Physiological Ocular Changes in Various Trimesters of Pregnancy.

INTRODUCTION: A large number of hormonal, metabolic, immunologic and haematological changes occur in all organ system of female body during pregnancy. Human eye and its function are no exception to these changes. PURPOSE: To evaluate physiological ocular changes in various trimesters of pregnancy and to compare them amongst the three trimesters. PATIENTS AND METHODS: A hospital based cross sectional study, using judgmental convenient sampling method, was done in both eyes of 120 pregnant females (40 in each trimester), with known last menstrual period, attending antenatal clinic of BPKIHS, Dharan. Women with known systemic or ocular diseases like conjunctivitis, keratitis, iridocyclitis, glaucoma, refractive error, were excluded. Demographic details of all patients were recorded and detailed ocular examination, including best corrected visual acuity, slit lamp examination, vertical and horizontal keratometry, central corneal thickness and intraocular pressure were performed and recorded. A comparison of these parameters was made amongst three trimesters. RESULTS: Visual acuity of all the subjects was 0 logMAR. Corneal curvature, both vertical and horizontal, significantly increased towards third trimester. Central corneal thickness progressively increased from first to third trimester (p= 0.019 Right eye, 0.016 Left eye). In contrary to this, intraocular pressure significantly decreased during successive stages of pregnancy (P=0.000 both eye). CONCLUSION: Significant increase in corneal curvature and central corneal thickness along with, decrease in intraocular pressure occur during successive trimesters of pregnancy. All pregnant women should have routine ocular examination; changes noted, if any, should receive attention and period of gestation should be considered prior to making a diagnosis.

Prevalence of diabetic retinopathy among self-reported adult diabetics in districts of Eastern Nepal in a community based study.

INTRODUCTION: Diabetic retinopathy (DR) is the leading cause of blindness among working age adults around the world. Each year more and more people live with this condition, which can result in life-changing complications. OBJECTIVE: To determine the prevalence and risk factors of diabetic retinopathy (DR) in a large community based screening programme, in order to estimate the future burden of the disease. MATERIALS AND METHODS: A cross sectional community based study was conducted between 1st January and 31st December 2014 in a purposive sample of adults with selfreported diabetes mellitus (DM) from Morang and Sunsari district of Nepal. A structured questionnaire was used to collect patient data. Ophthalmological evaluation was done and fundus was examined for grading DR using direct and indirect ophthalmoscope. RESULTS: Among the 698 diabetic patients, mean age was 55.02±11.8 years (ranging from 24 to 91 years). 12.3% of diabetic were not under any treatment. Only 69.3% of patients had visited eye specialist for diabetic retinopathy screening. Prevalence of DR was found to be 15.3%; 13.9% had non-proliferative DR and 1.4% had proliferative DR. Prevalence of diabetic macular edema was 2.1%. In Morang district prevalence of DR was 14.2% and in Sunsari district it was 16.2%. In the binary-logistic regression analysis, duration of diabetes was associated with significantly increased risk of DR (OR: 1.13; 95% confidence interval (CI), 1.09 to 1.17; p<0.001). History of absence of arterial hypertension decreased the risk of DR (OR: 0.56; 95% CI, 0.36 to 0.87; p=0.01). CONCLUSION: One sixth of the patients with diabetes in the Eastern region of Nepal have retinopathy. Diabetic retinopathy risk increased with duration of diabetes and decreased with history of no co-existing arterial hypertension.