endothelial pathology. It had gained popularity over penetrating keratoplasty (PK) because of better outcome. METHODS: Retrospective data was collected from records of patients who underwent DSAEK from 2005 to 2019. Demography, indications and post-operative complications of DSAEK were analyzed. Outcome was measured in terms of graft clarity and vision. RESULTS: 93 eyes of 86 patients had undergone DSAEK in the study period of 15 years. Average age of the patients was 61.0 years. 55.9% were female. The common indications for DSAEK were cataract surgery related bullous keratopathy (n=47, 50.5%), Fuchs dystrophy (n=22, 23.6%) and failed graft (n=11, 11.8%). 8.6% of surgeries had graft detachment and 5.3% had pupillary block in the early post-operative period. Outcome analysis was done for cases (n=80) which had follow-up duration of at least 2 months (range: 2 months to 11 years; average: 28.5 months).Endothelial rejection occurred in 8 cases (10.0%), 5 of which regained graft clarity after treatment. At the last follow-up visit, 23.8% (n=19) of grafts had failed, which was mostly due to endothelial failure (n=16); 3 grafts failed due to infective keratitis. 42.5% (n=34) acquired best corrected vision of 6/18 or better. The average astigmatic error was 1.6 Diopter Cylinder by refraction. CONCLUSION: DSAEK showed good outcome with our results comparable to other studies. It had replaced traditional PK in our institute for endothelial dysfunction. Surgeons in the country should be encouraged and trained to do the procedure.

Effect of exposure to biomass smoke from cooking fuel types and eye disorders in women from hilly and plain regions of Nepal.

BACKGROUND/AIM: To study the association between exposure to biomass smoke from cooking fuels andi cataract, visual acuity and ocular symptoms in women. METHODS: We conducted a community-based cross-sectional study among women (≥20 years and without a previous diagnosis of cataract, ocular trauma or diabetes or those taking steroids) from hilly and plain regions of Nepal. Eligible participants received an interview and a comprehensive eye assessment (cataract development, visual acuity test and ocular symptoms). Participants' data on demographics, cooking fuel type and duration of use, and cooking habits were collected. We addressed potential confounders using the propensity score and other risk factors for ocular diseases through regression analysis. RESULTS: Of 784 participants, 30.6% used clean fuel (liquefied petroleum gas, methane, electricity) as their primary current fuel, and the remaining 69.4% used biomass fuels. Thirty-nine per cent of the total participants had cataracts-about twofold higher in those who currently used biomass fuel compared with those who used clean fuel (OR=2.27; 95% CI 1.09 to 4.77) and over threefold higher in those who always used biomass. Similarly, the nuclear cataract was twofold higher in the current biomass user group compared with the clean fuel user group (OR=2.53; 95% CI 1.18-5.42) and over threefold higher among those who always used biomass. A higher proportion of women using biomass had impaired vision, reported more ocular symptoms compared with those using clean fuel. Severe impaired vision and blindness were only present in biomass fuel users. However, the differences were only statistically significant for symptoms such as redness, burning sensation, a complaint of pain in the eye and tear in the eyes. CONCLUSIONS: Cataract was more prevalent in women using biomass for cooking compared with those using clean fuel.

Prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma in Bhaktapur district of Nepal: the Bhaktapur Glaucoma Study.

BACKGROUND: Cataract and glaucoma are the major causes of blindness in Nepal. Bhaktapur is one of the three districts of Kathmandu valley which represents a metropolitan city with a predominantly agrarian rural periphery. This study was undertaken to determine the prevalence of visual impairment, cataract surgery and awareness of cataract and glaucoma among subjects residing in this district of Nepal. METHODS: Subjects aged 40 years and above was selected using a cluster sampling methodology and a door to door enumeration was conducted for a population based cross sectional study. During the community field work, 11499 subjects underwent a structured interview regarding awareness (heard of) and knowledge (understanding of the disease) of cataract and glaucoma. At the base hospital 4003 out of 4800 (83.39%) subjects underwent a detailed ocular examination including log MAR visual acuity, refraction, applanation tonometry, cataract grading (LOCSΙΙ), retinal examination and SITA standard perimetry when indicated. RESULTS: The age-sex adjusted prevalence of blindness (best corrected <3/60) and low vision (best corrected <6/18 ≥ 3/60) was 0.43% (95%C.I. 0.25 - 0.68) and 3.97% (95% C.I. 3.40 - 4.60) respectively. Cataract (53.3%) was the principal cause of blindness. The leading causes of low vision were cataract (60.8%) followed by refractive error (12%). The cataract surgical coverage was 90.36% and was higher in the younger age group, females and illiterate subjects. Pseudophakia was seen in 94%. Awareness of cataract (6.7%) and glaucoma (2.4%) was very low. Among subjects who were aware, 70.4% had knowledge of cataract and 45.5% of glaucoma. Cataract was commonly known to be a 'pearl like dot' white opacity in the eye while glaucoma was known to cause blindness. Awareness remained unchanged in different age groups for cataract while for glaucoma there was an increase in awareness with age. Women were significantly less aware (odds ratio (OR): 0.63; 95%, confidence interval (CI): 0.54 - 0.74) for cataract and (OR: 0.64; 95% CI: 0.50 - 0.81) for glaucoma. Literacy was also correlated with awareness. CONCLUSION: The low prevalence of visual impairment and the high cataract surgical coverage suggests that cataract intervention programs have been successful in Bhaktapur. Awareness and knowledge of cataract and glaucoma was very poor among this population. Eye care programs needs to be directed towards preventing visual impairment from refractive errors, screening for incurable chronic eye diseases and promoting health education in order to raise awareness on cataract and glaucoma among this population.

Preoperative visual acuity of people undergoing cataract surgery in rural and urban Nepal.

BACKGROUND: Preoperative presenting visual acuity (PPVA) is not a commonly reported indicator for the delivery of cataract services. This study aimed to evaluate the PPVA of patients undergoing cataract surgery in rural and urban areas of Nepal. DESIGN: A prospective, non-interventional study conducted from October 2007 to March 2008 in a tertiary hospital and outreach clinics of Nepal. PARTICIPANTS: A total of 3023 consecutive subjects from urban and rural settings (1323 from the tertiary hospital and 1700 from outreach clinics) with cataract were included. METHODS: Visual acuity was tested with a Snellen E-chart at 6 m by ophthalmic assistants. All Outreach Microsurgical Eye Clinic patients were examined by either ophthalmologists or senior ophthalmic assistants. Patients at the Tertiary Eye Care Centre were examined only by ophthalmologists. MAIN OUTCOME MEASURES: Preoperative presenting visual acuity of patients undergoing cataract surgery was measured in both the settings. RESULTS: The sex ratio was 0.96 (male/female). Based on PPVA, 11.5% of patients operated were blind (PPVA < 3/60 in the better eye). The proportion of blind people operated was similar in rural (11.4%) to urban (11.6%) areas. The proportion of blind eyes operated was higher in rural (50.7%) compared to urban (38.9%) areas. CONCLUSION: Despite a comparatively high volume of cataract surgery carried out in Nepal every year, only about one in eight patients operated for cataract in the sample population was blind. PPVA is an important indicator for the progress towards eliminating cataract blindness.

Rationale, methods and baseline demographics of the Bhaktapur Glaucoma Study.

BACKGROUND: To describe the methodology and baseline data of a population-based study designed to determine the prevalence of glaucoma and to study the risk factors for glaucoma development in a Nepali population. DESIGN: Population-based cross-sectional study. PARTICIPANTS: Subjects 40 years and above residing in Bhaktapur District. PATIENTS AND METHODS: Power calculations suggest that a sample size of 4758 is required. Thirty clusters were randomly selected from the 2 municipalities and 16 Village Development Committees of Bhaktapur District in Nepal. A door-to-door census was conducted in the selected clusters to identify citizens 40 years of age and older. Demographic details were collected and a structured interview, regarding awareness for cataract and glaucoma was taken. All individuals fulfilling the eligibility criteria were recruited and referred to the Tilganga Institute of Ophthalmology in Kathmandu for a detailed clinical examination including glaucoma diagnostic procedures. Peripheral blood samples were taken to facilitate future genetic analysis. MAIN OUTCOME MEASURES: Prevalence of glaucoma, risk factors and genetic screening. RESULTS: A total of 4800 people were selected. The mean age of participants was 55.4 ± 12.3 years (range: 40-99) and 51.8% were female. In total, 64.8% of our cohort was aged less than 59 years and 60.5% were illiterate. Among the various ethnic races, 69.7% belonged to the Newar ethnic group. CONCLUSION: This study will determine the prevalence of glaucoma and allow for an increased understanding of the risk factors for glaucoma development in this region.

Acanthamoeba Keratitis - A Case Report.

INTRODUCTION: Acanthamoeba keratitis is a serious infection of the cornea which causes severe inflammation of the eye and loss of vision. CASE DESCRIPTION: A 45 years female came with a history of trauma of right eye with vegetative matter with severe pain and redness. Patient was treated with antibacterial, antifungal eye drops but the condition deteriorated. Diagnosis was based on presence of motile trophozoites and cyst in the culture of non nutrient agar with a lawn of E coli of the corneal ulcer scraping. Therapeutic penetrating keratoplasty was performed as the patient's condition deteriorated. CONCLUSION: Acanthamoeba keratitis is a rare parasitic vision threatening infection with poor prognosis in comparison to other infectious keratitis. Therefore prevention is very important.

A Case of Acute Gonococcal Conjunctivitis in an Unusual Age Group.

INTRODUCTION: This is a case of case of acute gonococcal conjunctivitis in a 2.5 years old female child. CASE: A 2.5 years old female child presented with redness, purulent and profuse discharge from left eye with associated upper eyelid swelling. The culture of conjunctival swab revealed Neisseria gonorrhoeae. The child was treated with intravenous antibiotics and fortified medications. CONCLUSION: Unlike young adults and newborn gonococcal conjunctivitis (GCC), children can have a nonsexual mode of transmission and could be seen in an unusual age group. For the management of the diseases, proper history including sexual abuse history and thorough physical examination is mandatory, which is sometimes difficult in a developing country. Gonococcal conjunctivitis in the toddler group should be kept in consideration.

Recurrence of Avellino Corneal Dystrophy Following Penetrating Keratoplasty: A Case Report.

Granular - lattice (Avellino) corneal dystrophy is inherited in an autosomal dominant fashion which affects stroma of the cornea with recurrent erosions and decreased vision due to clouding of cornea in later stage. We reported a case of 53-year old woman presented with pain and blurring of vision of left eye for 10 days with history of right eye deep anterior lamellar dystrophy and Left eye penetrating keratoplasty 5years back for Avellino dystrophy. On examination right eye graft was clear and left eye showed circular edges of irregular epithelium with patchy stains and epithelial defect suggestive of recurrence of dystrophy. A patient with recurrent corneal erosions and opacity in cornea has to be examined carefully so as not to overlook Avellino corneal dystrophy. Being a rare disorder this case has been reported to draw the attention of ophthalmologists about its recurrence following keratoplasty.

Female Clients Satisfaction towards Primary and Secondary Eye Health Facilities and Cost of Eye Care in Nepal.

INTRODUCTION: In Nepal, females suffer from disproportionately higher burden of blindness and vision impairment with low access to eye care. The available knowledge is inadequate to address the issues related to gender and generate information to reduce the gender disparity. The aim of this study was to determine female clients' satisfaction with services at eye facilities in Nepal and to estimate the cost of cataract surgery. MATERIALS AND METHODS: Exit interviews were conducted in 2018 with 308 female clients from eight facilities in five districts. Face to face interviews were conducted using a pretested semi-structured questionnaire adopted from the midterm review of Vision 2020. RESULTS: The mean age of participants was 54±17 years. Ninety seven percent (97%) of the participants reported that they received service as per their expectation and were satisfied with the service of the facilities. Major factors for satisfaction were: thorough eye examination (54%), behavior of health staff (40%), and cleanliness of health facility (39%). Another eighty percent (80%) of the participants mentioned that they would recommend or return to the same facility. Fifteen percent of the participants perceived that they faced problems at the eye facility because of their gender. Around three quarters (73%) paid health expenses from their pocket. Most (83%) of the participants rated user fees as either reasonable or inexpensive. CONCLUSION: The majority of participants reported receiving service as expected and willingness to return to the same eye health facility for future consultation. However, most participants had to pay the health care expenses out-of-pocket.

Tectonic Graft for Persistent Leakage and Visual Outcome After Corneal Perforation Repair: A Case Series.

Keratoplasty is a modality of treatment for large and leaking corneal perforation in a tertiary center. We report cases of 20and 30-years old men presented in an emergency with history of road traffic accident 1 and 3 days back. Best corrected visual acuity was hand movement in both injured eye. Slit lamp examination of both cases revealed full thickness corneal laceration with Siedel test positive. Both cases underwent corneal laceration repair with resuturing and corneal glue on consecutive days but couldn't seal the leaking wound. Then ultimately both were undergone for tectonic keratoplasty. The final best corrected visual activity of involved eye was 6/36 in case 1 and 6/24 in case 2. Most cases of traumatic corneal perforation undergone urgent corneal repair but sometimes very difficult to seal the wound. In such cases donor cornea tissue may have to be used to maintain integrity of globe and better visual potential. Keywords: corneal perforation; laceration; siedel test; tectonic keratoplasty.