Assessment of tear secretion and tear film instability in cases with pterygium and normal subjects.

INTRODUCTION: Dry eye is a common disorder affecting a significant percentage of the population. MATERIALS AND METHODS: This study is a prospective, hospital-based, case-controlled study conducted between January 2009 and May 2010. Seventy-six pterygium cases and 152 age-and- sex matched controls presenting to the OPD of Manipal Teaching Hospital were included. The TBUT Schirmer's test and basal tear secretion were estimated in all patients. A TBUT of less than 10 seconds and a Schirmer's test of less than 10 mm were considered abnormal. RESULTS: Pterygium was bilateral in 15 (19.7 % ) and unilateral in 61 (80.3 %) patients. Ninety-two (92.1 %) pterygium patients reported either one or more of the six dry eye symptoms. Redness was the most common (67 %) symptom reported. The mean Schirmer's test I, mean basal secretion and mean TBUT values were 16.19 mm, 10.01 mm and 10.56 seconds in pterygium cases and 20.22 mm,13.25 mm and 26.25 seconds in the control group respectively. There was a statistically significant difference in the dry eye results between the pterygium cases and the control group (p value less than 0.05). The odds ratio between pterygium and dry eye was 3.28. Dry eye was present in 26 % of the normal patients and in 54 % of the pterygium cases. CONCLUSION: There is a strong relationship between dry eye and pterygium.

Pattern of refractive errors among the Nepalese population: a retrospective study.

INTRODUCTION: Refractive errors are a major cause of visual impairment in the population. PURPOSE: To find the pattern of refractive errors among patients evaluated in a tertiary care hospital in the western region of Nepal. MATERIALS AND METHODS: The present hospital-based retrospective study was conducted in the Department of Ophthalmology of the Manipal Teaching Hospital, situated in Pokhara, Nepal. Patients who had refractive error of at least 0.5 D (dioptre) were included for the study. RESULTS: During the study period, 15,410 patients attended the outpatient department and 10.8% of the patients were identified as having refractive error. The age of the patients in the present study ranged between 5 - 90 years. Myopia was the commonest refractive error followed by hypermetropia. There was no difference in the frequency of the type of refractive errors when they were defined using right the eye, the left eye or both the eyes. Males predominated among myopics and females predominated among hypermetropics. The majority of spherical errors was less than or equal to 2 D. Astigmatic power above 1D was rarely seen with hypermetropic astigmatism and was seen in around 13 % with myopic astigmatism. "Astigmatism against the rule" was more common than "astigmatism with the rule", irrespective of age. CONCLUSION: Refractive errors progressively shift along myopia up to the third decade and change to hypermetropia till the seventh decade. Hyperopic shift in the refractive error in young adults should be well noted while planning any refractive surgery in younger patients with myopia.

Management of glaucoma in a case of familial aniridia by trabeculectomy.

Aniridia is a rare developmental disorder. Glaucoma and complications associated with glaucoma surgery are a major cause of blindness in patients with aniridia. We describe here a case of a nine year old boy who presented with familial aniridia of both eyes along with glaucoma. He was treated by trabeculectomy of both eyes, which was successful in controlling the glaucoma.

Retinal detachment surgery at Nepal Eye Hospital.

INTRODUCTION: Retinal diseases are one of the important causes of blindness in Nepal. This study is done with objectives of finding the outcome of retinal detachment surgery. METHODS: A retrospective analysis of 110 patients who underwent retinal detachment surgery over five year period was conducted in Nepal. RESULTS: Retinal re-attachment was achieved in 94.4% and postoperative visual acuity of 6/36 to 6/6 was achieved in 52.7% (As possible risk factors, myopia was present in 34.5% ophkia in 29%, trauma in 9%, and lattice) degeneration was 5.4%. CONCLUSIONS: The study has shown a promising result for the retinal detachment surgery.

Plasma vitamin E and other analyte levels in Nepalese camp elephants (Elephas maximus).

Plasma concentrations of alpha-tocopherol (vitamin E) and other analytes in Asian elephants (Elephas maximus) in Nepal were determined during typical work camp management of the elephants. Elephants foraged for food for 4-6 hr each day under the control of mahouts and were also provided daily with cut forage and supplements of unhusked rice, cane molasses, and salt. Blood samples were taken monthly for 1 yr without chemical restraint from 26 female elephants in four camps. Elephants were 6-60+ yr of age. Mean (+/-SEM) alpha-tocopherol concentration was 0.77+/-0.047 microg/ml, with a range of 0.23-1.57 microg/ml. Subadults had lower concentrations than did older elephants, and there were significant differences in mean concentrations from different camps and in mean monthly concentrations. Plasma alpha-tocopherol concentration appears to vary widely between individuals, and a single value of <0.3 microg/ml is not sufficient to diagnose incipient vitamin E deficiency. Mean (+/-SEM) plasma retinol (vitamin A) concentration was 0.063+/-0.003 microg/ml with a range of 0.01-0.12 microg/ml. Subadults had higher concentrations than did older elephants, and mean retinal values differed significantly among camps. Beta-carotene was not found in plasma. Twenty-five other analytes determined or derived were generally similar to those reported in other Asian and African (Loxodonta africana) elephants. Estimates of nutrient intake, based upon diet composition, suggested that dietary concentrations of zinc and sodium may have been marginal, but the absence of signs of any nutrient deficiencies indicates that dietary husbandry in these elephant camps was generally satisfactory.

Prevalence of rhinosporidiosis of the eye and its adnexa in Nepal.

This study describes the clinical features, diagnosis, and treatment of rhinosporidiosis of the eye and its adnexa in a series of 76 cases in Nepal and six originating in India. The disease caused by the fungus Rhinosporidium seeberi was seen most frequently in young children between eight and 10 years of age. Males were infected more than females (2.5:1). The conjunctiva was the most common site of infection in 76 (92.68%) of the cases. The lacrimal sac was affected only in six (7.32%) cases. Simple total excision of the conjunctival polyps gave highly satisfactory results in cases of conjunctival sac infections. Except for one patient, there were no recurrences in the 76 cases. Meticulous excision of polyps provided a satisfactory result in the treatment of six cases with lacrimal sac infection. Recurrence was noted in one of these six cases followed up to two and a half years after surgery. The conditions diagnosed clinically were confirmed by histopathology. This review of 82 cases is the first such report of rhinosporidiosis from Nepal.

Results and evaluation of high volume intracapsular cataract surgery in Nepal.

One thousand intracapsular cataract extractions were performed by two ophthalmologists over a 57-day period at Lahan Eye Hospital in Nepal. Ninety-nine per cent of eyes had a visual acuity of less than 3/60 at surgery. Ninety-eight per cent of eyes achieved a visual acuity of 3/60 or better with aphakic spherical correction at discharge, of which 69% had a visual acuity of 6/36 or better. In 314 eyes seen at 1-month follow-up, 88% achieved 6/18 or better with full aphakic correction. The surgical time averaged less than 10 min and the cost of disposables less than pounds 1 per operation.

Vitamin A deficiency and corneal ulceration in south-east Nepal: implications for preventing blindness in children.

A retrospective review of the outpatient records of 4601 children aged 0-10 years who had been seen between January 1986 and December 1988 at Lahan Eye Hospital, south-east Nepal, revealed that 15.4% had evidence of active or past xerophthalmia. Of 293 children with corneal xerosis or corneal ulcer, 49% had been examined in the 4-month period May-August. The peak age for active noncorneal xerophthalmia was 5 years and for active corneal xerophthalmia, 3 years. Previous population-based studies in Nepal have documented the presence of noncorneal xerophthalmia (Bitot's spots) in children. The present study confirms that vitamin A deficiency is a major cause of blindness and loss of vision among children in the eastern plains of Nepal.