A histopathological study of ophthalmic lesions.

Ophthalmic lesions include a wide spectrum of conditions ranging from benign lesions to precancerous lesions and malignant lesions. The diagnosis of these lesions is based on the clinical as well as histopathological features. This was a prospective study of ophthalmic lesions conducted in the department of pathology of Nepal Medial College teaching hospital over a period of one year (September 2012 - August 2013). In this study period, we received total 11 ophthalmic biopsies. Out of these, 54.5% cases were conjunctival lesions and 45.5% cases were eye lid lesions. The age range was from 8 years to 40 years with the mean age of 25.5 years. All the cases were benign lesions, papilloma being the most common clinical and histopathological diagnosis. Other lesions like inclusion cyst, dermoid cyst, seborrheic keratosis, pilomatrixoma, nevus and molluscum contagiosum are also included in our study.

Pattern of fungal isolates in cases of corneal ulcer in the western periphery of Nepal.

PURPOSE: To find out the epidemiologic features in 686 consecutive cases of fungal keratitis presenting in a tertiary eye hospital in the western region of Nepal. MATERIALS AND METHODS: A prospective hospital - based study was carried out on 1880 consecutive patients presenting with corneal ulcer in the outpatient department and cornea clinic of Lumbini Eye Institute, Bhairawa, Nepal. The socio-demographic data, predisposing risk factors, prior treatment modalities, laboratory results and the distribution pattern of fungus species were analyzed. RESULTS: Diagnosis of fungus keratitis was established in 686 (36 %) out of the total study group of 1880 cases. The spectrum of fungi isolated were Fusarium species (Fusarium spp.) in 219 (31.9 %), followed by unidentified dematiaceous 151 (22 %), curvularia 122 (17.7 %) and unidentified hyaline in 111 cases (16.1 %). Men (59.3 %) were more commonly affected than women (40.6 %). The young adults age group of 31-40 years was most commonly involved (26.6 %). Corneal trauma (58 %) and topical steroids (12 %) were the most common predisposing risk factors noted. CONCLUSION: In contrast to the other studies done in Nepal, we found Fusarium to be the most common fungal isolate causing corneal ulcer followed by unidentified dematiaceous, unidentified hyaline and curvularia. Corneal trauma was the commonest predisposing risk factor in causing fungal keratitis.

Scleral buckle surgery for pseudophakic and aphakic retinal detachment in western Nepal.

INTRODUCTION: Retinal detachment remains one of the most serious complications of cataract surgery. Treatment of this condition has represented a challenge for vitreoretinal surgeons.Scleral buckle (SB) surgery is one of the treatment options in pseudophakic and aphakic retinal detachment (RD). AIMS: To find out the anatomical and visual outcome of SB in pseudophakic and aphakic RD. SUBJECTS AND METHODS: Retrospective case series of 46 consecutive eyes of 46 patients with RD (38 pseudophakic and 8 aphakic eyes) that had undergone conventional SB surgery were reviewed from patient files. Postoperative retinal status at 3 weeks, 6 weeks and 3 months were recorded to see the anatomical success rate after retinal reattachment surgery. Best corrected visual acuity (BCVA) at 3 months follow-up was noted. RESULTS: The mean age of the patients was 54.28 ± 13.49 years. Forty eyes (86.9 %) had primary attachment by 6 weeks duration. Five eyes had undergone repeat surgery within a six-week duration (pars plana vitrectomy). Forty patients had follow-up visit to 12 weeks, achieving retinal attachment in 37 eyes (80.5 %). Best corrected visual acuity (BCVA) at 3 months was better than 6/60 in 18 eyes (39.1%), BCVA better or equal to 1/60 but less than 6/60 in 18 eyes (39.1%) and BCVA less than 1/60 in 4 eyes (8.7 %). CONCLUSION: Conventional scleral buckling has good outcome for pseudophakic and aphakic RD and can be useful for patients in peripheral eye hospitals where patients cannot afford high cost surgeries.

Pattern of refractive errors among patients at a tertiary hospital in Kathmandu.

A hospital based cross sectional study was carried out to determine the pattern of refractive errors among patients attending the out patient department, Department of Ophthalmology, Nepal Medical College Teaching Hospital. A total of 1100 patients were evaluated, (male 43.67%; female 56.33%). Simple myopic astigmatism was the most prevalent type of refractive error accounting for 27.18% followed by simple myopia (21.66%) and compound myopic astigmatism (19.48%). Simple hypermetropia (15.03%) and mixed astigmatism (4.3%) were also noted. Simple myopia was prevalent among the younger age group in the first to third decades, whereas hypermetropia was seen in the older patients in the third to fifth decades.

Profile of vernal keratoconjunctivitis in Nepal: a hospital based study.

Vernal keratoconjunctivitis (VKC) or Spring Catarrh is recurrent, chronic, allergic conjunctivitis occurring in prepubertal age-group during spring and summer season. Though this is a self-limiting disorder, it often leads to visual impairment due to secondary corneal complications if not treated during active stage of the illness. Apart from this, the illness is known to affect the productivity and quality of life in school going children due to absenteeism and limitations to outdoor activities. Knowing the clinical profile of disease would provide the evidence for developing, treatment protocol in coming years. Therefore a hospital based study was designed to see the profile of VKC. Total of 220 patients were enrolled in this study. Male to female ratio with VKC was found to be 4:1. Clinical presentation showed seasonal variation; 78.2% during the spring and summer season. Bilateral involvement was seen in 100% cases, out of which 44.5% were limbal type. The best spectacle corrected visual status of better than 6/9 was in 96.4%, while 2.3% had vision less than 6/12. In 9.5% corneal involvement was seen as superficial keratopathy, while others, such as Shield ulcer, pannus, corneal scar, and keratoconus consisted of 8.3%. The disease is predominantly seen in male child with seasonal variation. Visual impairment is mainly due to involvement of cornea.

Surgical outcome of pars plana vitrectomy: a retrospective study in a peripheral tertiary eye care centre of Nepal.

BACKGROUND: Trans-pars plana vitrectomy (TPPV) is an effective surgical procedure to retain the useful vision in vitreoretinal diseases. OBJECTIVE: To evaluate the surgical outcome of pars plana vitreoretinal surgery. STUDY DESIGN: Retrospective non-comparative interventional case series. MATERIALS AND METHODS: A hospital-based retrospective interventional study of series of cases was carried out in retina clinic of Lumbini Eye Institute, Nepal, over a period of one-and-a-half years. Records of 64 patients who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. OUTCOME MEASUREMENT: The parameters studied were post-operative visual acuity and complications. RESULTS: Of 64 patients, 61% presented 2 months after the onset of symptoms. Preoperatively, 65.5% had visual acuity of hand motions to 3/60 followed by perception of light only in 26.6%. The main indication for TPPV was vitreous haemorrhage (VH), in 53%. The visual acuity improved to better than 6/60 in patients with VH (68%), whereas, overall, in 72% of the subjects, it improved by 2 lines postoperatively. The commonest intra-operative complications were iatrogenic retinal break (5, 7.8%) at the sclerostomy site. CONCLUSION: The main indication for TPPV is vitreous haemorrhage. Useful vision can be restored by pars plana vitrectomy in the majority of the patients. Retinal break is the commonest complication of TPPV.

Outcome of cluster endophthalmitis in western plain region of Nepal.

BACKGROUND: Post-operative endophthalmitis remains one of the most visually devastating complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. Excessive inflammation, particularly in the early post-operative phase, should be regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye as well as better visual outcome. OBJECTIVE: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis in high volume cataract surgical centre. MATERIALS AND METHODS: Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin, amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital's microbiology laboratory for culture and sensitivity testing. All patients received intravenous ciprofloxacin for 3 days and oral ciprofloxacin for 7 days. Topical Prednisolone acetate, Ofloxacin, Gentamycin and atropine were given to all patients. Patients were followed up till 6 weeks. RESULTS: 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2 cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60 to 5/60. CONCLUSION: Intravitreal antibiotics and steroid, along with systemic ciprofloxacin and subconjunctival vancomycin has good visual outcome for post operative cluster endophthalmitis.

Causes of vision impairment and assessment of need for low vision services for students of blind schools in Nepal.

BACKGROUND: The present study is first of its kind to evaluate causes of visual impairment of blind students in Nepal and assess their need for low vision rehabilitation services. AIM: To evaluate causes of vision impairment of students enrolled in blind schools in Nepal and assess the need for low vision rehabilitation services in these students. MATERIALS AND METHODS: A survey was conducted in 12 blind schools in Nepal, which were registered with Nepal Association for Welfare of Blindness (NAWB).It was conducted by a team of an ophthalmologist and an optometrist, by using standard eye examination protocols of the World Health Organization Prevention of Blindness Program (WHO/PBL). RESULTS: Of the 345 students enrolled in 12 schools, 285 students were examined (response rate of 82.61%). The students were in the 5 - 29 years age group. Nearly three-fourth of the children had become blind within one year of age and 52.3% visually impaired at birth and 20.7% developed vision impairment within one year of age. After refraction, 26 students (9.12%) had mild visual impairment, 21 students (7.37%) had severe visual impairment and 238 students (83.51%) were blind. The main cause of vision impairment was found to be corneal 35.79% and retina diseases, mainly dystrophy, 20.35% followed by problems with the whole globe, lens and optic nerve, accounting for 13.33%, 12.63% and 12.98% respectively. The major etiological factors were those of childhood such as Vitamin A deficiency, measles and similar causes (42.11%) followed by hereditary causes (25.26%). Of the total students examined, 48.07% were visually impaired due to preventable causes and 16.14% treatable aggregating to 64.21% of avoidable blindness. Fifty seven (28.22%) students could read smaller than 2 M print size after low vision assessment for near and 33(15.78%) students benefited with telescopic trial for distance low vision. CONCLUSION: In Nepal, renewed focus on providing best possible quality of life for visually impaired children by proper low vision assessment and eye health education focusing on, general public and community health workers, with governmental and institutional support is required to achieve Vision 2020 objectives to decrease childhood blindness.