Refractive and Binocular Vision Status and Associated Asthenopia among Clinical Microscopists.

Background Clinical microscopists are at a greater risk of developing binocular vision anomalies and asthenopia. Objective To assess the refractive and binocular vision status and to explore the association between the presence of asthenopic symptoms and microscopy work among clinical microscopists working at medical laboratory department. Method This cross-sectional study involved 37 clinical microscopists working at medical laboratory department of Dhulikhel Hospital, Nepal. The study was conducted from January to December 2013. Only those participants who had been using microscope for at least a year were enrolled in this study. Each participant underwent distance visual acuity (VA) assessment, refractions, and orthoptic evaluation, including measurement of distance and near phoria, near point of convergence (NPC), near point of accommodation (NPA), positive fusional vergence (PFV), adduction, and calculation of accommodation convergence/accommodation (AC/A) ratio. The tear test was also carried out in each subject. Information about use of glasses, microscopy work (duration, and time spent per day in microscope), and visual symptoms associated with the use of microscope such as eye strain, headache, double vision, and near vision were collected. Result The mean age of the clinical microscopists was 29 ± 5.7 years. The prevalence of refractive error was 56.76% and the mean spherical equivalent (SE) refractive error was -0.77 ± 0.86 D. Refractive error had neither correlation with microscopy work and asthenopic symptoms associated with it, and nor with binocular vision parametersNPC, AA and AC/A ratio. However, there was a positive association between asthenopic symptoms and microscopy work. There was statistically significant difference between symptomatic and asymptomatic subjects for binocular vision parameters, including NPC, AA and positive fusional vergence (PFV) for near. Conclusion Microscopy work has an impact on near binocular vision. Asthenopic symptoms bear a positive association with microscopy work. Refractive error has no significant correlation with either microscopy works or associated asthenopic symptoms.

Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal.

INTRODUCTION: A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA). OBJECTIVE: To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal. MATERIALS AND METHODS: A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5. RESULTS: A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet's membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60. CONCLUSION: Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.

Congenital isolated bilateral upper lid coloboma.

A case of congenital isolated coloboma of both the upper lids from just lateral to the lacrimal punctum up to the medial half, with symblepharon in the region of lower eyelid, was studied in a 7-year-old female child. She did not have any other associated anomalies. The birth and family histories were normal. The puncta were normal in position and well apposed to the globe. The closure of the lid coloboma was done by release of symblepharon along with direct closure of the defect, for the right eye first, and one month later, for the left eye.

Outcome of probing under topical anesthesia in children below 18 months of age with congenital nasolacrimal duct obstruction.

Congenital Nasolacrimal Duct Obstruction (CNLDO) is one of the commonest causes of Childhood epiphora. This study was carried outat Sagarmatha Chaudhary Eye Hospital (SCEH), Lahan to determine the success rate of probing and syringing in children below 18 months of age with CNLDO. A hospital based prospective interventional study of 106 children with age 4 to 18 months (Mean 7.67, SD 4.37) who underwent probing and syringing under topical anesthesia in minor procedure room of OPD. The children were divided into 3 age groups, Group A (age d" 6 months), Group B (age = 7-12 months) and Group C (age = 13-18 months). Success of probing was defined as complete relief of signs and symptoms on follow up at 3-6 weeks. Out of 106 children with CNLDO below 18 months of age, 97 (91.5%) children had better outcome with first attempt of probing. First attempt of probing resulted in resolution in 92.3% (108 out of 117) eyes; 95.6%, 92.7%, 87.1% in the age group less than 6 months, 7-12 and 13-18 months respectively. 9 eyes underwent a repeat procedure of which 6 eyes were cured. Probing and syringing below 6 months of life has shown to be very effective with almost 100% success. The overall success of probing and syringing among children less than 18 months was 97.4%.

Hospital-based community cataract surgery: comparison of visual outcomes between conventional extra-capsular cataract extraction and small incision cataract surgery.

INTRODUCTION: the small-incision cataract surgery is gaining popularity among the ophthalmic surgeons. OBJECTIVE: to compare the visual outcome of conventional extra-capsular cataract extraction (ECCE) and small-incision cataract surgery (SICS) in a hospital based community cataract program. MATERIALS AND METHODS: aprospective interventional study without randomization was carried out including the patients undergoing cataract surgery by either conventional ECCE or manual SICS. They were followed up for 6 weeks postoperatively. The visual outcomes were compared between the two groups. STATISTICS: the statistical program Epi-Info version 2000 was used to analyze the data. Mean values with standard deviations, 95% CI and p value were calculated. The p value of<0.05 was considered significant. RESULTS: of 85 patients, 44 (M: F=10:34) underwent ECCE and 41 (M: F=15:26) SICS (RR= 0.71, 95% CI=0.42-1.2, p value=0.16). Unaided visual acuity on the 1st postoperative day in the ECCE group was e"6/ 18 in 22.7%,<6/18-6/60 in 63.6 %,< 6/60 in 13.7%, whereas in the SICS group, the same was e"6/18 in 70.7%,<6/18-6/60 in 22 %,< 6/60 in 7.3% (95% CI= 0.23 -0.48, p=0.001). Best corrected visual acuity on the 6th week follow-up in the ECCE group was e"6/18 in 79.5%,<6/18-6/60 in 18.2 %,< 6/60 in 2.3% and in the SICS group the same was 6/18 in 90.5% and <6/18-6/60 in 4.9% (95% CI=0.44 -0.73; p=0.00 12). CONCLUSION: both ECCE and SICS are good procedures for hospital based community cataract surgery but within the 6 weeks postoperative period SICS gives better visual outcome. Remarkably higher number of female patients can be provided service in a hospital based community cataract programme as compared to males.

Spontaneous extrusion of subconjunctival cysticercous cyst: a case report.

Ocular cystericosis is the common occurrence among the people of lower socioeconomic status and poor personal hygiene in developing countries. However, spontaneous extrusion of subconjuctival cysticercous cyst is a rare incidence. The present case report describes a spontaneous extrusion of subconjunctival cyst in a 12 year old boy in our clinical set-up. The histopathological examination revealed subconjunctival cysticercous cyst. The extrusion was associated with improvement in clinical sign and symptoms. Cysticercosis should be considered in any case of inflammatory swelling of subconjunctival space especially in people of lower socioeconomic status and poor personal hygiene.

Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal.

Anemia and iron deficiency during pregnancy are prevalent in developing countries, but their causes are not always known. We assessed the prevalence and severity of anemia and iron deficiency and their association with helminths, malaria and vitamin A deficiency in a community-based sample of 336 pregnant women in the plains of Nepal. Hemoglobin, erythrocyte protoporphyrin (EP) and serum ferritin were assessed in venous blood samples. Overall, 72.6% of women were anemic (hemoglobin < 110 g/L), 19.9% had moderate to severe anemia (hemoglobin < 90 g/L) and 80.6% had iron deficiency (EP > 70 micromol/mol heme or serum ferritin < 10 microg/L). Eighty-eight percent of cases of anemia were associated with iron deficiency. More than half of the women (54.2%) had a low serum retinol concentration (<1.05 micromol/L), 74.2% were infected with hookworms and 19.8% had Plasmodium vivax malaria parasitemia. Hemoglobin, EP and serum ferritin concentrations were significantly worse and the prevalence of anemia, elevated EP and low serum ferritin was increased with increasing intensity of hookworm infection. Hookworm infection intensity was the strongest predictor of iron status, especially of depleted iron stores. Low serum retinol was most strongly associated with mild anemia, whereas P. vivax malaria and hookworm infection intensity were stronger predictors of moderate to severe anemia. These findings reinforce the need for programs to consider reducing the prevalence of hookworm, malaria infection and vitamin A deficiency where indicated, in addition to providing iron supplements to effectively control anemia.