Nepalese Journal of Ophthalmology 2023-04-24T05:58:40+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> Guidelines to Author, Copyright Transfer Statement, Patient Consent Form for Case Report, Acknowledgement 2023-04-24T05:58:40+00:00 Eli Pradhan <p>Not applicable.</p> 2023-04-22T00:00:00+00:00 Copyright (c) 2023 Ocular toxicity among patients taking anti-tubercular treatment 2022-01-17T16:30:24+00:00 Sanjeeta Sitaula Ranju Kharel Sitaula Shilu Thapa Sameer Chapagain Hira Nath Dahal <p><strong>Introduction: </strong><span style="font-weight: 400;">Tuberculosis remains a major public health problem in Nepal and anti-tubercular drugs used for the treatment of pulmonary and extrapulmonary tuberculosis can be associated with ocular toxicity. This prospective study aimed to evaluate the incidence of ocular toxicity among patients receiving anti-tubercular therapy and to assess the change in visual functions and ocular imaging before and after use of anti-tubercular therapy. </span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> A total of 89 eyes of 45 TB patients taking anti-tubercular therapy were enrolled. Detailed history and examination including best-corrected visual acuity (BCVA), colour vision (Farnsworth D-15t), contrast sensitivity (Pelli-Robson chart), Goldman visual field analysis and spectral domain optical coherence tomography for retinal nerve fibre layer (RNFL) analysis were assessed at baseline and at 6 months after starting anti-tubercular therapy. Visual evoked potential (VEP) was performed in suspected cases.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The mean age of the patients was 29.13±14.00 years and 62.2% were males. The mean weight of the subjects was 54.37±10.36 kg, mean daily dosage of ethambutol was 17.91±1.74 mg/day/kg and mean administration duration was 2.71±1.54 months. The incidence of ocular toxicity was 2.24%. Bilateral retrobulbar optic neuropathy occurred in a 27-year female of 55 kg receiving ethambutol (20 mg/kg/day) for 6 months for Pott’s spine. Her best-corrected visual acuity in both eyes was reduced to 6/36 from 6/6 and developed non-specific color vision defect, decreased contrast sensitivity, bilateral cecocentral visual field defect and mean decrease in retinal nerve fibre layer thickness compared to the baseline data. In rest cases, a statistically significant decrease in mean retinal nerve fibre layer thickness in both eyes suggested the evidence of subclinical toxicity. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Though less common, ethambutol toxicity can occur in patients under anti-tubercular therapy in the form of retrobulbar optic neuritis. Decreased contrast sensitivity and thinning in the mean retinal nerve fibre layer thickness can be the indicator of subclinical toxicity.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Dry eye syndrome among patients with type II diabetes mellitus in a tertiary care centre in South India 2022-05-11T16:08:19+00:00 Shimna Clara Prasad Sheldon James Goudinho Blessy Mary Koshy <p><strong>Introduction: </strong><span style="font-weight: 400;">One of the leading causes of dry eye syndrome (DES) is found to be diabetes mellitus (DM). The current study was conducted to detect possible tear film anomalies among diabetic individuals attributable to dry eye. The study aimed to assess the proportion of dry eye syndrome among patients with Type 2 diabetes mellitus.</span><strong> </strong></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> Two hundred patients with Type 2 diabetes mellitus who came to the Ophthalmology OPD from October 2018 to November 2020 in the 29-60 years age group were included in the study. Patient data, diabetic history, dry eye symptoms, blood sugar values and tests to measure tear volume and tear film instability were carried out among patients and dry eyes were graded.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The proportion of patients with dry eye symptoms among Type 2 diabetes mellitus were 61%. Mild dry eye syndrome was observed in 27%, moderate dry eye syndrome in 59% and severe dry eye syndrome in 14%. A statistically significant difference (p&lt;0.05) was noted between the severity of dry eye syndrome and dry eye test parameters. A strong positive correlation (r = 0.923) was noted between severity of dry eye syndrome and Standardised Patient Evaluation of Eye Dryness (SPEED) score which was statistically significant (p &lt; 0.001).</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">In our study, there was higher prevalence of dry eyes in patients who had Type 2 diabetes Mellitus which might be attributed to reduced tear secretion in diabetes mellitus patients caused by autonomic dysfunction in these patients. We recommend that dry eye evaluation should be an integral part of ocular examination in diabetic patients for early detection and treatment so that further complications can be prevented, which may lead to severe visual impairment.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Conjunctival swab positivity and conjunctivitis in SARS-COV-2 in a tertiary care center of Western Odisha 2022-05-01T06:43:21+00:00 Jayashree Dora Ruturaj Sahoo Ravindra Kumar Chowdhury Sanghamitra Pati Saroj Dash Babul Kumar Agrawal <p><strong>Introduction: </strong><span style="font-weight: 400;">The principal route of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) is respiratory droplets. Reverse transcription-polymerase chain reaction (RT-PCR) test of throat swabs, nasopharyngeal swabs, sputum, endotracheal aspirates and bronchoalveolar lavage is the diagnostic test of severe acute respiratory syndrome coronavirus-2. Since the epithelium of the conjunctiva contains angiotensin-converting enzyme-2 receptors, the presence of the severe acute respiratory syndrome coronavirus-2 in conjunctival secretion can be expected. The present study is designed to detect severe acute respiratory syndrome coronavirus-2 from conjunctival secretions and the prevalence of conjunctivitis in laboratory-confirmed CoronaVirus disease-19 (COVID-19) patients.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This is a prospective observational study</span> <span style="font-weight: 400;">carried out in a tertiary care hospital in western Odisha, India from September 2020 to November 2020 during the first wave of CoronaVirus disease-19. One hundred and thirteen laboratory-confirmed CoronaVirus disease-19 positive patients either by reverse transcription-polymerase chain reaction or Rapid antigen test (RAT) from nasopharyngeal swabs were included. Conjunctival swabs were collected from all these patients with proper precautionary measures and sent for reverse transcription-polymerase chain reaction test. Any signs of conjunctivitis at any stage of the illness were observed in all the patients.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Out of 113 samples, reverse transcription-polymerase chain reaction test of the conjunctival swab was found to be positive in three patients (2.65%). The mean cycle threshold (CT) value of these three swabs was 27.16. No signs of conjunctivitis were found in any of these patients. Diabetes and hypertension were associated comorbidities in one patient.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;"> The absence of conjunctivitis despite the presence of virus in the conjunctival swab gives a message to the ophthalmologists to take precautionary measures during a routine eye examination.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Outcome of phacoemulsification without anti-vascular endothelial growth factor in patients with treatment naïve diabetic retinopathy 2022-07-19T00:55:56+00:00 Roshija Khanal Rijal Sushant Adiga Kaushal Pokharel Sabin Dhakal Thaneshwar Rijal Sitaram Khadka <p><strong>Introduction: </strong><span style="font-weight: 400;">This retrospective, non-randomized, observational study was conducted at ASG Eye Hospital, Kathmandu to evaluate the outcome of phacoemulsification without anti-Vascular Endothelial Growth Factor (VEGF) in patients with treatment naïve diabetic retinopathy.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">Records of all patients who underwent phacoemulsification without Bevacizumab in treatment of naïve patients with any grade of non-proliferative Diabetic Retinopathy (NPDR) were seen. Pre-operative and post-operative visual acuity along with central macular thickness (CMT) was compared.</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: The study comprised 32 eyes of 20 patients with treatment naïve non-proliferative Diabetic Retinopathy who underwent phacoemulsification. Twelve were men and eight were women with an average age of 69.2 years (range 55 years to 83 years). The average preoperative central macular thickness as measured on optical coherence tomography was 254.63± 20.25 microns and 1-month postoperative central macular thickness was 254.72± 19.96 microns; the study did not find any significant difference (p-value 0.918). The average difference in the central macular thickness between the 1-month postoperative and preoperative values was 0.09 microns.</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Uneventful phacoemulsification in eyes with treatment naïve diabetic retinopathy does not cause an increase in central macular thickness after surgery and thus anti-Vascular Endothelial Growth Factor as an adjunct is not mandatory.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Comparison of central macular thickness between diabetic patients without clinical retinopathy and non-diabetic patients 2021-10-05T08:49:51+00:00 Upasana Pokhrel Eli Pradhan Rabindra Singh Thakuri Kaushal Pokhrel Govinda Paudyal <p><strong>Introduction: </strong><span style="font-weight: 400;">Diabetic retinopathy (DR) is one of the leading causes of blindness in patients between 20 and 60 years of age which can be prevented by early detection of diabetic retinopathy. </span><span style="font-weight: 400;">The duration of diabetes is probably the strongest predictor for development and progression of retinopathy.</span><span style="font-weight: 400;"> Optical Coherence Tomography (OCT) is a recent advance in imaging which is sensitive in early detection of small changes in macular thickness.</span></p> <p><strong>Materials and Methods: </strong><span style="font-weight: 400;">This hospital based cross-sectional study was done at a tertiary referral center in Kathmandu, Nepal where 364 eyes of 182 patients (182 eyes in 91 patients in each group diabetes without retinopathy group and nondiabetic group) were evaluated. Thickness of the macula was determined by using Spectral Domain Optical Coherence Tomography (SD- OCT) and compared between diabetic patients without clinical retinopathy and nondiabetic patients.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">The mean CMT as measured by Spectral Domain Optical Coherence Tomography in diabetic patients was 236.29±40.31 µm whereas it was 244.25±30.51 µm in non-diabetic cases. The mean central macular thickness of diabetic patients with duration of diabetes less than 1 year, 1-5 years, 6-10 years, 11-15 years and more than 15 years were 217.19±42.22, 233.49±45.69, 248.5±31.37, 250.89±21.62 and 240.75±11.26 respectively.</span></p> <p><strong>Conclusions: </strong><span style="font-weight: 400;">This study concluded that in diabetic patients there was an initial decrease in central macular thickness which gradually increased with increasing duration of diabetes mellitus. Examination of macular thickness could be a useful modality to evaluate progression of disease before appearance of other clinical signs of diabetic retinopathy.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Demography, indications and outcome of descemet stripping automated endothelial keratoplasty in Nepal 2022-05-11T16:16:00+00:00 Leena Bajracharya Leesha Shrestha Joshi Rachana Singh Rana Reeta Gurung <p><strong>Background:</strong></p> <p>Descemet stripping automated endothelial keratoplasty (DSAEK) is performed for corneal endothelial pathology. It had gained popularity over penetrating keratoplasty (PK) because of better outcome.</p> <p><strong>Methods</strong>: </p> <p>Retrospective data was collected from records of patients who underwent DSAEK from 2005 to 2019. Demography, indications and post-operative complications of DSAEK were analyzed. Outcome was measured in terms of graft clarity and vision.</p> <p><strong>Results:</strong></p> <p>93 eyes of 86 patients had undergone DSAEK in the study period of 15 years. Average age of the patients was 61.0 years. 55.9% were female. The common indications for DSAEK were cataract surgery related bullous keratopathy (n=47, 50.5%), Fuchs dystrophy (n=22, 23.6%) and failed graft (n=11, 11.8%). 8.6% of surgeries had graft detachment and 5.3% had pupillary block in the early post-operative period. Outcome analysis was done for cases (n=80) which had follow-up duration of at least 2 months (range: 2 months to 11 years; average: 28.5 months).Endothelial rejection occurred in 8 cases (10.0%), 5 of which regained graft clarity after treatment. At the last follow-up visit, 23.8% (n=19) of grafts had failed, which was mostly due to endothelial failure (n=16); 3 grafts failed due to infective keratitis. 42.5% (n=34) acquired best corrected vision of 6/18 or better. The average astigmatic error was 1.6 Diopter Cylinder by refraction.</p> <p><strong>Conclusion: </strong></p> <p>DSAEK showed good outcome with our results comparable to other studies. It had replaced traditional PK in our institute for endothelial dysfunction. Surgeons in the country should be encouraged and trained to do the procedure.</p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Evaluation of dry eye symptoms in lecturers working in medical colleges of Nepal: An online cross-sectional study following SARS-CoV-2 outbreak 2022-07-25T05:28:34+00:00 Bipin Bista Padam Raj Bista Rasik Neupane Sharad Gupta Anwit Raj Pandey Aastha Singh Reena Yadav <p><strong>Introduction</strong><span style="font-weight: 400;">: Dry eye is one of the frequently encountered ophthalmological disorders. Following the pandemic of Coronavirus disease 2019, use of masks and electronic devices has taken an upraise globally. These factors are one of the causes for dry eye disease. This study emphasises dry eye symptoms among lecturers working in medical colleges of Nepal.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;"> This was a descriptive cross sectional study conducted among 217 lecturers working in various medical colleges in Nepal. Dry eye evaluation was done using the Ocular Surface Disease Index (OSDI) questionnaire. Analysis of data was using Microsoft Excel 2016 and IBM Statistical Package for Social Sciences (SPSS) version 26.0.</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: One fourth (25.80%) of 217 participants experienced symptoms of dry eye disease.</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: Increasing use of mask and laptop during this pandemic era has shown to cause mild dry eye symptoms in lecturers working in medical colleges of Nepal. Proper care and precaution needs to be practised in order to minimise dry eye symptoms and its consequences.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Safety and efficacy of cyclosporine (0.05% versus 0.09%) in dry eye disease. Is it the strength of cyclosporin that really matters? 2022-03-23T05:50:09+00:00 Mukesh Rajpoot Divya Singh Kankambari Pandey Rahul Bhargava <p><strong>Introduction:</strong><span style="font-weight: 400;"> This is a multicenter, randomized, interventional, double masked study aimed to compare safety and efficacy of cyclosporine (0.05% versus 0.09%) in dry eye disease. </span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> Random allocation of patients (n=450) was done in two groups by parallel assignment (1:1). Group1(n=225) received CAs 0.05% drops twice daily, and group 2 (n=225) received CAs 0.09% drops twice daily for 3 months. Primary outcomes were changes from baseline in Lissamine green staining score, Nelson grade on conjunctival impression cytology and tear film osmolarity. Secondary outcomes were changes in dry eye symptom score. Schirmer’s test scores, changes in corneal fluorescein staining and changes in tear film break up time. </span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Within the groups, there was a significant improvement (ANOVA, P&lt;0.05) in tear film osmolarity, lissamine green staining score, dry eye symptom score, corneal fluorescein staining and Schirmer test scores over 3 months of intervention. However, the difference in Nelson Grade, goblet cell density, and tear film break-up time was not statistically significant. Between the groups, there was a significantly better improvement in tear film osmolarity (ANOVA, P&lt;0.001), Lissamine green staining score (ANOVA, P=0.002), corneal fluorescein staining (ANOVA, P=0.011), dry eye symptoms (ANOVA, P=0.040) and Schirmer test scores (ANOVA, P=0.001) with CAs 0.09%. However, the improvement in Nelson grade, tear film break-up time was not significantly different between the two groups. The overall patient’s comfort was significantly better over time in patients on CAs 0.05% (ANOVA, P&lt;0.001).</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: Increasing strength of CAs better improves corneal staining, tear production, tear film osmolarity but not conjunctival morphology and tear film stability.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Comparative study of latanoprost (0.005%) and bimatoprost (0.03%) in primary open angle glaucoma 2022-02-09T09:20:34+00:00 Neyaz Kausar Kamala Thapa <p><strong>Introduction: </strong><span style="font-weight: 400;">Glaucoma can cause vision loss by damaging the optic nerve and increased intraocular pressure is one of the primary risk factors.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This was a hospital based, prospective, comparative, single masked (observer masked) study conducted on patients attending glaucoma department of Nepal Eye Hospital within a period of 1 year from February 2020 to January 2021. The sample size was 50. Specially designed proforma was used to collect the patient. Patients falling are divided in group A and group B randomly, patients using latanoprost were placed in group A and patients using bimatoprost were placed in group B. The examination procedure included history taking, Snellen visual acuity, refraction, gonioscopy, IOP measurement, slit lamp biomicroscopy and fundoscopy with 90 diopter lens. </span></p> <p><span style="font-weight: 400;">R</span><strong>esults: </strong><span style="font-weight: 400;">Among fifty patients 33 (66%) were males and 17 (34 %) were females, 35 (70%) belonged to urban and 15 (30%) from rural population. Maximum number of patients were in the age group of 16—30 years i.e. 15 (30%), second highest group was 61—75 years of age group i.e. 14 (28%) , 11 i.e. 22% of patients were of 46—60 years of age group. Nine (18%) of patients were 31—45 years of age group and 1 i.e. 2% was above 75 years of age. Twenty percent presented with hypertension, 14 % with diabetes mellitus and 66 % with no systemic history. Ten percent had family history of glaucoma and 90% patients had no family history . Twenty-eight percent of patients had a family history of smoking and 72 % had no history. The mean IOP of group A (0.005% latanoprost) patients initially before the start of the treatment was 27.16 mm Hg, at sixth month IOP was 17.24 mm Hg, mean difference was 9.92 mm Hg and p value was &lt; 0.001. The mean IOP of group B (0.03% bimatoprost) patients initially before the start of the treatment was 26.88 mm Hg , at the sixth month the IOP was 15.88 mm Hg , and the mean difference was 11.00 mm Hg and p value was &lt; 0.001. There was a significant difference in IOP at first visit and 6 months in both groups, p&lt;0.001. (The t-test is used.) However, the mean difference of group B, 11.00, is greater than group A, 9.92.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Male gender, increasing age, urban population, hypertension, diabetes mellitus, and high intraocular pressure were the most prevalent risk factors. The most important factor is early detection of signs and symptoms and measurement of diurnal intraocular pressure.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Proliferative diabetic retinopathy detection: Comparison of clinical examination, optomap photographs and fluorescein angiography 2021-09-01T00:36:31+00:00 Ramesh Venkatesh Nikitha Reddy Chaitra Jayadev Ram Snehith Pulipaka Naresh Kumar Yadav Thirumalesh Mochi Basavaraj <p><strong>Introduction: </strong><span style="font-weight: 400;">This study aimed to analyse the clinical retinal examination findings and undilated Optomap ultrawide field retinal imaging for the detection of proliferative diabetic retinopathy (DR) as compared to the fluorescein angiography (FA).</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">In this retrospective cross-sectional study, five hundred and twenty-three patients diagnosed with diabetic retinopathy on dilated retinal examination underwent fluorescein angiography and undilated Optomap imaging. Fluorescein angiography and undilated Optomap images were graded by masked graders and the diagnosis was labelled either as proliferative diabetic retinopathy or non-proliferative diabetic retinopathy. Sensitivity and specificity was calculated comparing the diagnosis obtained from the dilated retinal examination and the undilated Optomap images against the fluorescein angiography image findings. </span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Gradable quality fluorescein angiography and undilated Optomap images with a clinical diagnosis mentioned in the medical record for that particular visit were available in 980 (right eye – 656; 67%; left eye – 324; 33%) eyes of 496 patients. There were 332 (67%) males and 164 (33%) females with a mean age of 60.3 ± 9.51 years (range: 32 – 81 years). Sensitivity of clinical examination and undilated Optomap images in accurately identifying proliferative diabetic retinopathy was 63.5% and 43.5% respectively. Specificity of clinical examination and undilated Optomap images in accurately identifying proliferative diabetic retinopathy was 88.5% and 76.2% respectively. On comparison of the undilated Optomap imaging findings against the clinical examination findings, the sensitivity and specificity were 47.7% and 75.1% respectively. </span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Both clinical fundus evaluation and undilated Optomap imaging were relatively inferior to fluorescein angiography in the detection of proliferative diabetic retinopathy, which hence remains the choice of imaging modality giving scope for wider application.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Study of natural course of serous macular detachment in pregnancy induced hypertensive patients at a tertiary care centre 2022-05-13T08:01:13+00:00 Shilpa Yellur Devegowda Kalpana Badami Nagaraj Hithashree Hampannavar Rajanna Hemalatha B Chikhanumanthappa Ravi Bypareddy Manoj Kumar N Kavitha L Tumbadi Jessica Basumatary <p><strong>Introduction:</strong><span style="font-weight: 400;"> The research aimed to study the natural course of serous macular detachment SRD) in patients with pregnancy induced hypertension (PIH), and document fundus changes, OCT findings and visual outcome.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This is a prospective observational study. Admitted patients underwent ocular screening, and detailed dilated indirect ophthalmoscopy. Those with serous macular detachment were further evaluated with OCT; characteristics of OCT analysed and recorded. All eyes were followed up till macular resolution was noted.</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: Out of 4950 cases, 22 patients (38 eyes) had serous macular detachment. Mean central macular thickness (CMT) was 512.29 (SD 242.074). RPE irregularity (31.6%),subretinal hyperreflective dots (26.3%) and subretinal membranes (23.7%) were more commonly seen OCT features in these eyes.</span></p> <p><span style="font-weight: 400;">The difference between mean vision and mean central macular thickness at different intervals was statistically significant : F(3, 111)=65.514, p - 0.001; F(3, 111)=47.331, p – 0.001 respectively. All eyes had resolution of retinal detachment with full visual recovery following delivery. However, 10 pregnancies had foetal mortality.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;"> The incidence of ocular affection in pregnancy induced hypertension is 1-2%. Retinal detachment in such cases have good visual potential following termination of pregnancy. However, the cases had a high incidence of foetal demise. Therefore, early emphasis on early detection of ocular involvement in pregnancy induced hypertension and timely intervention is focused on to prevent foetal demise.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Ethambutol induced toxic optic neuropathy - A retrospective study in a tertiary eye care centre in Southern India 2022-05-03T08:48:03+00:00 Mahesh Kumar Shanmugam Swetha Sajja Akkayasamy Kowsalya Harini Krishna Balakrishnan K N Jayasri <p><strong>Introduction: </strong><span style="font-weight: 400;">Ethambutol is an antibiotic used as a first line drug in the treatment of tuberculosis and a vision threatening side effect of EMB is ethambutol-induced optic neuropathy (EON). The aim of the study is to create awareness about the potentiality of ethambutol to cause ethambutol-induced optic neuropathy, careful monitoring of dose and patient education.</span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> A retrospective observational study of 14 patients whose complete Anti- tubercular treatment records could be retrieved were included. Epidemiological data including age, sex, systemic illness were recorded. Duration between optic nerve toxicity , usage of ethambutol and the drug dosage were noted. Best corrected visual acuity, anterior segment examination including pupils, extraocular movements, colour vision, central fields and fundus examination were evaluated. The patients were followed up at one and three month intervals. </span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Associated systemic illness was found to be a confounding factor for the development of ethambutol-induced optic neuropathy. 57% of patients had diabetes mellitus followed by hypertension (14.2%), renal disease (7.1%). The average daily dose of Ethambutol ingested was 1078.5 mg (21 mg/kg) and this high dose could have been the primary cause for development of ethambutol-induced optic neuropathy. Vision ranged from total blindness to mild visual impairment and poor recovery of vision was noted even after discontinuing ethambutol.</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Only a minority of patients showed improvement in visual function following discontinuation of ethambutol and the toxicity was found to be dose-dependent. Patients with comorbidities like renal impairment and diabetes mellitus appeared to be at greater risk. Ophthalmological examination before commencing treatment and periodic evaluation thereafter is mandatory. </span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Barriers to cataract surgery in peri-urban regions of Eastern Nepal: An experience at a government eye department 2023-04-04T10:50:25+00:00 Zahir Ansari Ravi Kumar Maharjan Rakshya Basnet Sahana Khatoon Ashesh Koirala <p>NA</p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Ocular oncology service in Nepal: A demand with time 2022-12-18T01:35:50+00:00 Rohit Saiju <p>NA</p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Infectious crystalline keratopathy: A case series 2021-09-27T04:33:25+00:00 Shalini Mohan Kunal Sahai Vinita Gupta <p><span style="font-weight: 400;">This is the case series of three patients of infectious crystalline keratopathy (ICK) presented to us after undergoing penetrating keratoplasty between 2010 to 2020. The lesions showed classical crystalline patterns and clinical diagnosis was made. The patients were treated by broad spectrum antibiotics till the complete resolution of the lesions. The cases highlight the clinical features, diagnosis and management of this rare and resistant disease. </span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Tubercular granuloma arising from floor of orbit : A rare occurrence 2022-03-23T06:27:27+00:00 Lubna Khan <p><strong>Introduction: </strong><span style="font-weight: 400;">Tuberculosis of the orbit is a unilateral entity commonly involving the bony wall, periosteum or soft tissue in left orbit. It is a rarity.</span></p> <p><strong>Case: </strong><span style="font-weight: 400;">A fifty seven years old female presented with a localised mass near inferior orbital margin. Owing to its small size and superficial location in orbit, there was no soft tissue displacement or motility disturbance. </span></p> <p><strong>Observations: </strong><span style="font-weight: 400;">Dissection revealed a localised firm mass attached to periorbita covering the orbital floor. The mass was excised and on histopathological analysis it was found to be composed of multiple granulomas containing abundant Giant cells. Considering such a picture at cellular level, ELISA for tuberculosis was done. Values were suggestive of recent infection. The patient was put on antitubercular multidrug regimen for six months one week after excision of mass, with a follow up of four years, having no recurrence till date.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Though orbital tuberculosis is much more common in childhood, it should always be considered in the differential diagnosis of orbital mass in adults also. At times, even in an otherwise healthy individual, tuberculosis might be diagnosed because of an orbital mass. </span></p> <p><span style="font-weight: 400;">Ophthalmologists should have a high index of suspicion since orbital tuberculosis has been underdiagnosed in the past.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Acquired ankyloblepharon post purulent membranous conjunctivitis and its novel surgical management: A case report 2022-03-23T06:49:42+00:00 Nidhi Sharma Anjali Nagar <p><strong>Introduction:</strong><span style="font-weight: 400;"> Ankyloblepharon is a partial or complete fusion of eyelids by webs of skin. It may be congenital or acquired. Herein we report a rare case of acquired bilateral ankyloblepharon that developed after purulent membranous conjunctivitis. We will also discuss its unique surgical management which has not been reported previously in the literature.</span></p> <p><strong>Case:</strong><span style="font-weight: 400;"> A 21 year old male presented with complaints of narrowing of eyes for the last six months following an attack of acute purulent membranous conjunctivitis. Surgical excision of the adhesions was done. We used conjunctival autograft to cover the raw area left after excision as a new modality of treatment. The graft was successfully taken up and no recurrence of adhesions was found at 1 year follow up.</span></p> <p><strong>Observations:</strong><span style="font-weight: 400;"> Various modalities of treatment for ankyloblepharon have been reported which includes excision of tissue and suturing and amniotic graft. Here we have used conjunctival autograft on the raw area after excision of adhesions and the result obtained was good. </span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> To the best of our knowledge this is the first and a rare case of acquired ankyloblepharon in a young male following a single episode of purulent membranous conjunctivitis. Conjunctival autograft can be successfully used to cover the raw areas left after excision of adhesions. </span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Bilateral keratomalacia secondary to xerophthalmia 2022-05-13T06:31:47+00:00 Jyoti Sapkota Rachana Rana <p><strong>Introduction: </strong><span style="font-weight: 400;">Vitamin A deficiency leads to a wide spectrum of ocular manifestations ranging from conjunctival xerosis to corneal ulceration and perforation. Penetrating keratoplasty along with vitamin A supplementation can save the eye and useful vision.</span></p> <p><strong>Case: </strong><span style="font-weight: 400;">A 10-year-old boy presented with decreased vision in both eyes for 3 months. Slit-lamp examination with diffuse light revealed bilateral corneal thinning with iris prolapse at inferior aspect of cornea. He underwent therapeutic penetrating keratoplasty in both eyes. Vitamin A supplementation was given as per national protocol. Till 1 year postoperatively visual acuity in RE was 6/18 and LE was pre-phthisical. </span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: </span><span style="font-weight: 400;">Vitamin A deficiency is potentially a sight threatening condition, which may lead to keratomalacia and corneal perforation if neglected. Timely management with Vitamin A supplementation and penetrating keratoplasty can save the eye and vision.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Early management of capillary haemangioma to prevent stimulus-deprivation amblyopia 2022-11-16T08:39:29+00:00 Hare Ram Ojha Neha Verma <p><strong>Introduction</strong><span style="font-weight: 400;">: Infantile capillary haemangiomas (IHs) are common, benign tumours that are self -limiting and generally found in the head and neck region.</span></p> <p><strong>Case</strong><span style="font-weight: 400;">: We present a case of a three month old female baby who presented with a left upper eyelid capillary haemangioma because of which she could not lift the upper lid subjecting her to a high risk of stimulus- deprivation amblyopia. Treatment was provided in the form of an intralesional Triamcinolone acetate injection (40 mg/ml) under general anaesthesia, along with oral Propranolol (1 mg/kg body in 2 divided doses for the first two days, followed by 2 mg/kg in 2 divided doses for ten days (continued upto four months) and topical Timolol (0.5%) lid massage twice a day upto a period of six months.</span></p> <p><strong>Observation</strong><span style="font-weight: 400;">: No adverse effects were reported and a marked reduction in size of the tumor was observed thereby providing an immediate relief to the child.</span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: Hence a combination therapy using intralesional steroids, along with oral propranolol and topical timolol over the lesion has proven to be very effective in providing early response.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology An unusual presentation of uveo-meningeoencephalitic syndrome 2021-06-22T13:41:01+00:00 Prachi Abhishek Dave Neha Bharti Bhupesh Singh Sudhank Bharti <p><strong>Introduction: </strong><span style="font-weight: 400;">Unilateral uveo-meningeoenchephalitic syndrome is a relatively rare entity. Our case highlights the importance of keeping this entity in mind when a unilateral picture suggestive of </span><span style="font-weight: 400;">Vogt Koyanagi Harada</span><span style="font-weight: 400;"> syndrome crops up. </span></p> <p><strong>Case</strong><strong>: </strong><span style="font-weight: 400;">A 34-year-old male came with chief complaints of blurring of vision in the right eye since two days with a prodrome of intense headache and redness in the right eye. On examination, the vision in the right eye was counting fingers close to face and 20/20 in the left eye. Clinical examination suggested unilateral uveo-meningeoenchephalitic syndrome which was confirmed on multimodal imaging. </span></p> <p><strong>Observations</strong><span style="font-weight: 400;">: This case highlights the fact that though uveo-meningeoenchephalitic syndrome is bilateral, by definition; the initial presentation may still be unilateral and a prompt diagnosis and treatment can prevent the involvement of the other eye.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Any case presenting with signs of symptoms suggestive of Vogt Koyanagi Harada should be treated as Vogt Koyanagi Harada even though the initial presentation may be unilateral. A prompt diagnosis and early treatment will ensure that the other eye does not get involved. Early Vogt Koyanagi Harada may just present with choroidal hyperpermeability and multiple septate pockets of SRF without any vitreous cells or anterior segment inflammation.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Evaluation of teachers’ self-efficacy on integration of eye health education and promotion at basic schools in Solukhumbu district, Nepal: A cross-sectional study 2022-06-15T11:01:35+00:00 Pushpa Babu Basnet Chitra Bahadur Budhathoki Shanti Prasad Khanal Jib Acharya Krishna Prasad Pathak <p><strong>Introduction: </strong><span style="font-weight: 400;">Many studies have shown that eye health services in Nepal are still far behind in reaching schools. Therefore, the aim of this study is to examine the teacher’s self-efficacy for the incorporation of eye health promotion activities.</span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> A cross-sectional study design was applied with a self-administrated questionnaire. A total of 292 teachers were randomly selected for this study. </span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Male (153.38) older-aged and Dalit ethnic group (159.81) teachers, as well as teachers who had participated (146.85) in the program, had higher self-efficacy to conduct school eye health-promoting activities than non-participants in schools. But, teaching experience is not determined to get self-efficacy for testing of visual acuity. Teachers with higher qualifications are found to be skillful. </span></p> <p><strong>Conclusion</strong><span style="font-weight: 400;">: The school's eye health program has not been superseded by any relevant legislation. As a result, it's critical to concentrate on provisions that may be included in the school curriculum.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology Clinical spectrum of HLA-B27-associated ocular inflammation 2022-12-24T06:43:45+00:00 Richa Pyare Parthopratim Dutta Majumder <p><strong>Introduction: </strong><span style="font-weight: 400;">HLA-B27-associated anterior uveitis is the most common identifiable cause of anterior uveitis in adults worldwide. It is associated with significant ocular morbidity in young patients due to its typically recurrent attacks of inflammation and vision-threatening ocular complications.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">This review was compiled using articles identified by searching on PubMed with all relevant keywords such as HLA B27, HLA B27 uveitis, spondyloarthritis, Ankylosing spondylitis, HLA B27 systemic associations.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">We summarize the current knowledge on the HLA B27 associated uveitis epidemiology, genetics, clinical profile, systemic associations, laboratory investigations, complications and management.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">HLA-B27-associated uveitis is a commonly encountered entity in the uveitic clinic. Its management must be in coordination with a rheumatologist. Early and appropriately intense treatment is essential for optimal visual prognosis.</span></p> 2022-12-31T00:00:00+00:00 Copyright (c) 2022 Nepalese Journal of Ophthalmology