Study of Intraocular Pressure following Neodynium Yttrium Aluminium Garnet Laser Capsulotomy with the Use of Brimonidine: A Descriptive Cross-sectional Study.

INTRODUCTION: Posterior capsular opacification is a common complication after cataract surgery. Neodynium Yttrium Aluminium Garnet laser capsulotomy is still the preferred treatment for posterior capsular opacification. This study was done to determine the use of Brimonidine eye drop in preventing the rise of intraocular pressure post-Neodynium Yttrium Aluminium Garnet laser capsulotomy. METHODS: A descriptive cross-sectional study was conducted in Lumbini eye institute and research center, Bhairahawa, Nepal, in 200 eyes with posterior capsular opacification using Brimonidine from Feb 1, 2019, to July 30, 2019. The Institutional Review Committee approved the study with approval number 0237. A convenient sampling method was used. Pre-capsulotomy best-corrected visual acuity, slit-lamp examination of the anterior segment, and dilated fundus examination were done. Intraocular pressure was measured with Goldmann Applanation Tonometer. Post capsulotomy patients were evaluated after one hour, two hours, and two weeks for intraocular pressure and any complications. The statistical analysis was done using Statistical Package of Social Sciences version 20.0 statistical analysis software. The descriptive statistical analysis of the study was done after the collection of the data. RESULTS: Mean age of patients at presentation was 61.61±SD 1.09. The mean intraocular pressure following Neodynium Yttrium aluminum garnet laser capsulotomy using brimonidine at 1 hour was 12.73±3.3 mmHg.and two hours was 11.98±3.2 mmHg. The mean energy per pulse was 2.3±SD 0.3 mJ. The mean duration of posterior capsular opacification from cataract surgery was 22.28 weeks. CONCLUSIONS: Neodynium Yttrium Aluminium Garnet laser capsulotomy had lower intraocular pressure after the Brimonidine eye drop procedure. The maximum mean reduction in intraocular pressure was observed after two hours.

Non-Endoscopic Endo-nasal Dacryocystorhinostomy in a Saddle shaped nose: A Case Report.

INTRODUCTION: Non Endoscopic endo-nasal dacryocystorhinostomy retains the benefit of an Endo-nasal approach and can be done without using an expensive video endoscope or laser system. CASE PRESENTATION: A 22 years old female presented with epiphora and medial canthal mass in her left eye, accompanied by discharge and recurrent conjunctival congestion since childhood. Physical examination revealed loss of height of the nose with discharge in her left eye, and am immobile and non-tender mass below the level of medial canthal tendon. On applying pressure over the lesion there was mucopurulent discharge from both the upper and lower punctum . The bridge of the nose was very flat and external dacryocystectomy was a challenge. A non-endoscopic endonasal dacryocystorhinostomy with silicon tube intubation was planned. During the procedure, the bone was lower than normal requiring more bone nibbling. Epiphora was resolved immediately after surgery. CONCLUSION: Non-Endoscopic endo-nasal dacryocystorhinostomy has the benefit of doing it through an endo-nasal approach without expensive and space consuming video-endoscope making more room for bone nibbling even in a narrow and deformed nasal cavity.

Lens induced glaucoma in a tertiary eye care centre in Western Nepal.

INTRODUCTION: Lens induced glaucoma due to hypermature cataracts is an important cause of secondary glaucoma in the developing world. The most common etiology of lens induced glaucoma is phacomorphic glaucoma from untreated senile cataract. OBJECTIVES: To study the demographics, clinical presentations and surgical outcome of lens induced glaucoma (LIG). MATERIALS AND METHODS: It is the prospective case series of fifty three patients eyes with LIG over a 6 months period from June 2015 to November 2015. All cases of lens induced glaucoma underwent cataract surgery. Data including demographics, clinical presentations, surgical outcome were analysed using Statistical Package for Social Studies 20.0. RESULTS: The mean age was 61.5 years (Standard deviation 8.9) with predominantly women (30, 56.6%) were affected. Phacomorphic glaucoma (38, 71.7%) was the main cause of lens induced glaucoma, followed by phacolytic glaucoma (15, 28.3%). The main clinical symptoms were reduced vision (100%), eye pain (96.2%) and redness of eyes (62.3%). All patients (100%) presented with visual acuity of <3/60 or worse and intraocular pressure (IOP) more than 40 mm Hg (34, 64.2%). All 53(100%) patients underwent cataract surgery and all of them had tremendously reduced intraocular pressure with a mean 13.9 mmHg and vision had improved from >6/18 as noted in 16(30.2%) cases. CONCLUSIONS: The main clinical presentations of LIG are triad of acute reduced vision, eye pain and redness. The better final BCVA is found when there is an early presentation and less IOP at the time of presentation Public awareness, early detection and early intervention aids in good visual recovery and control of intraocular pressure in LIG.