Comparative Study on Knowledge and Awareness of Common Ocular Diseases Among Rural and Urban Community in Siraha District of Nepal: The Lahan Study.

INTRODUCTION: Awareness and knowledge about the common ocular conditions can help people to seek early eye care services. The understanding and acceptance of the importance of routine eye examinations can help in timely detection and treatment of the eye diseases and thus help to reduce the burden of avoidable ocular blindness from the general population. OBJECTIVE: This study aims to assess and analyze the information related to knowledge and awareness of common ocular diseases and eye health among the rural and urban communities of the Siraha district, Nepal. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted between April and June 2018 in Lahan Municipality ward number 6 (urban) and Sakhuwa Nankarkatti Rural Municipality ward number 4 (rural) in Siraha district. The sample size of 975 was calculated from study population of 3247. A systematic random sampling technique was used to interview adults above 18 years of age, using a pre-tested structured questionnaire. The collected data was analyzed. RESULTS: Out of total 975 participants, 514 (52.7%) were from rural community in Sakhuwa Rural Municipality and 461 (47.3%) were from urban community in Lahan Municipality. The mean age was 38.38 ± 15 years. Female participants were more (63.2%) compared to male (36.8%). Overall, 58.3% were literate and 41.7% were illiterate. Rural community had more uneducated participants (48%) compared to urban community (34%). In rural community, 69% were aware about cataract, 83% had knowledge about its treatment; while in urban community 81% were aware about cataract and 86% had knowledge about its treatment. The awareness of glaucoma among the participants was poor, more so in rural cohort (15%) than the urban cohort (25%). The knowledge of glaucoma was 14% in rural and 62% in urban cohort. Awareness that diabetes can affect the eye was found to be significantly lower (p = 0.01) in rural population (25%) compared to that in urban population (41%) in this study. The knowledge about diabetic retinopathy was lower in rural community (38%) compared to urban community (49%). Awareness about Night Blindness was lesser in rural (62%) compared to urban (70%) community (p = 0.17). Awareness about refractive errors were 37% in rural compared to 60% in urban community. The major sources of information were society and eye hospital in both community. CONCLUSION: The knowledge and awareness level regarding common ocular diseases was high among the community people of urban community (Lahan) in comparison to rural community (Sakhuwa Nankarkatti). Awareness and knowledge level mainly regarding glaucoma and diabetic retinopathy was very poor in both urban and rural community. There is need to conduct comprehensive awareness programs on common ocular diseases like cataract, glaucoma, diabetic retinopathy, night blindness, congenital eye disease, ocular trauma, eye donations and others in both rural and urban areas to raise the awareness level and improve attitudes and right practices reducing the burden of avoidable blindness.

Firework-related Ocular Injuries During Festival Season: A Hospitalbased Study in a Tertiary Eye Care Center of Nepal.

INTRODUCTION: Firework-related ocular injuries are an important cause of preventable ocular injuries and are common during the festival season. Despite the strict legislation in Nepal, the use of a firework is still commonly used during Tihar and Chaath festivals. OBJECTIVE: To evaluate demographic distribution, mode, causative firework, type of fireworks-related ocular injuries, and visual outcome at a tertiary eye hospital in Eastern Nepal. METHODS: This is a hospital-based prospective interventional study. All the patients with firework-related injuries who attended the emergency and outpatient department of SCEH, Lahan, during or within 1 month of the festival season (Tihar and Chaath puja) were included in this study. RESULTS: Total of 65 eyes were included. The left eye was involved in 49.1%, 82.5% were males. Mean age of the patients was 15.3±14.7 years (range 5yr - 75yr). Children less than 16 years were predominantly involved (77.2%). Firecrackers (56.1%) were the most common type of fireworks causing injury. The closed globe injuries were more (78.5%) compared to open globe injuries (21.5%). Surgical management was done in 50.9% of cases. Following management visual acuity of most patients improved. Only 8 eyes (12.3%) had visual acuity less than 3/60 after management compared to 28 eyes (43.1%) at the time of presentation. CONCLUSION: Firework related ocular injuries are important causes of preventable blindness. A combined approach of public awareness about the possible dangers, preventive measures, early treatment by trained primary ophthalmic care, and implementation of strict legislations are essential to reduce blindness due to this preventable cause.

Quantification of Inflammation Following Nd:YAG Laser Capsulotomy and Assessing the Anti-inflammatory Effects of Nepafenac 0.1% and Betamethasone 0.1.

Purpose: To quantify the intraocular inflammation, measured using laser flare photometry (LFP), after Nd:YAG capsulotomy and compare the effects of different topical anti-inflammatory regimes.Methods: A single-center, prospective, randomized controlled study, which included 90 eyes of 90 patients with visually significant posterior capsular opacification. In all patients, Nd:YAG capsulotomy was done and was then randomized into three groups: (A) Topical betamethasone 0.1%; (B) Topical nepafenac 0.1%; and (C) Control group: did not receive any anti-inflammatory agent post capsulotomy.Results: There was a significant increase in the mean LFP values 2 h following laser capsulotomy (p < 0.001) and then declined gradually and came back to pre-laser values by 2 weeks in all three groups. The mean LFP values, central macular thickness, and best corrected visual acuity were comparable among groups. None developed central macular edema.Conclusion: Intraocular inflammation following Nd:YAG capsulotomies is minimal and transient. Routine use of prophylactic anti-inflammatory agents may be avoided.

Inverted temporal internal limiting membrane flap technique for chronic large traumatic macular hole.

Various modifications of surgical techniques and surgical adjuncts are adopted with standard pars plana vitrectomy (PPV) to improve the outcome of traumatic macular hole (TMH) surgeries. We describe a successful closure of a chronic large TMH of three years duration with inverted temporal internal limiting membrane (ILM) flap technique. A 36-year-old male patient had an optical coherence tomography (OCT) documented chronic macular hole (MH) for three years following blunt trauma. Fundus examination also showed choroidal rupture scar temporal to fovea. The minimum MH diameter was 769 µ and the basal diameter 1431 µ in OCT. Standard PPV with inverted temporal ILM flap and gas tamponade was done. The postoperative period was uneventful. The best corrected visual acuity improved from 6/60 preoperatively to 6/18 six months postoperatively, and OCT showed a closed MH with anatomical type 1 closure. This case highlights that the inverted temporal ILM flap technique is a safe and effective technique for patients with even chronic and large TMH.

Canalicular Curettage to the Rescue: a report of three cases.

INTRODUCTION: Canalicular curettage is a surgical procedure used to remove canalicular contents and debris from canaliculi. It is usually indicated for chronic, persistent or recalcitrant canalicular diseases with no resolution of symptoms after conservative management. We describe 3 different cases of persistent canalicular diseases which needed canalicular curettage to rescue from the conditions leading to successful outcomes. Cases and observations: • Case 1: A 45-year-old male presented with recurrent punctal granuloma 3 months after DCR surgery. Canalicular exploration and curettage with one-snip punctoplasty following excision of the mass revealed a segment of remnant silicone stent. There was no recurrence of mass in subsequent follow up visits. • Case 2: A 35-year-old female presented with recurrent canaliculitis for last 6 months. Canalicular curettage revealed multiple small calcified masses of varying size and shape. The patient had good postoperative recovery and showed no recurrence of symptoms. • Case 3: A 32-year-old female presented with gradually increasing pedunculated mass arising out of punctum for last one month. Excision of mass with canalicular curettage was done. Biopsy proved it to be squamous papilloma of the canaliculi. There was no recurrence of mass. CONCLUSION: Canalicular curettage is a simple, safe and effective surgical intervention to rescue from the recalcitrant canalicular conditions like canaliculitits, retained foreign bodies, canalicular neoplasms leading to successful outcomes.

Upper Fornix Approach to the Superonasal Intraconal Space: An Experience Including a Pediatric Patient.

In this study, we present 2 patients, including 1 pediatric patient, with orbital tumors in the deep superonasal intraconal space, which were approached with upper fornix technique combined with a superior lateral cantholysis. The first patient was a 1-year-old girl who had presented with left upper eyelid retraction since the age of 2 months. Imaging studies revealed an orbital mass in the left postero-superonasal intraconal space. The second patient was a 71-year-old man who complained of decreased vision after cataract surgery in the left eye. Imaging studies revealed an orbital mass in the left superonasal intraconal space surrounding the optic nerve in the posterior orbit. In both the patients, incisional biopsy of the orbital mass with upper fornix approach was performed under general anesthesia. The diagnoses of congenital upper eyelid retraction caused by fibrosis in patient #1 and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in patient #2 were made, after pathological examinations. No significant intra- or postoperative complications occurred during a follow-up period of 10 months and 2 months, respectively.

Large choroidal melanoma presenting as neovascular glaucoma.

Choroidal melanoma is a relatively rare tumour with a poor prognosis, though it is the most common primary malignancy of the eye among adults. Choroidal melanoma has been reported to present as acute angle closure glaucoma, secondary glaucoma, chronic uveitis, cataract, and staphyloma. We report a case of a28-year-old male presenting with features of neovascular glaucoma in the right eye and having initially been treated with anti-glaucoma medications. However, ultrasonography revealed a mushroom-shaped, elevated, solid lesion with low to moderate internal reflectivity and regular internal structure suggestive of choroidal melanoma. Histopathological examination along with the immunohistochemistry studies of the lesion following enucleation of the eye confirmed the diagnosis of malignant choroidal melanoma. We highlight with this case that large choroidal melanoma may rarely present with features of neovascular glaucoma. The etiology of neovascular glaucoma should be investigated carefully and a potentially life-threatening intraocular tumour should be excluded, although it is a rare presentation.

Biometry characteristics in congenital cataract patients before surgery in a tertiary eye care centre in Nepal.

PURPOSE: To evaluate the anterior segment biometry characteristics in congenital cataract patients before undergoing surgery in a tertiary eye care centre. METHODS: We retrospectively reviewed the charts of congenital cataract patients aged less than 15 years who had undergone the congenital cataract surgery from Jan-Dec, 2015. 451 eyes of 351 patients were reviewed. The eyes were examined using an autorefract-keratometer, applanation A-scan and parameters like keratometry, axial length, corneal astigmatism were noted. RESULTS: The mean age at the surgery was 92.4 ±â€¯4.13 months (range 6 months to 15 years). The ratio of boys to girls was 2.34:1. The mean axial length was 21.94 ±â€¯1.94 mm. Girls had shorter axial length than boys (21.53 mm vs 22.11 mm, p = 0.01). The axial length in the cataractous eyes in bilateral cases was significantly smaller than that in the unilateral cases (21.46 mm vs 22.55 mm, p < 0.0001).The mean keratometry was 44.12 ±â€¯2.6 D. Girls had larger mean keratometry value than boys (44.71 vs 43.88, p = 0.0032). Keratometry values were higher in cataractous eyes in bilateral cases than in the unilateral cases (44.61 D vs 43.51 D, p < 0.0001). The mean corneal astigmatism was 1.49 ±â€¯1.13 D. The prevalence of the corneal astigmatism of 2.0 D or more was 25.5%. The with-the-rule astigmatism was the most frequent type (62.53%). Girls had higher mean astigmatism than boys (p = 0.0122). The mean corneal astigmatism was higher in the cataractous eyes in bilateral cases than in the unilateral cases (p = 0.0094). CONCLUSIONS: The axial length, mean keratometry and corneal astigmatism in congenital cataract patients varied with age, gender, and laterality. The data on biometry characteristics of Nepalese pediatric patients provided in the present study are of clinical significance and hence greatly enhance the guidelines for treatment decisions, IOL power calculations and management of congenital cataract patients.

Intraocular eyelashes and iris cyst in anterior chamber following penetrating eye injury: a case report.

BACKGROUND: The presence of intraocular eyelashes following penetrating eye injury or ocular surgery is relatively uncommon. The response of the eye to intraocular eyelashes is variable. The eyelash may be symptomatic or may remain asymptomatic for long periods. OBJECTIVE: We report a case with two intraocular eyelashes and an iris cyst after 2 years of asymptomatic period following penetrating eye injury. CASE PRESENTATION: A 24-year-old male presented with decreased vision in the left eye which he had noticed for the previous 2 weeks. His visual acuity was 6/6 in the right eye and 6/18 in the left eye, improving to 6/9 with -2.5 DC × 140° correction. The intraocular pressure was 12 mmHg in both eyes. On slit-lamp examination, the left eye showed 8 mm linear peripheral corneal opacity nasally, two eyelashes in the superior anterior chamber, and an iris cyst measuring 4 mm × 4 mm in the superior iris. The right eye was normal. Dilated fundus examination of both eyes was normal. The eyelashes and cyst were removed surgically. There were no complications during the 3-month follow-up period. CONCLUSION: Intraocular implantation of eyelashes following penetrating eye injury can remain asymptomatic for long periods; however, late development of iris cyst may occur.

Usher syndrome Type I in an adult Nepalese male: a rare case report.

Usher syndrome, also known as retinitis pigmentosa-dysacusis syndrome, is an extremely rare genetic disorder, characterized by retinitis pigmentosa (RP) and congenital sensorineural hearing loss. It has been estimated to account for 3-6% of the congenitally deaf population, upto 8-33% of individuals with RP and half of all cases with combined deafness and blindness (Vernon M,1969; Boughman JA et al,1983). The prevalence of Usher syndrome have been reported to range from 3.5 to 6.2 per 100,000 in different populations (Vernon M,1969; Boughman JA et al,1983; Yan D et al, 2010). We report a case of Usher syndrome type I in an adult Nepalese male with typical congenital profound hearing loss, and night blindness secondary to retinitis pigmentosa.

Bilateral ectopia lentis with isolated lens coloboma in Marfan syndrome.

A rare case of bilateral ectopia lentis with isolated lens coloboma in Marfan syndrome is reported. A 21-year-old female presented with decreased vision in both eyes. Her unaided visual acuity was 20/200 and 20/400 in the right and left eye, respectively, improving to 20/40 with -4.5 DS/-3.0 DC x 10° correction in the right eye and 20/80 with -10.0 DS/-6.5 Dc x10° correction in the left eye. On slit lamp examination under mydriasis, both eyes revealed ectopia lentis with lens coloboma and stretched zonules. Fundus examination revealed pigmentary changes at the fovea. On systemic evaluation, she was diagnosed with Marfan syndrome. She was prescribed a refractive correction in form of a contact lens and kept under observation.

In Vivo Confocal Microscopic Architecture of Corneal Nerves in a Case of Multiple Endocrine Neoplasia Type 2b.

A detailed ocular examination and in vivo confocal microscopy (IVCM) using the Heidelberg retinal tomograph 3 with Rostock cornea module were performed in a patient with multiple endocrine neoplasia (MEN) 2b syndrome. Ocular findings included ptosis secondary to thickening of the lid margins, subconjunctival and perilimbal neuromas, and prominent corneal nerves extending up to the pupillary area. IVCM demonstrated structural alterations of both the main nerve trunks and the smaller branches. The main nerve trunks were grossly thickened while the smaller fibers were present in an intertwining manner in the anterior stroma. Some fibers showed prominent looping and nodular dilatations at irregular intervals along the length of the nerves. These nodular dilatations were in all probability ganglioneuromas of corneal nerves demonstrated by histopathology in earlier reports of MEN 2b. IVCM may be potentially useful in detecting the nerve alterations in MEN 2b even before other ocular or systemic features become apparent clinically.

Effect of topical ketorolac 0.4%, nepafenac 0.1%, and bromfenac 0.09% on postoperative inflammation using laser flare photometry in patients having phacoemulsification.

PURPOSE: To study the effect of topical ketorolac 0.4% (Acular LS), bromfenac 0.09% (Megabrom), and nepafenac 0.1% (Nevanac) on postoperative inflammation using laser flare photometry in patients having phacoemulsification with posterior chamber intraocular lens (PC IOL) implantation. SETTING: Tertiary care center, Chandigarh, India. DESIGN: Prospective randomized case series. METHODS: Patients with age-related cataract having phacoemulsification with PC IOL implantation were randomized into 4 groups receiving topical ketorolac 0.4% (Group A), bromfenac 0.09% (Group B), nepafenac 0.1% (Group C), or no nonsteroidal antiinflammatory drugs (NSAIDs) (Group D, control). The topical NSAIDs were started 1 day prior to the surgery and continued for 6 weeks postoperatively. All patients received a standard regimen of moxifloxacin 0.5% (Vigamox) and prednisolone acetate 1.0% (Pred Forte) eyedrops in tapering doses postoperatively. Visual acuity, intraocular pressure (IOP), laser flare photometry, and fundus examination were done preoperatively and postoperatively at 1 day and 1, 2, 4, and 8 weeks. RESULTS: The study comprised 120 patients (120 eyes) (Group A = 33 patients, Group B = 30 patients, Group C = 31 patients, and Group D = 26 patients). The laser flare photometry values at the end of 4 weeks and 8 weeks were minimal in the nepafenac group compared with the other NSAID groups and the no-NSAID group (P = .032 at 4 weeks and P = .252 at 8 weeks). CONCLUSIONS: The topical NSAIDs ketorolac 0.4%, bromfenac 0.09%, and nepafenac 0.1% were effective for the reduction of postoperative inflammation following phacoemulsification. Compared with ketorolac tromethamine, bromfenac, and the control, nepafenac was significantly effective 1 month postoperatively in reducing anterior chamber flare, as evidenced by decreased laser flare photometry. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.