Nepalese Journal of Ophthalmology <p>Official journal of the Nepal Ophthalmic Society. Full text articles available here and on the journal's own <a title="NEPJOPH website" href="" target="_blank">website</a>.</p><p>Nepalese Journal of Ophthalmology does NOT charge authors for article submission and processing fees.</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">DOAJ</a>.</p> Nepal Ophthalmic Society en-US Nepalese Journal of Ophthalmology 2072-6805 <p class="Pa3">© Nepalese Journal of Opthalmology</p><p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License" /></a><br />Articles in the Nepalese Journal of Ophthalmology are Open Access articles under a <a href="" rel="license">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a> (CC BY-NC-ND). This license permits use, distribution and reproduction in any medium, provided the original work is properly cited, is not changed in any way, and is not used for commercial purposes.</p> Eye Care in Four Decades in Nepal <p>The Eye Care in Nepal was in rudimentary state till 1971 with the number of cataract surgery being less than 500 cases per year including the mobile Eye camps. The Bir hospital was the only eye hospital at that period, however, it was without slit lamp nor operating microscope and the waiting list of bilateral cataract was more than one year. Those elderly people who came with bilateral cataract with a big hope could not be operated due to less number of eye beds and operation theater.</p><p>Prof Ram Prasad Pokhrael visited various mobile eye camps in remote hills and saw the tremendous problem of blindness. With a lot of struggle of creating awareness amongst the public for the need of eye hospital and with the support from few stakeholders, Nepal Eye Hospital was created in 1974.</p> Ram Prasad Pokhrel ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 1 2 10.3126/nepjoph.v10i1.21660 Intralesional Triamcinolone Acetonide (TA) Versus Incision and Curettage (I & C) for Medium and Large Size Chalazia <p><strong>Introduction: </strong>Chalazion is a common inflammatory mass lesion of eyelid. Incision and curettage is a conventional treatment but intralesional steroid is also a safe option for multiple chalazia and chalazion near lacrimal drainage system. So, we conducted an interventional study to compare the treatment outcomes of injection triamcinolone acetonide (TA) versus incision and curettage (I&amp;C) in medium and large sized primary chalazion.</p><p><strong>Objective: </strong>To compare the success rate of intralesional TA versus I&amp;C for the treatment of medium and large sized primary chalazia.</p><p><strong>Materials and Methods: </strong>An interventional study was carried out in 118 patients with primary chalazion. The patients were divided equally into two groups A and B of medium sized (3-7mm) and large sized chalazia (&gt;7mm) respectively. Treatment modality either I&amp;C or TA was decided in each group by randomization Cytological evaluation was done for each case and diagnosis other than chalazion was excluded. Main outcome measure was resolution in size more than 80%. Secondary outcome measure was correlation of cytological features with size, duration, success rate and complications.</p><p><strong>Conclusion: </strong>Intralesional TA was found to be as effective as I&amp;C in both the groups. In cytological analysis, we found that in large sized chalazia I&amp;C is superior to TA in suppurating granuloma.</p> Renu Singhania Nidhi Sharma Shashi Vashisht Taru Dewan ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 3 10 10.3126/nepjoph.v10i1.21661 Myopic Shift After Intraocular Lens Implantation in Children Less Than Two Years of Age <p><strong>Purpose: </strong>The purpose of this study was to evaluate the myopic shift over a period of 2 years following implantation of intraocular lens (IOL) in children less than 2 years of age with axial length less than 22 mm.</p><p><strong>Method: </strong>A retrospective analysis of records of children below 2 years of age with axial length less than 22 mm who had undergone cataract surgery with primary IOL implantation over a period of 7 years was undertaken. Mean myopic shift was analyzed at 6 months, in first year, second year and end of 2 years following surgery.</p><p><strong>Results: </strong>Total 40 eyes of 23 children were included (mean age 13.55±7.38 months); with mean myopic shift at end of 2 years -2.35±2.15. Myopic shift in eyes with undercorrection in range of 3-4 D (group-I) and 5-7 D (group-II) was compared using Mann-Whitney test. Mean myopic shift at end of 2 years was -2.93±2.55 in group-I and -1.88±1.77 in group-II (p value not significant). There was no significant difference in myopic shift between two groups at 6 months and 1 year; a borderline significant difference was found in second year (p= 0.04).</p><p><strong>Conclusion: </strong>In our study amount of myopic shift in first two years in children with axial length less than 22 mm is below the expected normal. There was not much significant difference in the myopic shift over a period of 2 years in eyes, which were undercorrected by 3-4 D against those with 5-7 D. Thus aiming for less residual hyperopia by less undercorrection did not increase myopic shift. Thus high-level hyperopic glasses in the early years could be avoided and help in prevention of amblyopia after paediatric cataract surgery.</p> Suma Ganesh Reena Gupta Sumita Sethi Chandra Gurung Raman Mehta ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 11 15 10.3126/nepjoph.v10i1.21662 Physiological Ocular Changes in Various Trimesters of Pregnancy <p><strong>Introduction: </strong>A large number of hormonal, metabolic, immunologic and haematological changes occur in all organ system of female body during pregnancy. Human eye and its function are no exception to these changes.</p><p><strong>Purpose</strong>: To evaluate physiological ocular changes in various trimesters of pregnancy and to compare them amongst the three trimesters.</p><p><strong>Patients and Methods</strong><strong><em>: </em></strong>A hospital based cross sectional study, using judgmental convenient sampling method, was done in both eyes of 120 pregnant females (40 in each trimester), with known last menstrual period, attending antenatal clinic of BPKIHS, Dharan. Women with known systemic or ocular diseases like conjunctivitis, keratitis, iridocyclitis, glaucoma, refractive error, were excluded. Demographic details of all patients were recorded and detailed ocular examination, including best corrected visual acuity, slit lamp examination, vertical and horizontal keratometry, central corneal thickness and intraocular pressure were performed and recorded. A comparison of these parameters was made amongst three trimesters.</p><p><strong>Results</strong>: Visual acuity of all the subjects was 0 logMAR. Corneal curvature, both vertical and horizontal, significantly increased towards third trimester. Central corneal thickness progressively increased from first to third trimester (p<em>= </em>0.019 Right eye, 0.016 Left eye). In contrary to this, intraocular pressure significantly decreased during successive stages of pregnancy (<em>P=0.000 </em>both eye).</p><p><strong>Conclusion</strong>: Significant increase in corneal curvature and central corneal thickness along with, decrease in intraocular pressure occur during successive trimesters of pregnancy. All pregnant women should have routine ocular examination; changes noted, if any, should receive attention and period of gestation should be considered prior to making a diagnosis.</p> Nisha Agrawal Lalit T Agarwal Poonam Lavaju Sanjib Kumar Chaudhary ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 16 22 10.3126/nepjoph.v10i1.21685 New Clinical and Laboratory Findings of SHAPU <p><strong>Introduction: </strong>The cause of Seasonal hyperacute panuveitis (SHAPU) also known as seasonal endophthalmitis is not yet confirmed. So far, bacteria have been isolated from the vitreous of three cases, VZV from the aqueous of one case and anellovirus from the vitreous of 30 cases of SHAPU. Its connection with moth is still assumed but not proven yet.</p><p><strong>Objective: </strong>To study the clinical and microbiological features of SHAPU. To find out indirect evidence of it connection with moths.</p><p><strong>Method: </strong>Prospective longitudinal study of all the cases of SHAPU observed at Tilganga Institute of Ophthalmology in 2009 and 2010. A detailed ocular examination was performed on each case and vitreous fluid was removed from almost all cases for microbiological study.</p><p><strong>Result: </strong>66 cases of SHAPU were identified. Most were children. Twenty-three percent reported a recent history of white moth contact. Fine brown hairs, were present in 5 eyes. Bacteria were isolated from the vitreous of 9 eyes, PCR testing of the vitreous of all 48 cases showed no evidence of HSV, VZV or CMV DNA. Twenty of 34 cases (58.8%) who presented within 7 days of onset of symptoms had a final visual acuity ≥ 6/60 whereas 4/25 cases (16.0%) who presented after 7 days had final visual acuity ≥ 6/60 (p=0.001).</p><p><strong>Conclusion: </strong>Herpes group of virus is the less likely cause of SHAPU. Bacteria are found in more cases. Early presentation is associated with a better visual outcome. Role of moth in its pathogenesis is still suspected.  </p> Anu Manandhar Todd P Margolis Bhaiya Khanal ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 23 31 10.3126/nepjoph.v10i1.21684 Profile of Corneal Ulcer in a Month of harvesting Season in a Tertiary Level Eye Hospital of Eastern Nepal <p><strong>Introduction</strong>: Agricultural workers are prone to corneal injuries due to vegetative trauma especially during the harvesting season. This study reports the number of new cases of corneal injuries and corneal ulcer presenting in a month of harvesting season.</p><p><strong>Methods</strong>: This is a cross-sectional, hospital based study of all new cases of corneal injury and corneal ulcer presenting to the cornea department from 1st November, 2016 to 30th November, 2016. Typical or suspected cases of corneal ulcer of viral, immunologic or metabolic causes were excluded. Detailed history and clinical examination was carried out. Corneal scrapes in cases with corneal ulcer were taken and subjected to direct microscopy. Details of the findings were recorded in a proforma designed for the study. Statistical analysis was done by SPSS 18.</p><p><strong>Results</strong>: 259 cases presented during that period. Females were more affected (54%). Fifty-one percent of the cases presented from Nepal. Forty-eight percent gave history of ocular trauma by vegetative material. 40% presented within a week of development of symptoms, and about 40% after 2 weeks. Fifty percent of the cases had not presented to an eye care professional. 9% were using topical steroids. Progressive status of the disease was noted in 80%. Sixty-five percent presented with corneal ulcer of less than 2 mm size. Direct smear examination was carried out in 105 cases and 73% of them showed fungal elements.</p><p><strong>Conclusion</strong>: Awareness of agriculture related corneal injuries due to trauma by vegetative materials and methods to prevent such injuries is very important.  </p> Vijay Gautam Abinash Chaudhary Sanjay Kumar Singh Pooja Gautam Rai ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 32 38 10.3126/nepjoph.v10i1.21686 Patterns of Macular Edema in Uveitis as Diagnosed by Optical Coherence Tomography in Tertiary Eye Center <p><strong>Aim: </strong>The aim of the study is to classify the patterns of uveitic macular edema using Optical Coherence Tomography as a diagnostic tool.</p><p><strong>Methodology</strong>: It is the Descriptive, cross-sectional study. All patients fulfilling the diagnostic criteria with Optical coherence tomography diagnosed macular edema were enrolled from 1 January 2012 to 30 June 2013. Patterns of uveitic macular edema were classified.</p><p><strong>Results: </strong>A total of 65 eyes of 47 patients were included. Twenty eight (59.57%) were male. The male to female ratio was 1.5:1. The mean age was 38 years (SD 14.68). Twenty nine patients (61.71%) had unilateral involvement and 18 (38.29%) had bilateral involvement. Forty five eyes of 33 cases (69.23%, 70.21%) had intermediate uveitis, followed by 10 eyes of 7 cases (15.38, 14.9%) of posterior uveitis, 6 eyes of 5 cases (9.23%, 10.63 %) of anterior uveitis and 4 eyes of 2 cases (6.16%,4.2%) of pan-uveitis. Patterns of macular edema were classified: diff use macular edema (DME), cystoid macular edema (CME) and serous retinal detachment (SRD) of which 35 (53.84%) eyes had CME. The etiological diagnosis was found in 7(14.90 %) out of 47 patients.</p><p><strong>Conclusion</strong>: A significant percentage of cases were idiopathic. Macular edema may go unnoticed unless OCT is performed. Macular detachment is an important feature of macular edema that affects visual acuity and is not readily detected by Fundus Fluorescein Angiography (FFA). Optical coherence tomography (OCT) is safe and non-invasive technique and has the potential for measuring changes in retinal thickness and axial extent of edema.</p> Sharad Gupta Dev Narayan Shah Sagun Narayan Joshi Manoj Aryal Lila Raj Puri ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 39 46 10.3126/nepjoph.v10i1.21687 Work Related Ocular Injury: Nepal <p><strong>Introduction: </strong>Occupational eye injuries comprise a major source of ocular trauma. Knowledge of the epidemiology of occupational eye injuries is essential to formulate viable safety strategies.</p><p><strong>Objectives: </strong>To evaluate the demographics, patterns of protective eye wear use, and patterns of occupational eye injury among workers in Hetauda, Nepal.</p><p><strong>Materials and methods</strong>: Community based cross-sectional prospective survey was carried out from September 2010 to July 2011. Survey included all workers irrespective of their age and those who are willing to participate in survey by filling details on structured questioners and comprehensive eye examination at community level.</p><p><strong>Results</strong>: 1236 surveys were collected. 38.3% (473) of workers surveyed reported experiencing a work-related eye injury. Over two-thirds [68.3% (844)] of workers surveyed reported never wearing safety eyewear while at work. There was a positive correlation between male sex (P&lt;0.001), reported previous work-related injury (P&lt;0.001), and attending school (P=0.016) and use of personal protective equipment (PPE).</p><p><strong>Conclusions</strong>: The population studied demonstrates a significant level of work related injury. There are potentially modifiable factors that could lead to increased use of eye protection.</p> Ben Limbu Grant Moore Amir H. Marvasti Mariel E. Poole Rohit Saiju ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 47 56 10.3126/nepjoph.v10i1.21689 Assessment of Drug Usage Pattern in Patients Treated for Vernal Keratoconjunctivitis Attending a Tertiary Eye Care Centre in Eastern India: A Cross-Sectional Study <p><strong>Introduction: </strong>Vernal keratoconunctivitis is a recurrent, seasonal, allergic condition affecting children and adolescents in warmer regions worldwide.</p><p><strong>Objective: </strong>To assess the drug usage pattern for the management of vernal keratoconjunctivitis (VKC).</p><p><strong>Materials &amp; Methods: </strong>This was a 12 weeks long hospital based cross sectional study conducted in the outpatient unit of the department of ophthalmology of a teaching hospital. It included all consecutive patients diagnosed with VKC who satisfied the inclusion criteria. Patients underwent clinical examination and the severity of their disease was graded. Their prescriptions were scanned for duration of therapy, total number of medications, route of administration, the frequency of dosage and change in medications if any, generic names of drugs being prescribed or not and all demographic parameters were recorded in a suitable record form. A p value of &lt;0.05 was considered to be statistically significant.</p><p><strong>Results: </strong>248 patients were enrolled in this study of whom the majority were male (172). The average age of the patients was 8.27 years (SD ± 3.02 years). The mean duration of disease was 15 months (SD ± 9.13 years). The greatest number of children belonged to severity grade 1 (27.82%). The total number of drugs prescribed in this study was 583 with an average of 2.26 drugs per encounter. The commonest prescribed drugs were topical anti-allergics (26.75%) followed closely by lubricants (25.73%) and topical steroids (21.42%).</p><p><strong>Conclusion: </strong>Anti allergics and lubricants are the mainstays in the management of VKC. The current study is reflective of this. Clearer guidelines need to be formulated for the better and rational management of VKC.</p> Aditi Maitra Shashwat Bhattacharyya Arunava Biswas Swapan Kumar Samanta Shatavisha Mukherjee Nikhil Era ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 57 65 10.3126/nepjoph.v10i1.21690 Clinical characteristics and visual outcome, prognostic factor, visual acuity and globe survival in posterior segment intraocular foreign body at Tilganga Institute of Ophthalmology <p><strong>Purpose</strong>: To evaluate clinical characteristics, visual outcomes and globe survival after intraocular foreign body removal from posterior segment via pars plana approach<strong>. </strong></p><p><strong>Methods</strong>: A hospital based retrospective study. All the patients of penetrating eye injury with intraocular foreign body in posterior segment as detected by computed tomography were enrolled from 2012 to 2014.</p><p><strong>Results</strong>: Thirty patients of 30 eyes were included. The mean age was 27.7 years. (2-52). Twenty-four (80%) were male. Out of 30 eyes 19 (63.3%) eyes had injury at Zone 1 and 11 (36.7%) eyes had injury at Zone 2. The mean time spent between primary repair following surgery and intra ocular foreign body removal, was 15.47 days. Retinal detachment and endophthalmitis prior to intraocular foreign body removal was present in 9/30 of eyes. We looked for correlation between post operative Phthisis bulbi with zone of injury and pre operative endophthalmitis and preoperative retinal detachment. However, p value for the above correlation was more than 0.552 and 0.815 respectively, which was statistically not significant.</p><p><strong>Conclusions: </strong>The eyes with posterior segment intraocular foreign bodies showing clinical features of preoperative endophthalmitis, retinal detachment and the zone of injury also did not have any direct significance with globe survival.  </p> Sanjita Sharma Raba Thapa Sanyam Bajimaya Eli Pradhan Govinda Poudyal ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 66 72 10.3126/nepjoph.v10i1.21691 Cysticercosis Masquerading as Lipo–Dermoid <p>Cysticercosis is caused by the larval stage of Taenia solium (Pork tape worm). Humans are the definitive hosts where the life cycle is completed and pig is the intermediate host. Incidence in India varies from 2-38% based on the consumption of pork, general hygiene and socio-economic status of the population. The parasite on reaching the small intestine encysts itself in various tissues. Most commonly Brain, Eyes, subcutaneous tissue. Intravitreal cyst is the commonest intra ocular presentation. Death of the parasite and release of the contents of the cyst causes an intense inflammatory reaction that can be devastating. We report the condition in a nine-year-old boy who presented with mild right upper lid swelling wherein cysticercus cellulosae cyst was found within the mass of the right lateral rectus muscle. It becomes important to report this case because of the unusual site of the cyst which masqueraded as a lipo-dermoid.</p> Mridhula Sekar Nita Umesh Shanbhag N Sahana ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 73 76 10.3126/nepjoph.v10i1.21697 Scleral Buckling and Corneal Topography in a Rare Case of Keratoconus with Rhegmatogenous Retinal Detachment in an Indian Patient <p><strong>Background: </strong>Management of Rhegmatogenous Retinal Detachment (RRD) in keratoconus could be challenging in various aspects. Visualisation of fundus due to altered reflex along with axial myopia could pose difficulty while performing pars plana vitrectomy. Our patient underwent Scleral Buckling with good anatomical results. We came across an isolated case of Keratoconus with Retinal detachment without any pre existing comorbidities unlike earlier reports where patients with history of atopic dermatitis had Keratoconus associated with RRD. The main purpose was to know the outcome of scleral buckling and its effect on corneal topography in a case of keratoconus with RRD.</p><p><strong>Case: </strong>A 35 year old female presented with diminution of vision in both eyes since childhood, but more so in the right eye (RE) since last 6 months. She was aphakic with VA of 1/60 and 2/60 in the right and left eye respectively. She was diagnosed as both eyes keratoconus with RE near total rhegmatogenous retinal detachment (RRD) with sub retinal gliosis. She gave no history of vigorous eye rubbing or atopic dermatitis. For RE she underwent uneventful scleral buckling surgery.</p><p><strong>Observation: </strong>In post operative follow up, the retina was attached. Placido based corneal topography was done pre operatively with keratometry reading of RE – K1 62.79@96º, K2 – 55.92@6˚ and repeated at the end of three months follow up with readings of RE – K1-61.45@98˚, K2- 54.50@ 8˚. There were minimal changes in the keratometry values post operatively with flattening of vertical meridian and horizontal meridian.</p><p><strong>Conclusion: </strong>In keratoconus, RD can occur without any predisposed or preceding condition. Although majority of cases are associated with atopic dermatitis and eye rubbing. Scleral buckling (SB) was successful with good functional and anatomical outcome., however it has minimal effect on corneal topography.  </p> B N Kalpana Y D Shilpa Sneha Priya Prabhakar S M Ram Prakash B C Hemalatha B Ravi Sheetal Devaru ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 77 81 10.3126/nepjoph.v10i1.21698 A Patient with Keratoconus, Axial Hyperopia and Pigmentary Retinopathy <p><strong>Introduction</strong>: Keratoconus has been known to be associated with various ocular conditions.</p><p><strong>Objective: </strong>To describe a case of high hyperopia, keratoconus and pigmentary retinopathy.</p><p><strong>Case: </strong>An eight year old boy, whose initial refractive error was high hyperopia with short axial length of 20mm, presented as bilateral advanced keratoconus with acute hydrops in one eye. Subsequently his other eye also developed hydrops. He had nystagmus and pigmentary retinopathy from his infancy. He was managed conservatively and the hydrops resolved in both the eyes leaving paracentral scar in the cornea.</p><p><strong>Conclusion: </strong>The triad of keratoconus, high hyperopia and pigmentary retinopathy has been quite rare. There could be syndromic association between the three simultaneous ocular findings.</p> Leena Bajracharya Ang Jangmu Lama ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 82 85 10.3126/nepjoph.v10i1.21718 Retinal Vasculitis in a Patient with Ankylosing Spondylitis: A rare Association <p><strong>Purpose: </strong>To report a case of retinal vasculitis in a patient with ankylosing spondylitis.</p><p><strong>Background: </strong>Posterior segment involvement in HLA B-27-associated uveitis is uncommon but we report a case wherein retinal vasculitis was associated with HLA-B 27 uveitis.</p><p><strong>Case: </strong>A 36-year-old male, a diagnosed case of ankylosing spondylitis, presented to us with severe anterior segment inflammation associated vitritis in both the eyes. He received topical, oral steroid and immunosuppressive and 3½-month after the control of his uveitis, he underwent cataract surgery in his left eye. Fundus evaluation following cataract surgery revealed sclerosed retinal vessels and wide-field fundus fluorescein angiography confirmed retinal vascular involvement in both the eyes.</p><p><strong>Conclusion: </strong>Retinal vasculitis, though rare can occur in patients with ankylosing spondylitis especially in conditions which present with panuveitis-like picture.</p> Anindya Kishore Majumder Rupak Roy Ranju Kharel Sitaula Kowsigan Magesan Parthopratim Dutta Majumder ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 86 89 10.3126/nepjoph.v10i1.21719 Bilateral Type-I Duane's Retraction Syndrome with bilateral Crocodile Tears: A Case Report <p><strong>Background</strong>: Duane's retraction Syndrome is a congenital form of strabismus characterized by horizontal eye movement limitation and globe retraction with palpebral fissure narrowing in attempted adduction. It may be associated with co-existing ocular and systemic pathologies. Crocodile tears, or a paradoxical gustatory lacrimal reflex can be either congenital or acquired. The congenital cases typically are associated with Duane’s syndrome in most of the cases.</p><p><strong>Case</strong>: We present in our case report, uncommon case of bilateral Duane’s syndrome with bilateral crocodile tears - both of which can be assumed to be of probably central origin. Though several cases have been reported, there are very few from the Indian subcontinent. Here, we also review the literature of the syndrome with crocodile tears.</p><p><strong>Conclusion: </strong>All cases of Duane’s retraction syndrome warrant a thorough screening for coexisting ocular and systemic abnormalities. Ours is a classic report of bilateral Duane’s syndrome with bilateral congenital crocodile tears, the coexistence of these two anomalies emphasising the aetiology to be anomalous innervation occurring at central level i.e. is brain stem.</p> Harsha Pagad Pooja Ramnani Sumita Karandikar Archana Tadwalkar Nita Shanbhag Akshay G Nair ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 90 93 10.3126/nepjoph.v10i1.21720 Pseudophacocele following a Bicycle Handle Injury: A Case Report <p><strong>Background: </strong>Pseudophacocele is a rare complication of blunt trauma in pseudophakic eyes.</p><p><strong>Case: </strong>We present a case of 60-year-old male who presented with pseudophacocele after injury from a bicycle handle. On presentation, visual acuity in the right eye was perception of light (PL) in 2 quadrants (superior and temporal) and left eye was 20/20. A PCIOL was seen superonasally in the right subconjunctival space with total hyphaema. Ultrasound demonstrated vitreous haemorrhage with membranes in right eye. We describe the surgical management and further clinical course of the patient.</p><strong>Conclusion: </strong>It is imperative to surgically manage these challenging cases. Despite optimum care visual outcomes are guarded in patients with severe blunt trauma. Sahil Thakur Parul Ichhpujani Suresh Kumar ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 94 97 10.3126/nepjoph.v10i1.21724 An Encounter with a Worm in Anterior Chamber: A Case Report <p><strong>Background: </strong>Several parasites are known to affect the eyes, some of them even causing blindness. Data on helminths infecting the eye are scant and mostly limited to case reports from different countries.</p><p><strong>Case: </strong>A 53 years old female presented with complaint of redness, foreign body sensation and diminution of vision in right eye since one month.</p><p><strong>Observations: </strong>On examination a live motile worm was found wriggling in the anterior chamber which was surgically removed. The microscopic findings were in favour of Dirofilaria. However, detailed histopathological examination and determination of species couldn’t be done.</p><p><strong>Conclusion: </strong>The occurrence of parasite in eye is an uncommon event. Most of these parasites are found in subconjunctival or subretinal regions. Those in anterior chamber is a very rare event. Recently Dirofilaria is being recognised as an emerging zoonosis.</p> Deepti Pradhan Chandni Pradhan Purushottam Joshi ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 98 101 10.3126/nepjoph.v10i1.21725 Benign Intracranial Hypertension -Is it Really Benign Always? <p><strong>Background: </strong>In children, benign or idiopathic intracranial hypertension (IIH) is uncommon. The presenting symptoms are usually variable, which attribute to delay in diagnosis. Frequently encountered symptoms include; headache, vomiting, visual impairment, neck pain and diplopia. IIH in pre-pubertal children has distinct characteristics from the adult form. Delayed diagnosis in children usually attributes to the inability in picking subtle visual changes, which can subsequently leads to permanent visual damage.</p><p><strong>Objective: </strong>We report cases of two adolescent girls having IIH who presented with papilloedema, could be managed with lumboperitoneal shunting which resulted in favorable outcomes in terms of improved visual acuity and relief of symptoms.</p><p><strong>Case: </strong>We report two cases of IIH, presented with headache and severe visual loss, which showed non responsiveness to medical management and improved with a lumboperitoneal shunt procedure.</p><p><strong>Conclusion: </strong>In IIH cases, enhanced awareness, prompt diagnosis and treatment are important, to avoid the risk of permanent visual damage. Urgent surgical intervention is essential in patients who do not respond to medical treatment.</p> Anita Ganger Narahari Kishore Kumar Praveen Kumar R K Sabharwal Amit Khosla Rohit Saxena ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 102 106 10.3126/nepjoph.v10i1.21726 Acute Endophthalmitis after Intravitreal Bevacizumab Injections at The Tertiary Centre in Nepal <p><strong>Introduction: </strong>There are many reports of endophthalmitis following Anti- VEG F use in developed countries and from India, but there are none from Nepal yet. Therefore, the aim of this study was to report the prevalence and management of acute endophthalmitis after intravitreal injection of bevacizumab.</p><p><strong>Methods: </strong>This is a clinical, retrospective, non-comparative study, performed in Tilganga Institute of Ophthalmology, Kathmandu, Nepal from Jan 2015 till Dec 2016. All consecutive cases of intravitreal 1.25 mg of bevacizumab injections during the study period were collected from Bevacizumab registry of the operation theatre. A total number of endophthalmitis, following intravitreal bevacizumab injections were collected from Endophthalmitis registry. The statistical analysis was carried out by SPSS for percentage calculation and its 95% Confidence Interval (CI) calculation.</p><p><strong>Results: </strong>There were 4182 injections performed during the study period for various retinal conditions. Two eyes of two patients with acute postoperative endophthalmitis were identified in the first week following intravitreal injections of 1.25 mg bevacizumab among a total of 4128 injections with a prevalence of 0.048% (95% CI: 0.00 to 0.12.).</p><p><strong>Conclusions: </strong>The prevalence of acute endophthalmitis following intravitreal Bevacizumab in our retrospective series was 0.048% and was comparable with the other studies conducted elsewhere. Acute post-injection endophthalmitis following intravitreal bevacizumab can result in severe loss of vision. Therefore prompt recognition and treatment are important part of its management in such patients.</p> Eli Pradhan Sushma Duwal Sanyam Bajimaya Raba Thapa Sanjita Sharma Anu Manandhar Manish Poudel Govinda Paudyal ##submission.copyrightStatement## 2018-11-20 2018-11-20 10 1 107 110 10.3126/nepjoph.v10i1.21727