Seasonal Hyperacute Panuveitis (SHAPU) Outbreak Amidst COVID-19 Pandemic.

PURPOSE: To document the demographic profile of the SHAPU outbreak amidst the COVID-19 pandemic. METHODS: A multicentric cross-sectional study of the 2021 SHAPU outbreak during the second phase of the COVID-19 outbreak. RESULTS: A total of 135 patients were diagnosed with SHAPU from August to December 2021, 77 (57%) were children <16 years, males 54.8% and 34.8% had direct physical contact with white moths and 41.5% had severe type of SHAPU. Dramatic increment in the moth abundance was noted in these outbreak sites. Few cases presented with atypical ocular findings, unlike past outbreaks. Due to the ongoing COVID-19 pandemic with restrictions on travel and transportation, timely management was difficult and good visual outcome was achieved only in mild-moderate cases with an early presentation. CONCLUSION: The surge in the number of SHAPU patients, its occurrence in areas previously unreported, and some atypical presentation added raised suspicion of a possible link between COVID-19 and SHAPU.

Increase in SHAPU patients, incidence in unreported areas of Nepal, atypical ocular presentations and shift in disease affection from children towards adults population have raised doubt between connections between SHAPU, white moths and COVID pandemic.

Classification of Seasonal Hyperacute Panuveitis (SHAPU).

INTRODUCTION: Classification are essential part of scientific methodology and has important role in medical reporting system. Even after having 46 years long history, Seasonal Hyperacute Panuveitis (SHAPU), the blinding diseases reported mainly from Nepal lacks a standard classification system. Thus, we aim to contribute in the ophthalmic nosology by purposing a classification system for SHAPU. METHODOLOGY: The classification is suggested on the background of prolonged experience of this entity by the group of investigators who have dedicated years of research on this topic. CONCLUSION: We are optimistic that the proposed classification system will help in effective planning and evaluation of this ocular emergency condition and deliver the appropriate and reliable information for timely management and prevention of complications.

Pain Perception in Cataract Surgery: Topical versus Peribulbar Anaesthesia.

INTRODUCTION: The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection. MATERIALS AND METHODS: The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain. RESULTS: In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p <0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p<0.001 for both genders). CONCLUSION: Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.

Assessing Profile and Treatment Outcome in Patients of Ocular Surface Squamous Neoplasia (OSSN).

PURPOSE: This study has attempted to assess the profile and treatment outcome of patients with OSSN and report the recurrence rate following treatment of primary OSSN. MATERIALS AND METHODS: This was a retrospective, non-comparative hospital based observational study. The case files of OSSN patients from Jan 2010 to Dec 2017were assessed. The study site was Himalaya Eye Hospital, Gharipatan, Pokhara. This hospital is the only eye hospital in province 4, Nepal. All the files of suspicious cases of conjunctival mass or OSSN were reviewed. Data regarding demographic characteristics, vision acuity, involved eye, clinical features, conjunctival lesion type, duration of symptoms, preoperative clinical diagnosis, history, other eye disease, associated systemic diseases, occupation as well as treatment modalities of the patients and its outcome were taken. RESULTS: Out of 40 cases, females were 21(52.5%) vesus 19(47.5%) male. Amongthem, 19 patients had keratinized stratified squamous epithelium, 17 had conjunctiva intraepithelial squamous neoplasia and 4 had invasive squalors cell carcinoma. Predominance age group was 15-59 age (25/40, 62.5%), among which 12 had keratinized stratified squamous epithelium, 11 conjunctival intraepithelial squamousneoplasia and 2 had invasive squamous cell carcinoma conjunctival lesion. The mean duration of symptoms was about nine months (S.D. = 5.972). The mean size of lesion mass was 3.28 mm (SD=1.569). More than half of the cases (55%, 22/40) had the mass located at nasal limbus. 95% (38/40) cases underwent lesion total excision and direct closure and 5% (2/40) underwent lesion excision followed by Amniotic Membrane grafting. Only 5% (2/40) cases, those who had undergone lesion excision, the lesion recurrence was observed during follow up period of 31 months. CONCLUSION: The outcome of the OSSN following the treatment was found to be satisfactory. Further studies with prolonged follow-up are recommended to evaluate the risk of recurrence and other adverse effects.

Co morbidities among cataract- operated patients in Rural Nepal.

INTRODUCTION: Himalaya Eye Hospital (HEH), established in 1993, is providing eye care services in Gandaki, Dhaulagiri and Karnali zones. It has been providing surgical and nonsurgical eye camps in rural areas of Gandaki, Dhaulagiri and Karnali zones. The aim of this study was to determine the prevalence of ocular and systemic co morbidities among the persons treated in rural Asian setting. METHOD: This is the prospective non-interventional study. Patients who came to take services in surgical eye camp in rural area of Nepal were included. Data were collected by interviewing the patients. They were interviewed by local volunteers with he questionnaires prepared in English language. The volunteers were explained about the medical terminology and they interviewed the patients in native language. RESULT: Out of 675 patients 401(59%) had systemic co morbidities. Back pain and arthritis being the most common with 321(48%) and 260(38%) respectively. CONCLUSION: This study shows the systemic co morbidities among the patients who came to seek ocular treatment in eye camp in rural area of Nepal. We should do this kind of studies in different area of Nepal. These kinds of study give us total burden of systemic morbidity and help to treat accordingly.

20G silicone rod as monocanalicular stent in repair of canalicular lacerations: experience from a tertiary eye care centre.

To evaluate the outcome of 20G silicone rod as monocanalicular stent in canalicular lacerations. Retrospective case series involving patients between July 2006 and June 2010. Fourteen canalicular repairs in 12 consecutive patients were done in the study period. Eleven were male and mean age was 30.5 years. A single canaliculus was involved in 10 patients and associated injury to the globe was noted in 3 patients. The median lag time between injury and repair was 3 (range 1-9) days. The mean duration of stenting was 6.9 (SD 3.2) weeks. Spontaneous extrusion of monocanalicular stent occurred in 3 patients. Patency on syringing was noted in 10 (70%) canaliculi over a median follow up of 7 (range 2-17) months. 20G silicone rod may be used as an effective and economical alternative in canalicular lacration repairs.