Effectiveness of a dietician-led intervention in reducing glycated haemoglobin among people with type 2 diabetes in Nepal: a single centre, open-label, randomised controlled trial.

Background: Nutrition education and counselling are considered a cornerstone for the management of type 2 diabetes (T2D). However, there is limited research related to the management of T2D through dietary approach, particularly in low-income and middle-income countries (LMICs) like Nepal. This study assessed the effectiveness of a dietician-led dietary intervention in reducing glycated haemoglobin (HbA1c) levels among people with T2D. Methods: An open-label, two-armed, hospital-based, randomised controlled trial was conducted at Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Participants were randomly assigned to either dietician-led dietary intervention group (n = 78) or usual care control group (n = 78). People with type 2 diabetes with HbA1c >6.5% and aged 24-64 years were included in the study. The primary outcome was a change in HbA1c level over six months, and secondary outcomes included changes in biochemical and clinical parameters, Problem Areas in Diabetes (PAID) score, diabetic knowledge, dietary adherence, and macronutrient intake level. Data were analysed using an intention-to-treat approach. This trial is registered with ClinicalTrials.gov, NCT04267367. Findings: Between August 15, 2021 and February 25, 2022, 156 people with type 2 diabetes were recruited for the study, of which 136 participants completed the trial. At six months of follow-up, compared to baseline values, the mean HbA1c (%) level decreased in the intervention group by 0.48 (95% CI: -0.80 to -0.16), while it increased in the control group by 0.22 (95% CI: -0.21 to 0.66). In an adjusted model, the reduction in HbA1c (%) levels for the intervention was 0.61 (95% CI: -1.04 to -0.17; p = 0.006). In addition, fasting blood glucose was decreased by 18.96 mg/dL (95% CI: -36.12 to -1.81; p = 0.031) after the intervention. The intervention resulted in the reduction of BMI, waist and hip circumference, PAID score, dietary adherence, and macronutrient intake in the intervention group compared to the control group. Interpretation: The dietician-led intervention improved glycaemic control, improved macronutrient intake, and clinical outcomes among people with type 2 diabetes. The dietician-led intervention may be considered for diabetes management in LMICs. Funding: The research was funded by the University Grants Commission (UGC), Nepal.

Factors affecting nutritional knowledge, attitude, practices and dietary intake among national players in Kathmandu, Nepal: a cross-sectional study.

INTRODUCTION: Good nutrition knowledge and nutrient intake have been regarded as significant determinants in enhancing athletes' performance and overall health status. This study aimed to assess knowledge, attitude, and practices of nutrition and dietary intake among athletes. METHODS: A cross-sectional study was conducted from January to April 2022 among national athletes from two sports clubs in Kathmandu Metropolitan City, Nepal. A semi-structured questionnaire was used to collect the data. Anthropometric measurements and dietary intake were recorded. Bivariate and multivariate binary logistic regression was used to estimate the crude odds ratios (cOR), and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: A total of 270 players were included in this study (mean age, 25 years; 49.6% male, 50.4% female). Almost half of the athletes had good nutrition knowledge [54.1% (146/270)], attitude [56.7% (153/270)], and practices [50% (135/270)] scores. The mean energy, carbohydrate, protein, and fat intake were 35.0 kcal/kg/day, 5.6, 0.9, and 0.9 g/kg/day, respectively. Likewise, mean calcium and iron intake were 370, and 12.5 mg, respectively. In the multivariate model, families with monthly household income less than 50,000 Nepalese rupees ($400) (adjusted Odds Ratio/aOR = 2.58; 95% CI: 1.12 to 5.96), and those who did not receive diet plan (aOR = 3.14; 95% CI: 1.25 to 7.84) were more likely to have poor nutrition knowledge. Players who did not check food labelling (aOR = 1.44; 95% CI: 0.78 to 2.63) were more likely to have negative attitude towards nutrition. Players who did not ever attend nutrition class (aOR = 3.54; 95% CI: 1.46 to 8.54) and those who did not consume different food during off and on the season of sports (aOR = 2.36; 95% CI: 1.39 to 4.01) were more likely to have poor nutrition practice. CONCLUSIONS: Half of the athletes' nutritional knowledge, attitudes, and practices score were satisfactory. Nutrient intake among athletes was suboptimal. Nutrition intervention programs are critical to improve nutritional knowledge, attitude and practice related to dietary intake among national athletes in Nepal.

Cataract among Patients with Renal Transplantation in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Intensive immunosuppressant therapy after renal transplantation has found to cause systemic and ocular side effects among them is cataracts. Studies on a similar topic have still remained explored in our setting. The aim of the study was to find out the prevalence of cataract among patients with renal transplantation in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among patients of renal transplantation at tertiary care centres from 1 May 2021 to 31 October 2021. The data was collected after the ethical approval from Institutional Review Committee [Reference number: 397(6-11) e2077/078]. Study proforma recorded the number of patients with cataracts, duration of steroid use, mean age and other comorbidities. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 31 renal transplant patients, 10 (32.26%) (15.80-48.72, 95% Confidence Interval) had cataract. Conclusions: The prevalence of cataract among renal transplantation patients was found to be lower than similar studies done in similar settings. Keywords: cataract; prevalence; renal transplantation; steroid.

Evaluation of depth perception and association of severity in Glaucoma patients and suspects.

BACKGROUND: To evaluate depth perception in Primary open angle glaucoma (POAG), glaucoma suspects compared to controls and to determine the association between depth perception and severity of glaucoma. METHODS: This was a hospital based, comparative, cross-sectional study. The ethical clearance was taken from institutional review committee of Institute of Medicine [Reference no.399 (6-11) E2 077-078]. Agematched, equal number of participants in each group (N=20) were evaluated with both Titmus and Frisby stereoacuity tests to measure depth perception as stereopsis threshold in seconds of arc. The participants were selected using the purposive sampling technique. RESULTS: There was no differences in age, sex, or best corrected visual acuity, intraocular pressure, central corneal thickness (CCT), found among the three groups (POAG, Glaucoma Suspects and Control) respectively. However, there was significant difference in cup disc ratio (CDR) between the groups. Equal number of male and female were there in each group, while in POAG group male to female ratio was 3:2. The mean stereoacuity threshold in control group was 53.5±23.23 seconds of arc with Titmus test and 38.75±18.83 seconds of arc with Frisby stereoacuity test. The difference in threshold was significant between control and glaucoma suspect with Titmus (t=1.991, p=0.05) and with Frisby (t=2.114, p=0.04). The difference was also significant in POAG group by Titmus (t=3.135, p=0.0033) and by Frisby (t=3.014, p=0.004). More so, with increasing severity of glaucoma, the mean threshold of stereopsis increased as seen with both Titmus and Frisby Tests (ANOVA, p < 0.001) CONCLUSION: Primary open angle glaucoma patients and glaucoma suspects, showed significant reduction in depth perception. Decreased stereoacuity was associated with greater glaucomatous visual field loss.

Factors affecting final functional outcomes in open-globe injuries and use of ocular trauma score as a predictive tool in Nepalese population.

BACKGROUND: Open globe injury (OGI) is one of the most devastating form of ocular trauma. The aim of the study is to identify the epidemiology and predict visual outcomes in traumatic open globe injuries using ocular trauma score (OTS) and correlate with final visual acuity (VA) at 3 months. METHODS: Patients older than 5 years, presenting to B.P. Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) from March 2016- March 2017 with OGI that met inclusion criteria were evaluated. Patient profile, nature and cause of injury, and time to presentation were recorded. Patients were managed accordingly and followed up to 3 months. An OTS score for each patient was calculated and raw scores were categorized accordingly. The VA after 3 months were compared to the predicted OTS values. RESULTS: Seventy-three eyes of 72 patients were examined. 76 % were male, and the mean age was 26.17 years (median, 23.5 years). The mean time from injury to presentation was < 6 hours (30 patients, 41 %). Thirty-seven eyes (51 %) had zone I trauma, followed by twenty eyes (27 %) with zone II, and sixteen eyes (22 %) with zone III trauma. Sixty-five patients (90 %) were managed surgically, and fifty (68 %) received intravitreal antibiotics with steroid. When compared, the projected VA as per OTS were able to predict actual final visual outcomes in 60 % of the eyes with OGI of various zones. CONCLUSIONS: OTS can be an accurate predictive tool for final visual acuity even with a short follow up period of 3 months; with poor presenting visual acuity, delayed presentation, posterior zones of injury, need for intravitreal injections, endophthalmitis, and globe rupture associated with poorer prognosis.

Bilateral Cryptophthalmus: First Case Report from Nepal.

INTRODUCTION: Cryptophthalmus is characterized by a partial or complete casing of the eyeball by the skin. Cryptophthalmus alongside other systemic abnormalities is well-known as Fraser syndrome. It is an unusual genetic disorder with limited literature. The complexities of disease and limited experience pose challenges in its management. CASE: A two-day-male neonate was brought by his parents with a complaint of swelling in the right orbital region and deformed left eye since birth. Examination revealed bilobed globular swelling in the right orbital region covered by a continuous sheet of skin from forehead to cheek with no visible ocular tissue. On the left side, there was absence of upper lid margin and eyelashes and superior symblepharon. He also had bilateral ear abnormalities and right renal agenesis. Surgical intervention was done. On the right side, removal of the globe and cyst was done. On the left side, upper eyelid reconstruction with symblepharon release was done with amniotic membrane transplantation. CONCLUSIONS: The management of cryptophthalmus is challenging. Reconstructive surgeries allow cosmesis but useful vision is rarely gained. This is the first case report from Nepal to date to the best of our knowledge.

Effect of High Myopia on Optic Nerve Head by Confocal Scanning Laser Ophthalmoscopy in Nepalese Eyes.

PURPOSE: To compare parameters of confocal scanning laser ophthalmoscopy (Heidelberg Retinal Tomograph [HRT] II) in high myopia with age- and sex-matched emmetropes. METHODS: A hospital-based cross-sectional study was conducted among Nepalese subjects aged 18 to 35 years at BP Koirala Lions Centre for Ophthalmic Studies, Institute of Medicine, Maharajgunj, Kathmandu from November 2015 to October 2016. Fifty consecutive subjects with high myopia (spherical equivalent ranging from -6.00 to -12.00 diopters) and age- and sex-matched emmetropic subjects were enrolled for comparison. Correlations between disc area and other HRT parameters, asymmetry between the right and left eyes, and comparisons between male and female subjects in both high myopic and emmetropic groups were evaluated. RESULTS: Disc area was not significantly (p = 0.11) larger in high myopic eyes than in emmetropic eyes. HRT parameters in highly myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes. Disc area was found to be significantly positively correlated with inter disc parameters and significantly negatively correlated with rim to disc area ratio in the high myopia group. Disc area and other intra-disc parameters showed significant correlations between right and left eyes in both high myopia and emmetropia, and no significant differences between males and females from a Nepalese population. CONCLUSIONS: Characteristics of HRT parameters in high myopic eyes involved smaller cup parameters and greater rim parameters compared with emmetropic eyes in a Nepalese population. The effect of disc area on HRT parameters differed significantly only in height variation contour by emmetropic eyes.

Congenital Microphthalmia with Intraorbital Cyst: A Rare Case Report.

Microphthalmia is considered to be the most common congenital malformation of the eye after congenital cataract. However, its association with intraorbital cyst is considered to be very rare. Most of the lesions are still misdiagnosed as orbital tumor and teratomas as there is a general paucity of data reported in literature. Herein, we report a rare case of congenital microphthalmia with intraorbital cyst in an eight-month-old male patient.

Severity of primary open-angle glaucoma in patients with hypertension and diabetes.

BACKGROUND: Primary open-angle glaucoma (POAG) is a progressive optic neuropathy with numerous risk factors. Its severity with associated risk factors remains a widely debated topic. AIM: To evaluate the severity of POAG in patients with hypertension (HTN) and diabetes or both. PATIENTS AND METHODS: This hospital-based, cross-sectional descriptive study was conducted for a period of 18 months from January 2016 to June 2017. Diagnosed cases of POAG were evaluated for severity with associated risk factors. RESULTS: A total of 221 patients were enrolled in the study. The mean age of the patients was 54.4 (SD ± 15.9) years with a male to female ratio of 0.93:1. Of the 221 patients, 68 (31%) had a family history of POAG. Mean intraocular pressure was 15.8±4.87 mmHg, and mean central corneal thickness was 535.4±34.9 µm. A total of 81 (36%) patients had HTN, 21 (9.50%) had diabetes mellitus (DM), and 15 (6.80%) had both HTN and DM. Analysis using SPSS version 20 was done. The severity of POAG was found to be significantly higher in patients with HTN, DM, or both when evaluated on the basis of anatomical and functional loss. CONCLUSION: POAG patients with HTN, DM, or both were found to have more severe POAG. Patients with these risk factors could represent "high-risk patients" with POAG. Patients with HTN and DM, or both may require evaluations on a more frequent basis to access the progression/severity of POAG.

Correlation of Peripapillary Retinal Nerve Fibre Layer Thickness and Visual Evoked Potential in Optic Neuritis in a Tertiary Eye Care Centre.

INTRODUCTION: Optic neuritis (ON) is the involvement of the optic nerve as a result of inflammation, demyelination or infection. OBJECTIVE: To study the correlation between peripapillary retinal nerve fibre layer thickness (pRNFL) and visual evoked potential (VEP) in ON cases. MATERIALS AND METHOD: A non-interventional, descriptive, cross sectional study enrolling 66 eyes of 49 patients with ON was done. pRNFL thickness was measured by Optical Coherence Tomography (OCT) and VEP was also done. OCT and VEP findings were compared with the control group. In addition correlation between pRNFL thickness and VEP was done. RESULTS: The mean pRNFL in affected eyes were significantly higher than the control superiorly (p-value<0.001), inferiorly (p-value <0.001), temporally (p-value 0.005) and nasally (p-value <0.001). The mean P100 latency in the affected eyes were significantly prolonged than the control eyes both at 1º (p-value<0.001) and at 15' (p-value=0.05). The mean N75-P100 amplitude in the affected eyes were significantly reduced than the control eyes both at 1º (p-value<0.001) and at 15' (p-value<0.001). The mean pRNFL thickness in all four quadrants and VEP findings of the affected eyes showed no significant correlation. CONCLUSION: The increased thickness in non-myelinated pRNFL has no correlation with the increased latency or decreased amplitude in cases of ON. However, OCT is seen as a useful tool in detecting and quantifying even subtle pRNFL changes in cases of optic neuritis.

Demographic pattern and clinical characteristics of optic neuritis in a tertiary eye care centre.

PURPOSE: To study the demographic pattern and clinical characteristics of optic neuritis cases in a tertiary eye care centre in Nepal. DESIGN: Descriptive, cross-sectional study. METHODOLOGY: Complete ocular examination was done in all the newly diagnosed cases of optic neuritis presenting from January 1st 2012 to June 30th 2013. Demographic pattern, clinical features, visual acuity, colour vision, contrast sensitivity and visual field defects were studied. RESULTS: Sixty seven eyes of 50 patients (28 females and 22 males) with optic neuritis were included in the study. The mean age was 34.32 years ± 13.72 years. The male: female ratio was 1:1.27. All the cases presented with complaint of blurring of vision. Painful ocular movement was noted in 58%. On ophthalmoscopic examination around 2/3rd of eyes suffered from papillitis (72%) and 1/3rd from retrobulbar optic neuritis (27%). Only one case of neuroretinitis (1%) was seen in the study. The colour vision pattern was variable. Contrast sensitivity was reduced in 94%. Centrocaecal scotoma was seen in 10.5%. CONCLUSION: Females were predominantly affected. Unilateral involvement was the most common presenting as papillitis.

Intraeye retinal nerve fiber layer and macular thickness asymmetry measurements for the discrimination of primary open-angle glaucoma and normal tension glaucoma / Mediciones intraoculares de las capas de fibras nerviosas de la retina y de la asimetría del grosor macular para la discriminación del glaucoma primario de ángulo abierto y el glaucoma normotensional

Purpose: The aim of this study was to evaluate the diagnostic capability of intraeye retinal nerve fiber layer (RNFL) thickness and macular thickness (MT) asymmetry measurements for the discrimination of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT). Methods: A total of 90 subjects were enrolled including 30 consecutive healthy subjects, 30 consecutive subjects with POAG, and 30 consecutive subjects with NTG. RNFL thicknesses around the optic disc as well as MT measurements were taken with circular and radial SD-OCT scans. Intraeye retinal and MT asymmetry were calculated as the absolute difference between superior and inferior hemispheres of the eye using posterior pole asymmetry analysis protocol. Analysis of variance was used for comparison and areas under the receiver operating characteristic (AROC) were obtained for different parameters among the three diagnostic groups. Results: There was a significant difference in MT asymmetry for all comparison groups (normal-NTG,p<0.05; normal-POAG, p<0.001; and NTG-POAG, p<0.001). Intraeye retinal nerve fiber thickness asymmetry measurements were not different between the groups (normal-NTG, p<0.187; normal-POAG, p<0.056; and NTG-POAG, p<0.837). The area under ROC curves exceeded 0.800 for all the studied parameters, including the MT asymmetry except for intraeye RNFL thickness asymmetry which had the lowest AROC as well as the least sensitivity for identifying subjects with NTG from normal (AROC=0.626, sensitivity=30%); POAG from normal (AROC=0.644, sensitivity=37%) and NTG from POAG (AROC=0.533, sensitivity=13%). Conclusion: The intraeye MT asymmetry holds significant potential as a distinguishing parameter for NTG and POAG (AU)

Objetivo: El objetivo de este estudio fue el de evaluar la capacidad diagnóstica de las mediciones intraoculares de la asimetría del grosor de las capas de fibras nerviosas de la retina (RNFL) y del grosor macular (MT) para la discriminación del glaucoma normotensional (NTG) y el glaucoma primario de ángulo abierto (POAG), mediante tomografía de coherencia óptica de dominio espectral (TCO-DE). Métodos: Se incluyó a un total de 90 sujetos, de los cuales treinta eran sujetos sanos consecutivos, treinta sujetos consecutivos con POAG, y treinta sujetos consecutivos con NTG. Los grosores de RNFL alrededor del disco óptico, así como las mediciones de MT, se obtuvieron mediante TCO-DE circular y radial. La asimetría intraocular retiniana y de MT se calcularon como diferencia absoluta entre los hemisferios oculares superior e inferior, utilizando el protocolo de análisis de asimetrías del polo posterior. Se utilizó para la comparación el análisis de la varianza, obteniéndose las áreas bajo la curva de características operativas del receptor (AUROC) para los diferentes parámetros en los tres grupos diagnósticos. Resultados: Se produjo una diferencia significativa en relación a la asimetría de MT para todos los grupos comparativos (normal-NTG, p<0,05; normal-POAG, p<,001y NTG-POAG, p<0,001), mientras que las mediciones intraoculares de la asimetría del grosor de las fibras nerviosas de la retina no reflejaron una diferencia entre los distintos grupos (normal-NTG p<0,187, normal-POAG, p<0,056y NTG-POAG, p<0,837). El área bajo la curva superó el valor de 0,800 para todos los parámetros en estudio, incluyendo la asimetría de MT, exceptuando la asimetría intraocular del grosor RNFL, que reflejó el menor valor de AUROC, al igual que una menor sensibilidad para la identificación de los sujetos con NTG respecto a los normales (AUROC=0,626, sensibilidad=30%), POAG respecto a los normales (AUROC=0,644, sensibilidad=37%) y NTG respecto a POAG (AUROC=0,662, sensibilidad=13%). Conclusión: La asimetría intraocular de MT tiene un potencial significativo como parámetro distintivo de NTG y POAG (AU)

Comparison of retinal nerve fiber layer and macular thickness for discriminating primary open-angle glaucoma and normal-tension glaucoma using optical coherence tomography.

PURPOSE: The aim of this study was to evaluate the discrimination capabilities of macular and peripapillary retinal nerve fiber layer (pRNFL) thickness parameters as measured using spectral domain optical coherence tomography (SD-OCT) between primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: A total of 90 subjects were enrolled: 30 healthy subjects, 30 subjects with POAG and 30 subjects with NTG, consecutively. Retinal nerve fiber layer thickness, macular thickness and volume measurements were obtained with circular and radial SD-OCT scans. All parameters were compared between groups using an analysis of variance test. Areas under receiver-operating characteristic (AROC) curves with sensitivities at specificities greater than or equal to 90 per cent were generated to compare discrimination capabilities of various parameters between POAG and NTG. RESULTS: Macular thickness and volume measurements were the highest in normal subjects, followed by NTG and POAG (p < 0.05). Average retinal nerve fiber layer thickness had perfect discrimination for normal-POAG (AROC: 1.000; sensitivity: 100 per cent) and near perfect discrimination for normal-NTG (AROC: 0.979; sensitivity: 93 per cent) as well as NTG-POAG pairs (AROC: 0.900; sensitivity: 60 per cent). Inferior outer macular thickness (IOMT) and total volume were the best macular thickness and volume parameters having similar AROCs and sensitivities between normal and POAG (IOMT, AROC: 0.987; sensitivity: 92 per cent and total volume, AROC: 0.997; sensitivity: 97 per cent), normal and NTG (IOMT, AROC: 0.862, sensitivity: 47 per cent and total volume, AROC: 0.898, sensitivity: 67 per cent) and also between NTG and POAG (IOMT, AROC: 0.910, sensitivity: 53 per cent and total volume, AROC: 0.922, sensitivity: 77 per cent). In each comparison group, there was no statistically significant difference in AROCs between average retinal nerve fiber layer and inferior outer macular thickness, as well as total volume. CONCLUSIONS: The macular parameters offer comparable performance to pRNFL parameters for the discrimination of NTG and POAG. Average retinal nerve fiber layer thickness, total macular volume and inferior outer macular thickness were the best SD-OCT parameters with superior discriminating capabilities.

Intraeye retinal nerve fiber layer and macular thickness asymmetry measurements for the discrimination of primary open-angle glaucoma and normal tension glaucoma.

PURPOSE: The aim of this study was to evaluate the diagnostic capability of intraeye retinal nerve fiber layer (RNFL) thickness and macular thickness (MT) asymmetry measurements for the discrimination of normal tension glaucoma (NTG) and primary open-angle glaucoma (POAG) using spectral domain optical coherence tomography (SD-OCT). METHODS: A total of 90 subjects were enrolled including 30 consecutive healthy subjects, 30 consecutive subjects with POAG, and 30 consecutive subjects with NTG. RNFL thicknesses around the optic disc as well as MT measurements were taken with circular and radial SD-OCT scans. Intraeye retinal and MT asymmetry were calculated as the absolute difference between superior and inferior hemispheres of the eye using posterior pole asymmetry analysis protocol. Analysis of variance was used for comparison and areas under the receiver operating characteristic (AROC) were obtained for different parameters among the three diagnostic groups. RESULTS: There was a significant difference in MT asymmetry for all comparison groups (normal-NTG, p<0.05; normal-POAG, p<0.001; and NTG-POAG, p<0.001). Intraeye retinal nerve fiber thickness asymmetry measurements were not different between the groups (normal-NTG, p<0.187; normal-POAG, p<0.056; and NTG-POAG, p<0.837). The area under ROC curves exceeded 0.800 for all the studied parameters, including the MT asymmetry except for intraeye RNFL thickness asymmetry which had the lowest AROC as well as the least sensitivity for identifying subjects with NTG from normal (AROC=0.626, sensitivity=30%); POAG from normal (AROC=0.644, sensitivity=37%) and NTG from POAG (AROC=0.533, sensitivity=13%). CONCLUSION: The intraeye MT asymmetry holds significant potential as a distinguishing parameter for NTG and POAG.

Retinal nerve fiber layer thickness in glaucomatous Nepalese eyes and its relation with visual field sensitivity.

BACKGROUND: To evaluate peripapillary retinal nerve fiber layer (RNFL) thickness in glaucomatous Nepalese eyes using spectral domain optical coherence tomography (SD-OCT) and study its relationship with visual field sensitivity. METHODS: A total of 120 eyes comprising primary open angle glaucoma (POAG), glaucoma suspects (GS), normal tension glaucoma (NTG) and healthy subjects (n=30 cases in each group) underwent a complete ophthalmic examination, including optic nerve head (ONH) evaluation and standard automated perimetry (SAP). RNFL thickness measurements around the optic disk were taken with circular spectral domain optical coherence tomography (SD-OCT) scans. Analysis of variance (ANOVA) was used for comparison of RNFL parameters among various study groups. The relationship of RNFL parameters with visual field (VF) global indices was evaluated with regression analysis. RESULTS: The mean pRNFL thickness was significantly less in the POAG (64.30±14.45µm, p<0.01), NTG (85.43±9.79µm, p<0.001) and GS (102.0±9.37µm, p<0.001) groups than in the healthy group (109.8±8.32µm). The RNFL was significantly thinner across all quadrants in all study group pairs (p<0.05) except for normal vs. GS (only superior and inferior quadrant, significant). Linear regression plots with RNFL thickness as a predictor of MD and LV demonstrated a strong and statistically significant degree of determination in the POAG group (R(2)=0.203 and 0.175, p=0.013 and 0.021). CONCLUSION: The RNFL thickness measurements with SD-OCT are lower in glaucomatous eyes as compared to age-matched GS and normal eyes in the Nepalese population. A high resolution SD-OCT could aid significantly in the early diagnosis of glaucoma in Nepal.

Outcome of horizontal strabismus surgery and parents' satisfaction.

INTRODUCTION: A clinical audit of strabismus surgery in children in terms of functional and cosmetic outcomes helps improve the quality of services in pediatric ophthalmology. OBJECTIVE: To evaluate the outcome of strabismus surgery and assess the satisfaction of the patients' parents with respect to the surgery outcome. SUBJECTS AND METHODS: A study of an interventional series of cases that included 60 strabismic subjects was carried out. The bilateral strabismus surgery under general anesthesia was performed on all subjects using the fornix approach. The parents' understanding about strabismus and the cosmetic outcome was assessed through a set of interview questionnaires. The main outcome measures were the amount of deviation, the parents' knowledge about strabismus and their satisfaction after the intervention. RESULTS: Of the 60 subjects, 32 (53.3%) were esotropic and 28 (46.7%) exotropic. The male to female ratio was 1:1. The mean age with standard deviation was 16.6±8.5 years,with a range of 3 to 35 years. The pre- operative mean esotropia with standard deviation was 48.2±14.8 pd, with a range of 22 to 114 pd). The pre-operative mean exotropia was 57.8±14.2 pd, with a range of 25 to 90 pd). In 93.47% of the subjects, the ocular deviation after surgery reduced significantly (p=less than 0.00). After the strabismus surgery, orthophoria was achieved in 15 (25%) subjects, and with excellent cosmetics. After surgery, gross binocular single vision was attained in 39.3% of the exotropes and in 17.9% of the esotropes. Only 30% of the parents were aware about the strabismus and the treatment modalities. Nearly 90% of the parents were satisfied with the cosmetic outcome. CONCLUSION: Horizontal and bilateral strabismus has good surgical outcome with improved cosmetic acceptance.

Retinal nerve fibre layer thickness in a healthy Nepalese population by spectral domain optical coherence tomography.

OBJECTIVE: To determine the normal values for peripapillary retinal nerve fibre layer thickness (RNFL) measured by spectral domain optical coherence tomography (SD- OCT) in a healthy Nepalese population and to compare the RNFL thicknesses between the genders and among the various age groups. MATERIAL AND METHODS: One hundred and fifty six eyes of 156 healthy Nepalese subjects (66 males and 88 females) of various age groups were enrolled in this observational, cross-sectional, hospital-based study. The peripapillary RNFL of the randomly chosen eye of each subject was imaged with a high resolution SD-OCT (Spectralis HRA+OCT, Heidelberg Engineering). The RNFL thickness was measured around the optic nerve head using 16 automatically averaged, consecutive, circular B scans with a 3.4 mm diameter and compared between the genders and among the various age groups. RESULTS: The mean age of the subjects was 38.94±17.00 years (range-14 to 76 years). The average peripapillary RNFL was found to be 102.64±9.56 µm (95% CI 97.01-101.93). The mean±SD peripapillary RNFL measurements at the superior, nasal, inferior and temporal sectors in the study population were 129.51±15.09 µm, 76.55±12.02 µm, 134.53±17.19 µm and 70.74±15.53 µm respectively. The average RNFL thickness was 99.47±10.18 µm in the male whereas it was 105.09±8.31 µm in the female participants. The RNFL decreased by 2.26 µm per age per decade. CONCLUSION: The Average RNFL thickness is 102.64±9.56 µm in the Nepalese population. Gender and age related variation in the RNFL could serve as a useful guideline in the diagnosis of glaucoma in our population.

Pattern of intraocular pressure fluctuation in uveitic eyes treated with corticosteroids.

PURPOSE: To determine IOP fluctuation in uveitic eyes treated with corticosteroids. DESIGN: Prospective Observational Study. METHOD: Study of 116 consecutive new uveitis patients visiting Uveitis clinic, BPKLCOS. IOP was meticulously monitored. Data was analyzed in SPSS-16 using paired samples 't-test'. RESULTS: The mean IOP in all patients at presentation, at 1 week, 3 weeks and 6 weeks were respectively 14.66 mmHg, 14.72 mmHg, 14.75 mmHg and 14.93 mmHg. This progressive IOP rise was not statistically significant. Ocular hypertension was seen in 20% eyes; 64.5% were due to corticosteroids. Steroid-induced ocular hypertension was seen in 37.03% of oral group, 14.28% of posterior subtenon group, 8.57% of topical group. Antiglaucoma medications were started in 61.2% of the cases with raised IOP. None had to undergo glaucoma filtering surgery. CONCLUSION: Incidence of ocular hypertension in uveitic eyes was 20% in this study. Majority of them was corticosteroid induced. Timely medical treatment averted the necessity of surgical intervention for IOP control.

Unusual case of bilateral angle closure glaucoma.

Bilateral angle closure glaucoma is a rare ocular emergency which can be a potentially blinding condition. A case of 72 years male, who developed headache and vomiting after five days of demise of his mother followed by blurring of vision. He was taken to the general hospital where all the routine tests and CT Scan head failed to reveal the cause. After two days of admission, patient was referred for ophthalmic consultation. On ocular examination he was diagnosed as a case of bilateral angle closure glaucoma. After two hours of treatment patient was comfortable with normal intraocular pressure and reasonably good vision.

Visual status and ocular morbidity in older adults living in residential care.

BACKGROUND: The frequency of visual impairment and blindness increases with age and is more prevalent among older adults living in residential care centers. The main aim of this study was to assess the visual status and determine the prevalence and major causes of visual impairment and blindness among the older adults living in residential care centers of Kathmandu Valley, Nepal. METHODS: A cross-sectional study was conducted on 385 residents of 60 years or older residing in seven residential care centers of Kathmandu Valley. Presenting distance visual acuity was assessed in each eye with a Snellen chart at 6-m distance in non-standardized outdoor illumination. Objective and subjective refractions were performed and the best-corrected distance visual acuity was considered in the better eye. Near acuity was assessed binocularly with The Lighthouse Near Acuity Card. Complete anterior and posterior segment examination was carried out. RESULTS: The mean age of residents was 74.34 ± 8.19 years. The majority was female residents (78.2 %). The prevalence of visual impairment and blindness was 43.70 %. Adequate refractive correction could alone reduce the prevalence of visual impairment and blindness by 15.40 %. Cataract was the leading cause of visual impairment and blindness, which was followed by age-related macular degeneration, corneal opacity, glaucoma, and macular scar. CONCLUSIONS: The prevalence of visual impairment and blindness is significant among the older adults living in residential care centers. The frequency of visual impairment and blindness can be prevented by adequate refractive correction, frequent eye examination, and appropriate high use of cataract surgery.