Nepalese Journal of Ophthalmology 2021-11-14T13:07:25+00:00 Dr Eli Pradhan Open Journal Systems <p>Official journal of the Nepal Ophthalmic Society. Full text articles available on NepJOL.</p> <p>Nepalese Journal of Ophthalmology charges authors article processing fees once accepted for publication.</p> <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License"></a><br>Articles are licensed under a <a href="" rel="license">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a> (CC BY-NC-ND).</p> <p>Nepalese Journal of Ophthalmology is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> Multidisciplinary Approach for Retinoblastoma Management 2021-09-14T04:11:29+00:00 Sristi Thakur Rakshya Basnet Kabindra Bajracharya <p><span style="font-weight: 400;">We read with keen interest the article by Shah et al "Pathologic Risk Factor in Retinoblastoma: An Institutional Experience Based on Analysis of Enucleated Eyes"(Shah A et al, 2012). They have highlighted high-risk histopathological features in Retinoblastoma with retrolaminar optic nerve invasion being the most common and also showed statistically significant correlation of high risk histological features with tumor size and AJCC stage of tumor. Their aim to assess the frequency and spectrum of high risk histopathological features in enucleated specimens of retinoblastoma was successful which may guide the clinician in timely planning for subsequent neoadjuvant therapy and prevent further ocular morbidity and mortality in children. We would like to congratulate authors for this article and with invoked interest it led us to go in more depth and we wish to discuss several aspects of the study that can potentially influence the results.</span></p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Choroidal Osteoma with Choroidal Neovascular Membrane treated with Anti- vascular Endothelial Growth Factor: A Rare Case with Review of Literatures 2021-06-26T19:29:55+00:00 Phuntsho Dorji Nor Tshering Lepcha Raba Thapa <p><strong>Introduction: </strong><span style="font-weight: 400;">Choroidal osteoma, usually unilateral, is a rare benign tumor of choroid. It is predominantly seen in young females. </span></p> <p><strong>Case: </strong><span style="font-weight: 400;">We report a case of a 35-year-old female with unilateral choroidal osteoma associated with choroidal neovascular membrane (CNVM). The diagnosis was confirmed with clinical examination, ocular ultrasonography, fundus fluorescein angiography and macular optical coherence tomography. Choroidal neovascular membrane improved with 3 doses of bevacizumab, an anti-vascular endothelial growth factors (Anti-VEGF).</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Anti-VEGF monotherapy can be a cost effective primary modality of treatment for choroidal neovascular membrane secondary to choroidal osteoma.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Choroidal Tuberculoma in a Healthy Immunocompetent Patient 2021-06-26T19:33:22+00:00 Hara Maya Gurung Krishna Gurung Anju Gurung Indraman Maharjan Eliya Shrestha Babita Gurung Hari Bikram Adhikari Saroj Prasad Nemkul <p><strong>Introduction:</strong><span style="font-weight: 400;"> Ocular tuberculosis as choroidal tuberculoma is a rare event. It creates a clinical diagnostic dilemma when there is no systemic involvement. </span></p> <p><strong>Case:</strong><span style="font-weight: 400;"> A 22-year-old man presented with the chief complaints of discomfort and blurring of vision of right eye for one week. On fundus examination under mydriatics of his right eye, a solitary mass which measured approximately 2DD (Disc Diameter) was appreciated at the superotemporal quadrant with the surrounding localized retinal detachment. Choroidal tuberculoma was suspected by a positive Mantoux test. Physician consultation and laboratory investigations ruled out the pulmonary and systemic manifestation of tuberculosis and other aetiology. Anti-tubercular treatment was started and this led to the improvement of vision and shrinkage of the choroidal mass into a flat chorioretinal scar at 3 months of anti-tubercular treatment . </span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Solitary choroidal tuberculoma though rare, can occur in a healthy, immunocompetent patient. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Upper Eyelid Nodule - An Unusual Presentation of Ocular Demodicosis 2021-06-26T19:34:19+00:00 Sabia Handa Parul Goyal Suryaprakash Sharma Amanjit Bal Manpreet Singh Pankaj Gupta <p><strong>Introduction:</strong><span style="font-weight: 400;"> Demodex mite is an external parasite which is implicated in various ocular conditions like anterior blepharitis, posterior blepharitis, meibomian gland dysfunction, chalazia and others. Although demodex has been shown to be a causative agent of chalazia, occurrence of a solitary inflammatory nodule due to demodex infestation has not been reported in literature.</span></p> <p><strong>Case</strong><span style="font-weight: 400;">: Our case describes the occurrence of an upper eyelid mass in a </span><span style="font-weight: 400;">62-year-old female which was found to have an associated demodex infestation.</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: This is the first report of demodex infestation presenting as a nodular eyelid mass. This parasite needs to be considered in the differential diagnosis of eyelid masses as this condition requires specific management.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Bilateral Cryptophthalmus: First Case Report from Nepal 2021-06-26T19:35:36+00:00 Nayana Pant Subash Bhatta Gulshan Bahadur Shrestha Madhu Thapa <p><strong>Introduction: </strong><span style="font-weight: 400;">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.</span></p> <p><strong>Case: </strong><span style="font-weight: 400;">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.</span></p> <p><strong>Conclusions: </strong><span style="font-weight: 400;">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.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Tuberculosis related Neuroretinitis and Retinal Vasculitis in an Immunocompetent Patient 2021-06-26T19:36:29+00:00 Neha Goel <p><strong>Introduction: </strong><span style="font-weight: 400;">This study aimed to describe the occurrence of bilateral neuroretinitis and retinal vasculitis in an immunocompetent female with disseminated tuberculosis.</span></p> <p><strong>Case description: </strong><span style="font-weight: 400;">A 25 year old female diagnosed with disseminated tuberculosis</span> <span style="font-weight: 400;">presented with sudden painful loss of vision bilaterally. On examination she was found to have bilateral neuroretinitis and retinal periphlebitis involving the posterior pole. She was prescribed systemic steroids in addition to the anti-tuberculous therapy that she was receiving. The fundus lesions gradually resolved over four months with modest improvement in visual acuity. There were no recurrences in the follow up period of 14 months. </span></p> <p><strong>Conclusions: </strong><span style="font-weight: 400;">Ocular involvement in the form of neuroretinitis with concomitant retinal vasculitis can occur in patients with disseminated tuberculosis. Addition of systemic steroids to anti-tuberculous therapy leads to anatomical resolution with improvement in visual acuity. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Unusual Tumours Hidden in Blind Eyes 2021-06-26T19:37:37+00:00 Smriti Nagpal Gupta Ruchi Goel Ravindra Kumar Saran Neha Rathie <p><strong>Introduction: </strong><span style="font-weight: 400;">This case report describes 3 cases of unsuspected neoplasms in previously blind eyes, with recent onset pain. </span></p> <p><strong>Cases and observations:</strong><span style="font-weight: 400;"> Case 1: Female with pain, redness in the non-seeing right eye (R/E) for two months. R/E had total cataract, low intraocular pressure and a well-defined globular mass lesion at the posterior pole, seen on ultrasound. Enucleation with an implant was done. Histopathology clinched the diagnosis of choroidal melanoma. Case 2: A 20-year male, developed pain, redness in left eye (L/E) for two months. L/E was blind since childhood, secondary to trauma. The patient underwent enucleation and detailed histopathological examination and immunohistochemistry supported a diagnosis of ependymoma with vascular malformation. Case 3: A 24-year male with pain, redness in L/E for six months, with decrease in size of eyeball. L/E had low vision since childhood. On examination, L/E was phthisical with diffuse conjunctival congestion, band-shaped keratopathy, cataract, and neovascularization of iris. Imaging revealed a small distorted globe with highly reflective mass along the posterior pole. Histopathology of the enucleated specimen confirmed the diagnosis of choroidal osteoma, with gliosis of the adjacent RPE. </span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> In the management of a painful blind eye, it is extremely important to rule out an intraocular malignancy, particularly in patients with recent onset of pain.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Eight and a Half Syndrome: A Rare Case of Pontine Infarction 2021-06-26T19:39:17+00:00 Akkayasamy Kowsalya Srinivasan Thanemozhi DO <p><strong>Introduction: </strong><span style="font-weight: 400;">This case report describes “one-and-a-half” syndrome with supranuclear facial palsy.</span></p> <p><strong>Case:</strong><span style="font-weight: 400;"> 39 years old male hypertensive patient presented with right facial nerve palsy, internuclear ophthalmoplegia and conjugate gaze palsy. Neuroimaging showed acute posterior pontine infarct at medial longitudinal fasciculus, paramedian pontine reticular formation, abducens nerve nucleus and seventh nerve fascicular zone.</span></p> <p><strong>Observation:</strong><span style="font-weight: 400;"> “One-and-a-half”syndrome is characterized by a lateral gaze palsy in one direction and internuclear ophthalmoplegia in the other. Our patient had Right sided one and a half syndrome along with the right facial nerve palsy. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Eight and a half syndrome is a rare manifestation of pontine infarction.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Microbiological and Antibiotic Sensitivity Profile of Postoperative Endophthalmitis in a Tertiary Eye Care Hospital of North India 2021-06-26T18:59:06+00:00 Richa Ranjan Manisha Agarwal Shalini Singh Rahul Mayor Lagan Paul Arpan Gandhi Neelam Sapra <p><strong>Introduction: </strong><span style="font-weight: 400;"> We describe the microbiological profile of postoperative endophthalmitis from northern India and analyse the pattern of antibiotic sensitivity which may have changed due to development of resistance secondary to overuse of antimicrobial drugs.</span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> This is a retrospective study of postoperative endophthalmitis from January 2011 to December 2017 in a tertiary eye hospital of northern India</span><span style="font-weight: 400;">. </span><span style="font-weight: 400;">Any patient developing endophthalmitis within one year of any intraocular procedure was</span><span style="font-weight: 400;"> included in the study. </span><span style="font-weight: 400;">According to severity, treatment with a trial of intravitreal antibiotic injections or core vitrectomy was decided</span><span style="font-weight: 400;">. </span><span style="font-weight: 400;">Ocular samples were collected which were either anterior chamber tap or vitreous biopsy and sent for microbiological examination. The samples were stained with Gram’s and KOH stain and cultured on chocolate agar, blood agar, brain heart infusion broth and Sabouraud dextrose agar.</span><span style="font-weight: 400;"><br /></span><strong>Results: </strong><span style="font-weight: 400;">A total of 545 patients of postoperative endophthalmitis were analysed which showed a male predilection (60.5%) with maximum patients between the age group 50-69 years. 292 patients (53.5%) were culture negative and 253 patients (46.4%) were culture positive. </span></p> <p><span style="font-weight: 400;">Most common organism identified was </span><em><span style="font-weight: 400;">Staphylococcus</span></em><span style="font-weight: 400;"> in 73 patients followed by </span><em><span style="font-weight: 400;">Pseudomonas</span></em><span style="font-weight: 400;"> in 48 patients. </span><em><span style="font-weight: 400;">Staphylococcus species</span></em><span style="font-weight: 400;"> was most sensitive to vancomycin (97%) followed by amikacin (91%) followed by gentamicin and moxifloxacin (88% each). </span><em><span style="font-weight: 400;">Pseudomonas</span></em><span style="font-weight: 400;"> was the second most common isolate which showed maximum sensitivity to imipenem (82%) followed by ciprofloxacin(60%). Polymicrobial infection was noted in 23 patients. The most common fungal isolate was aspergillus in 11 patients, followed by fusarium in 10 patients.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Our study shows that gram positive bacteria are the most common organisms in postoperative endophthalmitis and are most sensitive to vancomycin, followed by gram negative bacteria which show increased sensitivity with imipenem than commonly used antibiotic - ceftazidime.</span></p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Clinicopathologic Presentation and Management of Malignant Orbito-ocular Tumors at a Tertiary Care Hospital in Nepal 2021-06-26T18:59:55+00:00 Purnima Rajkarnikar Sthapit Malita Amatya Hom Bahadur Gurung Rohit Saiju <p><strong>Introduction: </strong><span style="font-weight: 400;">This study was conducted</span> <span style="font-weight: 400;">to evaluate the clinical presentations and management of various Orbito-ocular malignancies in Nepal.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This is a prospective study of ocular malignant cases conducted at a tertiary care eye hospital in Kathmandu, Nepal. One hundred and seventeen newly diagnosed eyes with ocular malignancy of 106 patients presenting to the clinic in a year from September 2018 to August 2019 were included for analysis. Patients’ demography, clinical features, various types of malignancies seen in eyes and their management were evaluated.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The mean age of patients was 30.35 years with a range from 1 month to 84 years and standard deviation of 26.63. 56% of the total were male. Red eyes and visible mass were the most common symptoms in 23% with intraocular contents in 48% being the most common site involved. Different types of ocular malignancies were detected, among which retinoblastoma was the most common in 38% of patients. Diagnosis in most patients was clinical and/or radiological; incision biopsy was required in 1.7% patients only. Surgical excision of the tumor was the most common treatment done in 29% followed by enucleation in 27% of eyes. Bilateral involvement of the eyes was seen in 10% of the patients. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Malignant orbito-ocular tumors can be seen in any age group. Retinoblastoma is the commonest malignancy seen. With the help of imaging, diagnosis is near accurate; hence biopsy is not required in most cases before commencing treatment.</span></p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology External Dacryocystorhinostomy and Patient Satisfaction: Perspective of General Ophthalmologist 2021-06-26T19:00:32+00:00 Suresh BK Rasaily Kaushal Pokharel Sulaxmi Katuwal Sabita Bishowkarma Ben Limbu Rohit Saiju <p><strong>Introduction:</strong><span style="font-weight: 400;"> This study aimed to evaluate patient satisfaction over time in patients undergoing external dacryocystorhinostomy for primary nasolacrimal duct obstruction when done by a general ophthalmologist.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">: This prospective interventional case series was done in a secondary level eye hospital in the Midwestern region of Nepal from 1st January 2018 to 30th December 2018. Fifty-four consecutive adult patients diagnosed with primary nasolacrimal duct obstruction who underwent external dacryocystorhinostomy performed by a general ophthalmologist were included. The surgical success rate was determined at six months on the basis of the resolution of symptoms with patency on syringing. Postoperative patient satisfaction was evaluated 6 months after surgery with a standardized Glasgow Benefit Inventory and post-intervention questionnaire.</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: A total of 54 eyes were operated on within the study period and a larger number of surgeries were done in the age group 26-30 years. Female constituted 79.6 % and male 20.4% with a ratio of 3.9:1. Overall surgical success rate 6 months after surgery was 96.30%. The mean total Glasgow benefit inventory (GBI) score was 48.83 ± 23.87 (95% CI, 42.96- 56.95), mean general subscale score was 52.70± 23.28 (95% CI, 46.49-60.38), social support subscale was 49.69 ± 44.68 (95% CI, 41.15-60.35) and physical health subscale score was 37.07 ± 41.19 (95% CI, 27.48-49.26).</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: The external dacryocystorhinostomy surgeries performed by general ophthalmologists achieved an excellent surgical success rate and good patient satisfaction proven by a validated questionnaire.</span> </p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Conventional versus Modified Tarso-frontalis Suspension Surgery using Targeted Lid Crease for Simple Congenital Blepharoptosis with Poor Levator Action 2021-06-26T19:06:25+00:00 Aashish Raj Pant Rinkal Suwal Purushottam Joshi Nisha Shrestha Ben Limbu <p><strong>Introduction:</strong><span style="font-weight: 400;"> The</span> <span style="font-weight: 400;">routine technique of tarso-frontalis suspension surgery for simple congenital blepharoptosis with poor levator action is cosmetically less rewarding due to either an absence or asymmetry of the postoperative eyelid crease. The objective of this study was to assess the eyelid crease quality after a modified open method of tarso-frontalis suspension surgery compared to the closed method.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">:</span> <span style="font-weight: 400;">This was a retrospective comparative study reviewing the case sheets of all the patients undergoing unilateral tarso-frontalis suspension surgery with silicon rod employing Fox pentagon design from September 2017 to February 2019 at Mechi Eye Hospital, Jhapa, Nepal. A review of 40 case sheets of congenital lid ptosis with poor levator function(</span><span style="font-weight: 400;">&lt;</span><span style="font-weight: 400;">4mm) aged 9 years or more was done. Tarso-frontalis suspension surgery, modified with a mini blepharoplasty incision, direct attachment of silicon rod to tarsus, completion of pentagon design with supra-brow incisions, and skin-orbicularis-tarsus-orbicularis-skin suture (open method) was done in 20 cases whereas other 20 cases underwent surgery with supraciliary stab incisions (closed method).</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The mean age of the patients was</span> <span style="font-weight: 400;">21.1</span><span style="font-weight: 400;">+</span><span style="font-weight: 400;">5.9 years (range 9-30 years). The ptosis amount ranged from 3–10mm. At the 6th postoperative month, most of the cases had good ptosis correction (90% open group, 85% closed group, p=0.74). However, cosmetic outcomes were better in the open group compared to the closed group: 100% symmetrical eyelid crease compared to 40% (p&lt;0.001) and 90% acceptance rate for eyelid contour compared to 70% (p=0.23).</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Predictable, targeted, and symmetrical lid crease can be obtained using the modified open method of tarso-frontalis suspension surgery.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Psychological Reactions among Staffs of a Tertiary Eye Hospital in Eastern Nepal during COVID-19 Pandemic 2021-06-26T19:07:29+00:00 Rinku Gautam Joshi Purushottam Joshi Pranav Shrestha Prabha Subedi Basnet Pawan Mahat <p><strong>Introduction: </strong><span style="font-weight: 400;">Eye examination and different procedures performed in close contact with eye and face, put medical and non medical staff of an eye hospital at higher risk for COVID-19. This causes increased psychological burden. The objective of this study was to find out depression, anxiety, stress and insomnia among Mechi Eye Hospital staff.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">:</span> <span style="font-weight: 400;">A web based cross-sectional study among Mechi Eye Hospital staff was done from 1st to 20th July 2020. Insomnia Severity Scale and DASS-21 were used.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Out of 220, 190 (86.6%) participated, 63.2% were female and 61.05% were medical staff with an overall mean age of 31.1±8.4 years. Overall prevalence of anxiety, depression, insomnia and stress were 20.5%, 18.9%, 16.3% and 12.6% respectively and those were common in female with 63.9% (p value &lt;0.02), 64.1% (p value 0.5), 58.4% (p value 0.2) and 100% (p value &lt;0.01) respectively. Depression, anxiety and insomnia were common in the age group 30-39 years (50%, p value&lt; 0.02), 20-29 years (56.4%, p value 0.1) and 20-29 years (70.9%, p value 0.8) respectively. Stress was common in 20-29 years and 30-39 years, 45.8% each (p value &lt;0.03). Depression (75%, p value 0.2), anxiety (71.7%, p value 0.9) and stress (70.8%, p value 1.0) were common in medical staff. Insomnia was present in medical staff only (p value&lt;0.01).</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Mechi Eye Hospital staff had greater prevalence of psychological reaction than the national baseline during the pandemic which was more common in female, younger age and medical staff.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Efficacy of Pneumatic Retinopexy in Treating Rhegmatogenous Retinal Detachment at King Abdullah Medical City in Makkah, Saudi Arabia – A retrospective cohort study 2021-06-26T19:10:13+00:00 Ashjan Yousef Bamahfouz Serene Jouhargy Mohammed Almalki Osama Alamri Raed Alsulami Saeed Alzahrani Ahmad Himayda <p><strong>Introduction: </strong><span style="font-weight: 400;">The aim of this study was to present the clinical presentation and short-term outcomes of uncomplicated rhegmatogenous retinal detachment managed by pneumatic retinopexy at a tertiary eye hospital in western Saudi Arabia.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;"> This one-armed retrospective cohort study evaluated selected cases of rhegmatogenous retinal detachment managed by pneumatic retinopexy between 2017 and 2018. Data were collected on patient demographics, preoperative ophthalmic assessment, surgical details, follow up at six months postoperatively, complications and the need for additional surgery. Anatomic success was defined as retinal attachment at 6 months and functional success was defined as vision &gt;20/200 at six months postoperatively. The association of lens status and concomitant laser treatment to anatomical success rates were evaluated.</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: The study sample consisted of 15 eyes with rhegmatogenous retinal detachment in the upper quadrant. In 14 cases, C</span><span style="font-weight: 400;">3</span><span style="font-weight: 400;">F</span><span style="font-weight: 400;">8</span><span style="font-weight: 400;"> gas was used. Anatomic and functional success was noted in 73.3% [95% confidence interval (CI) 51.0: 95.7] and 86.7% (95% CI 69.2; 100) of eyes, respectively. The association between anatomical success and lens status was not significant [RR = 4.5 (95% CI 0.6 ; 37.5), </span><em><span style="font-weight: 400;">P</span></em><span style="font-weight: 400;">=0.1]. There was no significant association between anatomical success and concomitant laser treatment. [RR = RR = 1.7 (95% CI 0.7 ; 4.0), </span><em><span style="font-weight: 400;">P</span></em><span style="font-weight: 400;">=0.2]. A 2</span><span style="font-weight: 400;">nd</span><span style="font-weight: 400;"> retinal surgery was not required in 33.3% of eyes (95% CI 9.5 ; 57.2). </span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: If stringent selection criteria are used for managing rhegmatogenous retinal detachment with pneumatic retinopexy, anatomical and functional success by six months postoperatively is achieved in the majority of cases. Additional surgeries could further improve outcomes. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Comparison of Ocular Biometry between Primary Open Angle Glaucoma Patients and Normal subjects 2021-06-26T19:12:50+00:00 Nisha Manandhar Chandni Pradhan Purushottam Joshi Prabha Subedi Pranav Shrestha <p><strong>Introduction:</strong><span style="font-weight: 400;"> Glaucoma is one of the major causes of irreversible blindness. In Nepal, the most common type of Glaucoma seen is Primary Open Angle Glaucoma. There are many risk factors associated with Primary Open Angle Glaucoma. The main objective of the study was to compare oc</span><span style="font-weight: 400;">ular biometric parameters in patients diagnosed with </span><span style="font-weight: 400;">Primary Open Angle Glaucoma</span><span style="font-weight: 400;"> and age matched controls.</span></p> <p><strong>Material and methods:</strong><span style="font-weight: 400;"> This is a hospital based cross sectional study done at Mechi Eye Hospital. The study included 137 cases of </span><span style="font-weight: 400;">Primary Open Angle Glaucoma</span><span style="font-weight: 400;"> and 75 normal individuals as control. Axial length (AL), anterior chamber depth (ACD), Keratometry ‘K’ value and Central Corneal Thickness (CCT) were measured. Mann – Whitney U test was used for statistical analysis.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Mean age in </span><span style="font-weight: 400;">Primary Open Angle Glaucoma</span><span style="font-weight: 400;"> group was (55.25 ± 10.16 years) and in the control group was (60.96 ± 10.91 years). Axial length in the </span><span style="font-weight: 400;">Primary Open Angle Glaucoma</span><span style="font-weight: 400;"> group (23.16 ±1.19 mm) was deeper as compared to the control group (22.69 ±0.89 mm), the difference was statistically significant (p&lt;0.001). Anterior chamber depth (ACD) was statistically deeper in the Primary</span><span style="font-weight: 400;"> Open Angle Glaucoma</span><span style="font-weight: 400;"> group (3.05 ±0.51 mm) as compared to the control group (2.86 ±0.46 mm), (p&lt;0.01). Central corneal thickness (CCT) was thinner in the Primary</span><span style="font-weight: 400;"> Open Angle Glaucoma</span><span style="font-weight: 400;"> group (519.5 ±36.25 um) as compared to the control group (525.40 ±37.77 um) but the difference was not found to be statistically significant (p&lt;0.19). K value in Primary</span><span style="font-weight: 400;"> Open Angle Glaucoma</span><span style="font-weight: 400;"> (7.54 ±0.41mm) was higher than age-matched controls (7.58 ± 0.33mm) but the difference was not statistically significant (p&lt;0.79).</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Patients with Primary</span><span style="font-weight: 400;"> Open Angle Glaucoma</span><span style="font-weight: 400;"> had longer Axial length (AL) and deeper Anterior chamber depth (ACD) as compared to normal individuals.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Comparison of Percent Tissue altered in Topography Guided and Wavefront Optimized Laser-assisted in situ Keratomileusis using Zeiss MEL 80 Excimer Laser 2021-06-26T19:13:47+00:00 Shwetambari Singh Neha Shilpy Dipali Purohit Zalak Shah <p><strong>Introduction: </strong><span style="font-weight: 400;">Laser-assisted in situ Keratomileusis (LASIK) is the most commonly performed refractive surgical procedure. The amount of tissue ablated in LASIK affects the safety and long-term outcome. The objective of this study was to compare the percent tissue altered (PTA) in topography guided (TG) and wavefront optimized (WFO) LASIK using Zeiss MEL 80 excimer laser.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">:</span> <span style="font-weight: 400;">This retrospective observational study was conducted at a tertiary eye center. Patients with moderate myopia who underwent LASIK between June 2016 and January 2019 were divided into two groups (Group I: TG LASIK, 69 eyes; Group II: WFO LASIK, 70 eyes). The groups were compared for preoperative parameters [spherical equivalent (SE), keratometry and pachymetry], intraoperative parameters [ablation depth (AD), PTA and residual stromal bed thickness (RSBT)] and postoperative parameters (vision, SE).</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Among preoperative parameters, SE and keratometry were similar while thinnest pachymetry was significantly less in group I. Among the intraoperative parameters, PTA (P &lt; 0.01) and AD (P &lt; 0.01) were significantly less in group I while RSBT (P = 0.54) was not significantly different. Postoperatively at 6 months, 92.75% (64) eyes in group I and 90% (63) eyes in group II had visual acuity of 6/6 or better (P = 0.57). 98.55% (68) and 97.14% (68) eyes in group I and group II respectively had SE refraction within ± 0.5 dioptres.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">TG LASIK induces less tissue alteration for given refractive error with similar visual outcome as compared to WFO LASIK which makes TG apparently safer and is the preferred technique for borderline thin corneas.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Prevalence of Ocular Diseases in Human Donor Eyes in New Zealand: A Study Based on Clinical and Histological Imaging 2021-06-26T19:15:19+00:00 Swathi Kanduri <p><strong>Introduction:</strong><span style="font-weight: 400;"> Fundus pathology in donor eyes was correlated with cross-sectional Optical Coherence Tomography (OCT) images and histological assessment was performed to determine the prevalence of retinal diseases without the constraints imposed during </span><em><span style="font-weight: 400;">in vivo</span></em><span style="font-weight: 400;"> clinical imaging.</span></p> <p><strong>Material and methods:</strong> <span style="font-weight: 400;"> A fundus camera and OCT imaging system was adapted to enable posterior segment imaging of the entire post-mortem human eye. Retinas from 59 donors (57 retina pairs and two single globes) were imaged in a seven-field imaging format and cross-sectional analysis was done using OCT. To confirm that the signs observed represented true disease incidence analysis of disease markers including gliosis (Glial Fibrillary Acidic Protein), hemichannel expression (Connexin43), Müller cell activation (vimentin) and choroidal endothelial cells (CD-31) and macrophages (CD-68 marker) was performed.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Pathological signs were correlated with clinical diagnoses in eyes from 25 donors (donor ages 45-87 years) but lesions were also found in 23 eyes (donor ages 39- 83 years) with no previously reported clinical diagnosis. Retinas from six donors aged 21-89 years of age were unremarkable. Of all donors, five donors had signs of age related macular degeneration (AMD) and 14 had signs of diabetic retinopathy (DR). Their lesions correlated with OCT and histopathology showed signs of activated microglia, Müller cell hyper-reactivity, increased Cx43 expression and choroidal inflammation. These data indicate that with over 8% of donors showing signs of AMD and 24% of donors showing signs of DR the incidence of AMD may be 1.7 times higher and DR up to 1.6 times higher than clinically reported.</span></p> <p><strong>Conclusions:</strong><span style="font-weight: 400;"> The detection of pathological signs characteristic of AMD and DR in donors suggests a higher prevalence of posterior segment abnormalities amongst New Zealanders donors than previously reported. A more detailed evaluation protocol of the posterior segment in patients will aid detection of lesions that are none the less pathological signs.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Sutureless Glue Free Versus Sutured Limbal Conjunctival Autografts in Primary Pterygium Surgery 2021-06-26T19:17:06+00:00 Dikshya Bista Raghunandan Byanju Maria Alexsandronva Gautam <p><strong>Introduction</strong><span style="font-weight: 400;">: Surgical excision is the definitive treatment for pterygium. Following excision, conjunctival autograft is usually preferred. Various methods for grafting with sutures, glue or autologous serum from the recipient bed are in use. </span><span style="font-weight: 400;">The objective of this study was</span><span style="font-weight: 400;"> to compare surgical outcomes of sutureless glue free conjunctival autograft with sutured (vicryl 8-0) conjunctival autograft in primary pterygium excision.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">: A prospective randomized interventional study was carried out in 100 eyes with primary pterygium. They were divided into two groups for conjunctival graft adhesion; sutureless glue free (group 1; n=50 eyes) and sutured with absorbable (vicryl 8-0) suture (group 2; n=50 eyes). Time taken for surgery, complications, postoperative symptoms and overall satisfaction score were noted. The patients were followed up on day 1, day 14 and 6 weeks after surgery. Recurrence was noted till 1 year after surgery.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The mean age was 46.76 ± 11.97 years (group 1) and 47.24±12.76 years (group 2). Group 1 had shorter duration of surgery (p&lt;0.001), less postoperative complaints (p&lt;0.001) and better patient satisfaction (p&lt;0.001) than group 2. Postoperative complications and gain in visual acuity in both the groups were not clinically significant. Recurrence was not significant in both groups until 1 year of follow up.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Pterygium surgery with sutureless glue free conjunctival autograft had fewer postoperative complaints and better patient satisfaction than pterygium surgery with sutured conjunctival autograft. The postoperative complications, recurrence were comparable to conventional sutured technique.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Impression Cytology Screening for Ocular Surface changes in various forms of Vernal Keratoconjunctivitis in Subtropical Central Zone in India 2021-06-26T19:19:19+00:00 Shreya Thatte Amit Varma Seemee Kapadia Suchi Paliwal Aviral Vasudeo <p><strong>Introduction:</strong><span style="font-weight: 400;"> Vernal keratoconjunctivitis (VKC) is a chronic recurrent allergic disorder of the eye more common in warm and dry climates like central India. Chronic and recurrent nature of disease requires long duration of treatment which leads to changes in ocular surface leading to cytomorphological distortion of goblet cells, that can be evaluated by impression cytology. Clinical presentation and impact of disease on cytomorphology of ocular surface was analysed in various forms of the VKC. The objective of this study was to find correlation of clinical profile and cytomorphological changes in ocular surface in patients with various forms of vernal keratoconjunctivitis.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">: </span><span style="font-weight: 400;">This cross sectional study analysed 120 eyes of 60 patients of various forms of vernal keratoconjunctivitis. Detailed history was taken along with complete ophthalmic examination. Vernal keratoconjunctivitis was graded as per Gokhale et al classification. Impression cytology for goblet cell morphology and metaplasia according to classification given by Saini et al was done. Cytological changes were noted for different age groups, duration of disease, and severity of disease.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Vernal keratoconjunctivitis was seen more commonly in males and in the second decade of life which shows a changing trend towards higher age. Milder forms were more commonly present than moderate and severe forms. Mostly Grade 2 changes were seen on impression cytology. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Increasing severity, duration of disease and age of presentation was directly proportionate to greater cytological changes on ocular surface.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Anatomical and Functional Success Analysis of Lacrimal Canalicular Lacerations Repaired with Bicanalicular Stents in a Tertiary Referral Teaching Center in Mexico 2021-06-26T19:17:45+00:00 Marisol Iñiguez-Soto Julián Espinosa-Noguera Adriana Dávila-Camargo Angel Nava-Castañeda <p><strong>Introduction: </strong><span style="font-weight: 400;">F</span><span style="font-weight: 400;">unctional and anatomical success after </span><span style="font-weight: 400;">canalicular</span><span style="font-weight: 400;"> laceration repair using only Crawford bicanalicular stents was evaluated in a ophthalmological teaching center. </span><span style="font-weight: 400;">The objective of this study was to evaluate functional and anatomical success after canalicular laceration repair using Crawford bicanalicular stents.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">Records of patients with canalicular laceration repair performed from 2010 to 2019 at Ophthalmology Institute Conde de Valenciana in Mexico City were reviewed. </span><span style="font-weight: 400;">Demographic data, injury mechanism and complications were recorded. Anatomical success was assessed with </span><span style="font-weight: 400;">canalicular</span><span style="font-weight: 400;"> irrigation and functional success was evaluated using Munk score. </span><span style="font-weight: 400;">Phi correlation coefficient was used to compare the correlation between epiphora and lack of permeability of injured canaliculus and the presence of complications at 6</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> month postoperative visit. </span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Two-hundred eight patients with lacrimal canalicular injury reconstruction were documented during the study period. The most common age of presentation and etiology was from 21 to 30 years old and injury with a sharp object, respectively. 96 patients were included for the correlation analysis. At 6</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> month, anatomical success was found in 75% and functional success was found in 77.8%. A statistically significant and directly proportional linear was found between the presence of epiphora and lack of permeability of injured canaliculus, (rφ 0.76, p &lt;0.05) and between the presence of epiphora and postoperative complications, (rφ 0.509, p &lt;0.05). </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Crawford bicanalicular stents are a valid and accessible option for canalicular laceration repair. Our success rate of lacrimal canalicular lacerations repaired with bicanalicular stents in a Mexican teaching hospital matches worldwide literature. Factors involved in the functional and anatomical success of the reconstruction include presence of postoperative complications and permeability of canaliculus after surgery. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Glaucoma Screening in Family Members of Glaucoma Patients at a Tertiary Eye Hospital in Eastern Region of Nepal 2021-06-26T19:20:17+00:00 Ravi Dhar Bhandari Bandana Khanal Manish Poudel Mohan Krishna Shrestha Suman Shamsher Thapa <p><strong>Introduction:</strong><span style="font-weight: 400;"> The second most common cause of blindness in the world is glaucoma.</span><span style="font-weight: 400;"> Family history plays an important role in early detection and management of patients with glaucoma.</span><span style="font-weight: 400;"> The main objective of this study was to determine the prevalence of glaucoma in first degree relatives of Primary open angle glaucoma (POAG) and Primary angle closure glaucoma (PACG) patients. Glaucoma awareness among the first degree relatives was also assessed. </span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> A cross sectional hospital based study was designed to examine and diagnose glaucoma among first degree relatives of patients with POAG and PACG, attending the outpatient department at Ramlal Golchha Eye Hospital in the Eastern region of Nepal from June 2016 to May 2017. A comprehensive eye examination was conducted by a glaucoma specialist at the hospital. All subjects underwent vision screening, refraction, slit lamp biomicroscopy, intraocular pressure (IOP) measurement, gonioscopy and a dilated fundus examination. All glaucoma suspects and those diagnosed with glaucoma were enrolled for visual field examination.</span><span style="font-weight: 400;"><br /></span><strong>Results:</strong><span style="font-weight: 400;"> Two hundred and twenty-seven first degree relatives of 72 patients were invited for the examination. Out of 227 individuals, 131 (males 67.94%, females 32.06%) agreed to participate in the study. A total of 23 (17.56%) individuals were diagnosed with glaucoma, 10 (43.47%) as POAG and 13 (56.52%) as PACG. Fourteen percent of parents, 22% of siblings and 9% of off-springs had open angle glaucoma. Among 13 PACG participants, 26.08% of parents, 26.08% of siblings and 4.34% of off-springs had angle closure glaucoma. Awareness among first degree relatives diagnosed with glaucoma was 21.74%.</span></p> <p><span style="font-weight: 400;"> </span><strong>Conclusion:</strong><span style="font-weight: 400;"> The prevalence of glaucoma among first degree relatives of glaucoma patients was higher than individuals without family history of glaucoma. Promoting awareness on glaucoma and the timely screening of family members can lead to early detection and prevention of blindness from the disease. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Comparison of Intraocular Pressure among Individuals with Systemic Hypertension and those with Normal Blood Pressure 2021-06-26T19:21:16+00:00 Sanket Parajuli Pooja Shrestha Jeevan K Shrestha Sadhana Sharma <p><strong>Introduction:</strong><span style="font-weight: 400;"> Systemic blood pressure, by far, is one of the most important factors that can have an effect on intraocular pressure. We have compared the intraocular pressure (IOP) among patients with systemic hypertension and those with normal blood pressure.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">A hospital based case control study was conducted from March 2017 to March 2018 in the Ophthalmology outpatient department at Dhulikhel Hospital. A total of 100 patients with hypertension were included in the case group (hypertensive group) and 100 cases with no systemic or ocular disease were included in the control group (normotensive group). Mean intraocular pressures were calculated and compared between the two groups.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Mean age of patients was 49.03 years in hypertensive group and 47.53 years in normotensive group. Mean IOP of the right eye in those with hypertension was 16.10 mmHg and in the left eye was 15.8 mmHg. Similarly mean IOP of the right eye in the normotensive group was 15.8 mmHg and the left eye was 16.2 mmHg. The difference between mean IOP of hypertensive and normotensive individuals was not statistically significant (p &gt; 0.05). The prevalence of ocular hypertension was found to be 7.5%.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">There was no statistically significant difference in IOP between hypertensive and normotensive individuals. However, a statistically significant difference in IOP was noted between ‘hypertensive with controlled blood pressure’ and ‘hypertensive with uncontrolled BP’ indicating that high blood pressure may be associated with high IOP.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Association of Thr715Pro P-Selectin Gene Polymorphism in Diabetic Retinopathy in North Indian Population: A Prospective Clinical Study 2021-06-26T19:23:01+00:00 Ritika Sharma Shri Kant Deepak Mishra Tanmay Srivastav Hemendra Singh <p><strong>Introduction: </strong><span style="font-weight: 400;">The aim of this study was to evaluate the role of Thr715Pro P-Selectin gene polymorphism in patients with Diabetic Retinopathy in North Indian population and establish its role in the pathophysiology as an independent factor.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">: This is a prospective clinical study conducted on 60 patients at a tertiary care centre in North India over a period of eighteen months. Sixty patients satisfying the inclusion criteria were selected from the Vitreoretina clinic in the department. They were categorised equally in three groups namely Diabetics with diabetic retinopathy (DwDR), Diabetics without diabetic retinopathy (DwoDR), and non diabetics. The non-diabetics group was further divided into healthy controls, Hypertensive Retinopathy (HR) and Non-exudative Age Related Macular Degeneration (NEAMD). All the patients underwent complete ophthalmic evaluation and blood samples were drawn for the genetic study with their informed consent. Data was analysed using SPSS software version 16.</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: The genotypic analysis between DwDR, DwoDR and the three subgroup of controls comprising of healthy controls, HR and NEAMD showed that Thr715Pro (A/C) polymorphism prevalence was significantly high in DwDR (p = 0.003) and DwoDR (p = 0.003) compared to healthy controls. No significant difference was noted between DwDR, DwoDR and the HR and NEAMD groups. </span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: Thr715Pro P-Selectin gene Polymorphism could not be established as an independent factor in the pathogenesis of diabetic retinopathy, as its association is found with other systemic diseases which create a prothrombotic state.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Barriers to Cataract Surgery in Peri-urban Regions of Eastern Nepal 2021-06-26T19:23:53+00:00 Sean Ng Ming Sheng Wang Kaiying Ho Wei-En Lee Mei Xuan Deborah Swati Vijayan Brjan Kaiji Betzler Mahek Agrawal Anadi Khatri Rupesh Agrawal <p><strong>Introduction:</strong><span style="font-weight: 400;"> Despite cataract being a condition easily treated by surgery, it continues to be the leading cause of blindness worldwide (35.15%). In Nepal, the proportion of blindness due to cataract is much higher, with cataract accounting for 62.2% of all blindness. An effective method of decreasing this figure is by addressing the main barriers preventing people from accessing cataract surgery. Knowing that these barriers are dynamic and region-specific, our study aimed to determine the current barriers faced in Morang and Sunsari districts of Nepal.</span></p> <p><strong>Materials and methods</strong><span style="font-weight: 400;">:</span><span style="font-weight: 400;"> Subjects were patients attending a cataract surgical camp, who had unilateral or bilateral blindness due to cataract. A survey was administered to determine the factors contributing to their delay in receiving treatment for cataract. Furthermore, the percentages of male and female subjects with bilateral blindness receiving treatment at the surgical camp were compared to the percentage of males and females with bilateral blindness due to cataract in Morang and Sunsari.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> The main barriers for both subjects with unilateral and bilateral blindness were the inability to afford treatment and the lack of awareness that cataract is treatable. Additionally, although more women were bilaterally blind due to cataract compared to men in Morang and Sunsari, men were more likely to receive treatment compared to women.</span></p> <p class="AbstractCxSpFirst"><strong>Conclusion:</strong><span style="font-weight: 400;"> Policies targeted at reducing costs of surgery, increasing the awareness of cataract surgery, and specifically increasing women’s access to cataract surgery would be effective methods in decreasing the prevalence of avoidable blindness due to cataract in Morang and Sunsari. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Arrugas Bone Trephine Assisted Flapless Dacryocystorhinostomy with Circumosteal – Mitomycin C Versus External Dacryocystorhinostomy: A Hospital Based Comparative Study 2021-06-26T19:27:35+00:00 Gyan Bhaskar Anita Ambastha Nilesh Mohan Shalini Sinha Srishti Shree <p><strong>Introduction: </strong><span style="font-weight: 400;">Primary acquired</span><span style="font-weight: 400;"> nasolacrimal duct obstruction is a common ophthalmic condition and has </span><span style="font-weight: 400;">conventionally been</span><span style="font-weight: 400;"> managed by </span><span style="font-weight: 400;">external dacryocystorhinostomy</span><span style="font-weight: 400;">. However this procedure is time consuming and involves making mucosal flaps. The aim of this study was t</span><span style="font-weight: 400;">o compare the surgical outcome in Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C versus conventional external dacryocystorhinostomy.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This is a retrospective non-randomized study of surgical outcome in patients of primary acquired</span><span style="font-weight: 400;"> nasolacrimal duct obstruction</span><span style="font-weight: 400;"> who underwent an Arrugas bone trephine assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C (group A) versus those who underwent conventional external dacryocystorhinostomy (group B) in a teaching hospital in North India. Patients with previously failed dacryocystorhinostomy, lacrimal fistula, canalicular and common canalicular obstruction were excluded. Success was defined as patent syringing at the end of one year. Surgical time was calculated from skin incision to skin suturing.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">There was complete resolution of epiphora with patent syringing in 43 out of 52 patients in group A, while in group B, 47 out of 55 patients had complete resolution of epiphora with patent syringing at the end of one year (p= 0.77). Mean surgical time was significantly lower in Group A than in Group B (p=&lt;.05). Scarring and closure of the ostium was the most common cause of failure in both groups (Group A, n=5, 9.6%; Group B, n= 3, 5.45%).</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: Arrugas bone trephine-assisted flapless dacryocystorhinostomy with Circumosteal - Mitomycin C is a viable alternative to conventional external dacryocystorhinostomy with comparable success rate and shorter surgical time and a faster learning curve.</span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Microbial Keratitis 2021-09-14T04:26:54+00:00 Namrata Sharma <p>Not available</p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Et tu Mucor? 2021-09-14T04:00:11+00:00 Anadi Khatri Gunjan Prasai Mukesh Pandey Muna Kharel Dikshya Bohara Madhav Panthi Najara Thapa Bhaskar Jha Eli Pradhan <p><strong>Introduction: </strong><span style="font-weight: 400;">Recently, the Indian subcontinent has been hard hit by the second wave of COVID-19. Along with it, the region has become a hot spot for mucormycosis infection in patients with COVID-19. The aim of this paper is to provide a scientific overview on the status of mucormycosis in pre-COVID-19 era and on how COVID-19 could have directly or indirectly expose the hidden burden of mucormycosis globally.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This paper is structured as a narrative review and is based on relevant published literature on both COVID-19 and mucormycosis. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Mucormycosis in the pre-COVID-19 era was almost a neglected entity. It was because the risk factors for both - More severe COVID-19 infections and Mucormycosis are almost similar – COVID-19 might have helped to expose the true magnitude of the mucormycosis and flagging it as a major public health concern requiring a revisit by medical science. </span></p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Guidelines to Author, Copyright Transfer Statement, Patient Consent Form for Case Report, Acknowledgement 2021-11-14T13:07:25+00:00 Eli Pradhan <p>Not applicable.</p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Female Clients Satisfaction towards Primary and Secondary Eye Health Facilities and Cost of Eye Care in Nepal 2021-06-26T19:45:11+00:00 Radhika Upreti Oli Manish Poudel Yadira Perez Hazel Anu Manandhar Mohan Krishna Shrestha Reeta Gurung <p><strong>Introduction:</strong><span style="font-weight: 400;"> In Nepal, females suffer from disproportionately higher burden of blindness and vision impairment with low access to eye care. The available knowledge is inadequate to address the issues related to gender and generate information to reduce the gender disparity. The aim of this study was to determine female clients’ satisfaction with services at eye facilities in Nepal and to estimate the cost of cataract surgery.</span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> Exit interviews were conducted in 2018 with 308 female clients from eight facilities in five districts. Face to face interviews were conducted using a pretested semi-structured questionnaire adopted from the midterm review of Vision 2020. </span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> The mean age of participants was 54±17 years. Ninety seven percent (97%) of the participants reported that they received service as per their expectation and were satisfied with the service of the facilities. Major factors for satisfaction were: thorough eye examination (54%), behavior of health staff (40%), and cleanliness of health facility (39%). Another eighty percent (80%) of the participants mentioned that they would recommend or return to the same facility. Fifteen percent of the participants perceived that they faced problems at the eye facility because of their gender. Around three quarters (73%) paid health expenses from their pocket. Most (83%) of the participants rated user fees as either reasonable or inexpensive.</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> The majority of participants reported receiving service as expected and willingness to return to the same eye health facility for future consultation. However, most participants had to pay the health care expenses out-of-pocket. </span></p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Trend of Intravitreal Bevacizumab Dispensing Technique in Nepal 2021-06-26T19:46:07+00:00 Roshija Khanal Rijal Deepesh Mourya Sanyam Bajimaya Anil Kumar Srivastava <p><strong>Introduction:</strong> The main purpose of this survey was to find out what technique for bevacizumab injection is practiced by ophthalmologists in Nepal and to evaluate which is the best technique of drug dispensing and what possible hindrances are there in following it.</p> <p><br /><strong>Materials and methods:</strong> This was an online survey using google forms.</p> <p><br /><strong>Results:</strong> There were a total of 34 participants in the survey. Most of the participants (58.8%) followed the same vial, multiple prick, multiple days method for giving intravitreal bevacizumab.. Majority of participants said they thought that aliquoting the drug and using it same day would be the best technique to prevent post injection endophthalmitis. Cost and unsuitability for small hospitals were the main factor preventing surgeons from practicing the best method.</p> <p><strong>Conclusion:</strong> Risk of endophthalmitis can be reduced by following proper drug dispensing techniques. Aliquoting bevacizumab in smaller syringes under aseptic conditions can reduce the risk of endophthalmitis.</p> 2021-06-26T00:00:00+00:00 Copyright (c) 2021 Nepalese Journal of Ophthalmology Dr. Keshav Raj Bhattarai 2021-11-14T12:55:53+00:00 Purushottam Joshi <p>Not applicable.</p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021 Prof. Dr. Poojyashree Karky 2021-11-14T13:02:20+00:00 Anjila Basnet <p>Not applicable.</p> 2021-11-18T00:00:00+00:00 Copyright (c) 2021