Nepalese Journal of Ophthalmology https://www.nepjol.info/index.php/NEPJOPH <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="http://creativecommons.org/licenses/by-nc-nd/4.0/" rel="license"><img style="border-width: 0;" src="https://i.creativecommons.org/l/by-nc-nd/4.0/88x31.png" alt="Creative Commons License"></a><br>Articles are licensed under a <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" 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="https://doaj.org/toc/2091-0320" target="_blank" rel="noopener">DOAJ</a>.</p> Nepal Ophthalmic Society en-US Nepalese Journal of Ophthalmology 2072-6805 <p class="Pa3">© Nepalese Journal of Opthalmology</p> Acanthamoeba Keratitis – A Case Report https://www.nepjol.info/index.php/NEPJOPH/article/view/29912 <p><strong>Introduction:</strong> Acanthamoeba keratitis is a serious infection of the cornea which causes severe inflammation of the eye and loss of vision.</p> <p><strong>Case description:</strong> A 45 years female came with a history of trauma of right eye with vegetative matter with severe pain and redness. Patient was treated with antibacterial, antifungal eye drops but the condition deteriorated. Diagnosis was based on presence of motile trophozoites and cyst in the culture of non nutrient agar with a lawn of E coli of the corneal ulcer scraping. Therapeutic penetrating keratoplasty was performed as the patient’s condition deteriorated.</p> <p><strong>Conclusion:</strong> Acanthamoeba keratitis is a rare parasitic vision threatening infection with poor prognosis in comparison to other infectious keratitis. Therefore prevention is very important.</p> Leesha Shrestha Joshi Reeta Gurung Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 133 136 10.3126/nepjoph.v13i1.29912 A Case of Acute Gonococcal Conjunctivitis in an Unusual Age Group https://www.nepjol.info/index.php/NEPJOPH/article/view/29021 <p><strong>Introduction:</strong> This is a case of case of acute gonococcal conjunctivitis in a 2.5 years old female child.</p> <p><strong>Case:</strong> A 2.5 years old female child presented with redness, purulent and profuse discharge from left eye with associated upper eyelid swelling. The culture of conjunctival swab revealed Neisseria gonorrhoeae. The child was treated with intravenous antibiotics and fortified medications.</p> <p><strong>Conclusion:</strong> Unlike young adults and newborn gonococcal conjunctivitis (GCC), children can have a nonsexual mode of transmission and could be seen in an unusual age group. For the management of the diseases, proper history including sexual abuse history and thorough physical examination is mandatory, which is sometimes difficult in a developing country. Gonococcal conjunctivitis in the toddler group should be kept in consideration.</p> Rachana Singh Rana Reeta Gurung Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 137 140 10.3126/nepjoph.v13i1.29021 Anterior Segment Findings in Ocular Myocysticercosis in Children: Is it non- specific? https://www.nepjol.info/index.php/NEPJOPH/article/view/28452 <p>Ocular cysticercosis is a preventable cause of blindness. Medical therapy has been recommended for the retro-orbital and extraocular muscle form. Surgical management is largely done in cases with conjunctival or lid affliction. Though, the medical management is simple; however, the diagnosis is challenging. The anterior segment findings often mimic the more common pathologies and hence often missed at the early stage. This case series of 3 pediatric patients, tries to highlight certain clinical clues which are suggestive of ocular myocysticercosis in children. Literature often recalls anterior segment findings in ocular myocysticercosis as “non- specific and nondiagnostic”. Canthal congestion and contiguous conjunctival congestion extending upto corresponding limbal border in absence of anterior chamber inflammation with other clinical clues are very suggestive of corresponding recti myocysticercosis.</p> Prabhakar Singh Abhishek Gupta Richa Gupta Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 141 145 10.3126/nepjoph.v13i1.28452 Branch Retinal Vein Occlusion in a Case of Sarcoidosis https://www.nepjol.info/index.php/NEPJOPH/article/view/28640 <p><strong>Abstract: </strong></p> <p><strong>Background: </strong>Sarcoidosis is a chronic inflammatory disorder characterized by non-caseation granuloma. It is an inflammatory disorder of unknown etiology. Sarcoidosis has variable ocular presentations&nbsp;&nbsp; from anterior uveitis to rare venous occlusions.</p> <p><strong>Case</strong>: We present a rare case of sarcoidosis with bilateral hilar lymphadenopathy and a compatible uveitis. Positive findings of mutton fat keratic precipitates, Koeppes nodule, posterior synechiae, trabecular meshwork nodules, Candle wax dripping sign, Branch retinal vein occlusion and choroidal granuloma in one eye supported the diagnosis of sarcoidosis. Elevated serum acetylcholine esterase and bilateral hilar lymphadenopathy also confirmed the diagnosis of sarcoidosis.</p> <p><strong>Observation</strong>: The patient responded well to oral steroids and laser photocoagulation of the vein occlusion area. The patient developed complications of steroid like Herpes Zooster of abdomen and avascular necrosis of femur.</p> <p><strong>Conclusion: </strong>Branch Retinal Vein Occlusion is a rare vascular complication in ocular sarcoidosis. Systemic steroids and laser for vein occlusion is mainstay of treatment. Physician must be aware of serious complications of steroid therapy, as seen in this case.</p> <p><strong>Keyword</strong>: Sarcoidosis, Branch retinal vein occlusion, Steroids.</p> Ruchi Shrestha Ranju Kharel Sitaula Pratap Karki Sagun Narayan Joshi Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 146 151 10.3126/nepjoph.v13i1.28640 Non-Endoscopic Endo-nasal Dacryocystorhinostomy in a Saddle shaped nose: A Case Report https://www.nepjol.info/index.php/NEPJOPH/article/view/30663 <p><strong>Introduction:</strong> Non Endoscopic endo-nasal dacryocystorhinostomy retains the benefit of an Endo-nasal approach and can be done without using an expensive video endoscope or laser system.</p> <p><strong>Case presentation:</strong> A 22 years old female presented with epiphora and medial canthal mass in her left eye, accompanied by discharge and recurrent conjunctival congestion since childhood. Physical examination revealed loss of height of the nose with discharge in her left eye, and am immobile and non-tender mass below the level of medial canthal tendon. On applying pressure over the lesion there was mucopurulent discharge from both the upper and lower punctum . The bridge of the nose was very flat and external dacryocystectomy was a challenge. A non-endoscopic endonasal dacryocystorhinostomy with silicon tube intubation was planned. During the procedure, the bone was lower than normal requiring more bone nibbling. Epiphora was resolved immediately after surgery.</p> <p><strong>Conclusion:</strong> Non-Endoscopic endo-nasal dacryocystorhinostomy has the benefit of doing it through an endo-nasal approach without expensive and space consuming video-endoscope making more room for bone nibbling even in a narrow and deformed nasal cavity.</p> Binita Bhattarai Koshal Shrestha Laxmi Devi Manandhar Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 152 156 10.3126/nepjoph.v13i1.30663 Managing Recurrent Orbital Lymphangioma in a Pubertal Female with Negative Pressure Aspiration and Intralesional Bleomycin Injection: A Case Report https://www.nepjol.info/index.php/NEPJOPH/article/view/30723 <p><strong>Introduction: </strong><span style="font-weight: 400;">Management of orbital lymphangioma is challenging. Complete surgical excision is often impossible due to its infiltrative nature. Sclerosing agents have been used in its management with variable outcomes. We report a case of recurrent orbital lymphangioma managed with intralesional bleomycin.&nbsp;</span></p> <p><strong>Case: </strong><span style="font-weight: 400;">A 14-year-old female presented with proptosis of the right eye for two weeks. She had a similar history at five years of age for which she underwent surgical excision. We performed negative pressure aspiration using a 20-gauge angiocatheter, injected bleomycin, and left the cannula in situ for repeat aspiration to maintain cyst collapse.&nbsp;</span></p> <p><strong>Observation: </strong><span style="font-weight: 400;">The</span><strong> l</strong><span style="font-weight: 400;">ymphangioma regressed, and there was no recurrence at six months of follow-up.&nbsp;</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">This report highlights the use of negative pressure aspiration and intralesional bleomycin injection by minimal intervention using angiocatheter in the successful management of orbital lymphangioma.</span></p> Santosh Chaudhary Aashish Raj Pant Badri Prasad Badhu Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 157 161 10.3126/nepjoph.v13i1.30723 Glaucoma in Developing Countries https://www.nepjol.info/index.php/NEPJOPH/article/view/35606 <p><span style="font-weight: 400;">Glaucoma is a leading cause of blindness worldwide. The diagnosis and management of glaucoma is especially difficult in the developing countries. Lack of cost effective screening strategies, low income, low rates of literacy and inadequate infrastructures and human resources for eye care services are the obstacles for delivering glaucoma service. Majority of people with glaucoma in developing countries usually present at an advanced stage at the time of diagnosis; which negatively affects their quality of life. Further research, proper allocation of resources and collaborative effort by blindness prevention programs will hopefully provide new evidences on cost effective ways to screen and manage glaucoma in the future. This article aims to highlight the burden of glaucoma and ways to address the challenges in developing countries.</span></p> Suman Shumshere Thapa Indira Paudyal Pratibha Lama Joshi Kalpana Singh Anil Parajuli Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 112 121 10.3126/nepjoph.v13i1.35606 Development in Tear Film Osmolarity Assessments: A Review https://www.nepjol.info/index.php/NEPJOPH/article/view/26128 <p>The aim of this article is to review the development in the assessment of tear film with tear osmolarity techniques. Also, to find out the average score for tear osmolarity in normal and keratoconjunctivitis sicca (KCS) patients based on the published work.</p> <p>The use of tear osmolarity techniques has been started about 50 years ago. Over the last years a number of researchers have investigated the human tear osmolarity. The tear osmolarity assessment techniques have two procedures. The first procedure which is old, that involves the detection of freezing point depression and vapour pressure. The second one which is more advance and known as the electronic method, that involves the use of electrical impedance technique.</p> <p>All techniques used to assess tear osmolarity are good, accurate, reliable and provide comparable data. Based on the published work reviewed in this article, the average tear osmolarity for normal subjects is 303.2 ± 7.0 compared to 322.7 ± 15.9 in subjects with KCS.</p> Raied Fagehi Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 122 132 10.3126/nepjoph.v13i1.26128 Prevalence and Causes of Visual Impairment and Blindness in Three Ecological Regions of Nepal https://www.nepjol.info/index.php/NEPJOPH/article/view/29217 <p><strong>Introduction</strong>: Visual impairment and blindness are significant public health issues&nbsp;worldwide. The objective of this study was to estimate the prevalence and causes of&nbsp;moderate to severe visual impairment (MSVI) and blindness in people aged 15 years&nbsp;and above across three ecological regions of Nepal.</p> <p><br><strong>Materials and methods:</strong> A comparative cross-sectional study was conducted in one&nbsp;district in each of the three ecological regions of Nepal. Number of participants from&nbsp;each region was distributed as per the prevalence findings of pilot study, with 2815&nbsp;participants enrolled in Dolakha, 1509 in Dhading and 910 in Sarlahi. Intensive training&nbsp;was provided to health workers on how to conduct door-to-door enumeration, visual&nbsp;acuity testing and referral when indicated for comprehensive ocular examination by&nbsp;technicians and ophthalmologists to diagnose and treat ocular morbidities. Collected&nbsp;data were analyzed using standard software. For categorical data, frequency, percentage&nbsp;and 95% CI were calculated and statistical tests were done using Chi-square/Fisher&nbsp;exact test.</p> <p><br><strong>Results:</strong> Altogether 5234 participants were enrolled in the study (participation rate&nbsp;96.4%). The overall prevalence of MSVI was 9.5% (495). It was 4.7% (133) in the&nbsp;mountainous region, 11.2% (169) in the Hill and 21.2% (193) in the Tarai. In those&nbsp;aged 15-49 years, MSVI prevalence was 1.5% (52) and 25.1% (433) in ≥50 years. The&nbsp;overall prevalence of blindness was 0.9% (47). It was 0.2% (6) in 15-49 and 2.3%&nbsp;(41) in ≥50 age groups. More than 95% visual impairment and blindness were due&nbsp;to cataract and uncorrected refractive error. Cataract was the leading cause of visual&nbsp;impairment and blindness (290, 53.5%), followed by uncorrected refractive error.</p> <p><br><strong>Conclusion:</strong> The prevalence of visual impairment and blindness varied significantly&nbsp;with age, ethnicity and locality. The management of uncorrected refractive error&nbsp;and operable cataract would reduce nine in ten cases of moderate to severe visual&nbsp;impairment and blindness.</p> Mohan Krishna Shrestha Sunjuri Sun Ben Limbu Manish Paudel Shankar Khanal Bandana Pradhan Mangala Shrestha Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 4 12 10.3126/nepjoph.v13i1.29217 Comparative Study on Knowledge and Awareness of Common Ocular Diseases Among Rural and Urban Community in Siraha District of Nepal: The Lahan Study https://www.nepjol.info/index.php/NEPJOPH/article/view/28010 <p><strong>Introduction:</strong> Awareness and knowledge about the common ocular conditions can help people to seek early eye care services. The understanding and acceptance of the importance of routine eye examinations can help in timely detection and treatment of the eye diseases and thus help to reduce the burden of avoidable ocular blindness from the general population.</p> <p><strong>Objective: </strong>This study aims to assess and analyze the information related to knowledge and awareness of common ocular diseases and eye health among the rural and urban communities of the Siraha district, Nepal.</p> <p><strong>Materials and methods:</strong> A descriptive cross-sectional study was conducted between April and June 2018 in Lahan Municipality ward number 6 (urban) and Sakhuwa Nankarkatti Rural Municipality ward number 4 (rural) in Siraha district. The sample size of 975 was calculated from study population of 3247. A systematic random sampling technique was used to interview adults above 18 years of age, using a pre-tested structured questionnaire. The collected data was analyzed.</p> <p><strong>Results: </strong>Out of total 975 participants, 514 (52.7%) were from rural community in Sakhuwa Rural Municipality and 461 (47.3%) were from urban community in Lahan Municipality. The mean age was 38.38 ± 15 years. Female participants were more (63.2%) compared to male (36.8%). Overall, 58.3% were literate and 41.7% were illiterate. Rural community had more uneducated participants (48%) compared to urban community (34%). In rural community, 69% were aware about cataract, 83% had knowledge about its treatment; while in urban community 81% were aware about cataract and 86% had knowledge about its treatment. The awareness of glaucoma among the participants was poor, more so in rural cohort (15%) than the urban cohort (25%). &nbsp;The knowledge of glaucoma was 14% in rural and 62% in urban cohort. Awareness that diabetes can affect the eye was found to be significantly lower (<em>p</em> = 0.01) in rural population (25%) compared to that in urban population (41%) in this study. The knowledge about diabetic retinopathy was lower in rural community (38%) compared to urban community (49%). Awareness about Night Blindness was lesser in rural (62%) compared to urban (70%) community (<em>p</em> = 0.17).&nbsp; Awareness about refractive errors were 37% in rural compared to 60% in urban community. The major sources of information were society and eye hospital in both community.</p> <p><strong>Conclusion: </strong>The knowledge and awareness level regarding common ocular diseases was high among the community people of urban community (Lahan) in comparison to rural community (Sakhuwa Nankarkatti). Awareness and knowledge level mainly regarding glaucoma and diabetic retinopathy was very poor in both urban and rural community. There is need to conduct comprehensive awareness programs on common ocular diseases like cataract, glaucoma, diabetic retinopathy, night blindness, congenital eye disease, ocular trauma, eye donations and others in both rural and urban areas to raise the awareness level and improve attitudes and right practices reducing the burden of avoidable blindness.</p> Sabin Sahu Rajiv Ranjan Karn Dipesh Ram Tejsu Malla Sanjib Chaudhary Sanjay Kumar Singh Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 13 21 10.3126/nepjoph.v13i1.28010 Posterior Segment Retained Intraocular Foreign Body: A Study from Western Nepal https://www.nepjol.info/index.php/NEPJOPH/article/view/28981 <p><strong>Introduction: </strong><span style="font-weight: 400;">Posterior segment retained Intraocular foreign body (IOFB) management is challenging. Facility of pars plana vitrectomy (PPV) and availability of well trained vitreo retina surgeons are the basic need to accomplish this work.&nbsp; Encircling band provide permanent 360° support to close the anterior retinal break and prevent traction on the retina. The objective of this study is to analyse the clinical characteristics and predictors of the final visual outcome and survival of the globe in cases of retained IOFB in the posterior eye segment.</span></p> <p><strong>Materials and methods:</strong><span style="font-weight: 400;"> A hospital based retrospective observational study was conducted. All the patients of retained IOFB in the posterior segment presented from January 2016 to June 2019 were enrolled. Patients presented with visual acuity of NPL were excluded. Statistical analysis was performed using a variety of tests using SPSS version 21.&nbsp;&nbsp;</span></p> <p><strong>Results</strong><span style="font-weight: 400;">: Forty eyes of 40 patients were included. The mean age was 27.08±10.68 years (range 5-66). 95% of our patients were male. Most of them (52.5%) worked on the farm. 26(65%) of 40 eyes had Zone I injury. The median time spent before presentation was 13.5 day. Retinal detachment, vitreous hemorrhage, and endophthalmitis were present in 15, 23 and 5 eyes, respectively, before IOFB removal. The mean LogMAR visual acuity was improved significantly from 2.50±0.87 to 1.33± 1.01 (p=0.003). Poor presenting visual acuity, retinal detachment and large diameter of IOFB were found as the predictor of poor final visual acuity.</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">&nbsp;Pars plana vitrectomy by a vitreo retinal surgeon can give encouraging results in the cases of retained posterior segment IOFB. Poor presenting visual acuity, large diameter of IOFB and RD before IOFB removal are predictors of poor visual outcome.</span></p> Bikram Bahadur Thapa Sweta Singh Gyanendra Lamichhane Shanti Gurung Saurav Piya Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 22 30 10.3126/nepjoph.v13i1.28981 Firework-related Ocular Injuries During Festival Season: A Hospitalbased Study in a Tertiary Eye Care Center of Nepal https://www.nepjol.info/index.php/NEPJOPH/article/view/31246 <p><strong>Introduction:</strong> Firework-related ocular injuries are an important cause of preventable ocular injuries and are common during the festival season. Despite the strict legislation in Nepal, the use of a firework is still commonly used during Tihar and Chaath festivals. <strong>Objective:</strong> To evaluate demographic distribution, mode, causative firework, type of fireworks-related ocular injuries, and visual outcome at a tertiary eye hospital in Eastern Nepal. <strong>Methods:</strong> This is a hospital-based prospective interventional study. All the patients with firework-related injuries who attended the emergency and outpatient department of SCEH, Lahan, during or within 1 month of the festival season (Tihar and Chaath puja) were included in this study. <strong>Results:</strong> Total of 65 eyes were included. The left eye was involved in 49.1%, 82.5% were males. Mean age of the patients was 15.3±14.7 years (range 5yr – 75yr). Children less than 16 years were predominantly involved (77.2%). Firecrackers (56.1%) were the most common type of fireworks causing injury. The closed globe injuries were more (78.5%) compared to open globe injuries (21.5%). Surgical management was done in 50.9% of cases. Following management visual acuity of most patients improved. Only 8 eyes (12.3%) had visual acuity less than 3/60 after management compared to 28 eyes (43.1%) at the time of presentation.</p> <p>&nbsp;</p> <p><strong>Conclusion:</strong> Firework related ocular injuries are important causes of preventable blindness. A combined approach of public awareness about the possible dangers, preventive measures, early treatment by trained primary ophthalmic care, and implementation of strict legislations are essential to reduce blindness due to this preventable cause.</p> <p>&nbsp;</p> <p>&nbsp;</p> Tejsu Malla Sabin Sahu Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 31 39 10.3126/nepjoph.v13i1.31246 Outcome of Injection Botulinum Toxin in Blepharospasm https://www.nepjol.info/index.php/NEPJOPH/article/view/30589 <p><strong>Introduction: </strong><span style="font-weight: 400;">Blepharospasm is a condition of involuntary spasm of the orbicularis oculi muscle which leads to intermittent or complete closure of the eyelids. Botulinum toxin is the currently recommended first line treatment for such blepharospasm. This study aims to find out the outcome of injection Botulinum toxin Type A in Blepharospasm.</span></p> <p><strong>Materials and methods:&nbsp; </strong><span style="font-weight: 400;">It was a hospital based, prospective, interventional study conducted on patients diagnosed as Benign essential blepharospasm (BEB), Meige syndrome (MS) and Hemifacial spasm (HFS) by oculoplastic surgeon at Oculoplasty department OPD, Tilganga Institute of Ophthalmology, from December 2018 to November 2019. After taking all standard precautions for botulinum toxin injections, 6 to 8 sites for injecting 2.5 to 5 IU of the toxin were given. All the patients were evaluated before and after injections according to Jankovic spasm grading and improvement in functional impairment scale and followed on one week, one month, three month and when the symptoms reappeared.&nbsp;</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">A total of 43 cases which included 32 cases of Benign essential Blepharospasm, 9 Hemifacial spasm and 2 Meige syndrome. The mean Jankovic severity score was 3.51 </span><strong>±</strong><span style="font-weight: 400;"> 0.51 (range 3-4). The mean improvement in functional score was 2.60 </span><strong>±</strong><span style="font-weight: 400;"> 0.54 (range 1-3), was statistically significant (p-value &lt;0.001).The effective period of injection was 130 </span><strong>±</strong><span style="font-weight: 400;"> 20.82 (93 – 189) days.38 patients had repeated injections after reappearance of symptoms. 4 patients had side effects of redness and hematoma at one site.&nbsp;</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> This study concludes that Botulinum toxin type A is effective in the management of Benign essential blepharospasm, Hemifacial spasm and Meige syndrome. This along with a good safety profile justifies its role as a first line treatment therapy in blepharospasm. However, it is a temporary treatment option where the effect lasts for a short period of time and repeated injections are required. </span></p> Malita Amatya Ben Limbu Purnima Rajkarnikar Sthapit Hom Bahadur Gurung Rohit Saiju Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 40 49 10.3126/nepjoph.v13i1.30589 Pain Perception in Cataract Surgery: Topical versus Peribulbar Anaesthesia https://www.nepjol.info/index.php/NEPJOPH/article/view/30574 <p><strong>Introduction: </strong><span style="font-weight: 400;">The requirement for very deep akinesia has decreased with the use of modern phacoemulsification technique for cataract surgery. The use of topical anesthesia has increased as a way to reduce complications associated with anaesthesia with injection and to allow the most rapid visual recovery. The objective of this study was to assess the patient reported pain in phacoemulsification cataract surgery under topical anaesthesia versus peribulbar anaesthesia administered using an injection.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">The subjects for this study were the patients undergoing phacoemulsification cataract surgery at HEH. Subjects were divided into two groups, one having topical anaesthesia for phacoemulsification and the other having peribulbar anaesthesia with injection. The data for the study was collected in a ten point visual analogue graphic pain scale. After the surgery was over the patients reported on the felt pain wherein the scale zero was assigned for no pain at all, 1 to 3 for mild pain, 4-6 for moderate pain and 7-10 for severe pain.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">In total, 366 subjects received peribulbar anaesthesia and 336 subjects received topical anaesthetic drops. The mean pain score between the two groups was found to be higher in the peribulbar injection group (p &lt;0.001). The mean pain score for both males and females was found to be higher in the peribulbar injection group (p&lt;0.001 for both genders).</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Topical anaesthesia for phacoemulsification cataract surgery tends to cause less pain and discomfort for patients.</span></p> Indraman Maharjan Eliya Shrestha Babita Gurung Hara Maya Gurung Hari Bikram Adhikari Pawan Baral Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 50 58 10.3126/nepjoph.v13i1.30574 Risk Factors Associated with Meibomian Gland Dysfunction: A Hospital Based Study https://www.nepjol.info/index.php/NEPJOPH/article/view/30605 <p><strong>Introduction: </strong><span style="font-weight: 400;">Meibomian Gland Dysfunction (MGD) is a chronic diffuse abnormality of the Meibomian glands often found as a result of precipitating factors like dyslipidemia, infections, hypertension, diabetes, etc. This study aims to find the prevalence of various risk factors of Meibomian Gland Dysfunction (MGD) which will ultimately help in managing the disease and explaining the prognosis.</span></p> <p><strong>Materials and methods:&nbsp; </strong><span style="font-weight: 400;">A hospital based cross-sectional study. A total of 400 patients with MGD over the age of 30 were examined. Patients with a history of taking lipid altering drugs, pre-existing ocular comorbidities were excluded from the study.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> Severity of MGD increased with ageing. There was a significant risk of higher grades of MGD in hypertensives, diabetics &amp; post-menopausal women. Higher levels of LDL cholesterol showed significant risk.&nbsp;</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Blood sugar, blood pressure, blood cholesterol were seen to be the risk factors in the study and thus, should be kept within normal limits to reduce the severity of disease. Alcohol &amp; cigarette consumption should be avoided even if they didn’t show a significant relationship.</span></p> Nitin Tulsyan Namrata Gupta Nisha Agrawal Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 59 64 10.3126/nepjoph.v13i1.30605 Outcome of Non-drainage Scleral Buckling in Primary Rhegmatogenous Retinal Detachment https://www.nepjol.info/index.php/NEPJOPH/article/view/28767 <p><strong>Introduction:</strong><span style="font-weight: 400;"> Scleral buckling (SB) was the principal surgical intervention for patients with rhegmatogenous retinal detachment (RRD) until the development of pars plana vitrectomy. The study aims to evaluate the outcome of SB without subretinal fluid (SRF) drainage in RRD.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">&nbsp;A retrospective observational study was conducted at a tertiary eye care center. Charts of patients operated with SB without SRF drainage for RRD between January 2014 and December 2015 were evaluated. The main outcome measure was the primary reattachment rate at 1 month after single SB surgery. Other outcome measures were final reattachment rate after further intervention, visual improvement and relation of various parameters with retinal reattachment.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> One hundred and seventeen patients were included of which 90 (76.9%) were men. Mean age was 26.68±12.6 years (Range 9-60). All eyes were phakic. Only 1 patient had a macula on RD. The primary reattachment rate was 84.6% (n=99). Mean LogMAR (±SD) visual acuity (VA) improved from 1.92(±0.46) to 1.02(±0.42). Extent of RD, number of breaks, and type of break was found to have no association with retinal reattachment. Association between type of PVR and status of retina post buckling was found to be significant (p=0.026) with retinal reattachment seen in 100% in PVR-A and only 60% in PVR-C2. Final reattachment rate was 98.2%. Complications encountered were postoperative diplopia (n=1), suture granuloma (n=1) and buckle infection (n=2).</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Scleral buckling without SRF drainage, an exclusively extra ocular procedure, is an effective and safe treatment modality for non-complicated RRD.</span></p> Lalit Agarwal Nisha Agrawal Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 65 72 10.3126/nepjoph.v13i1.28767 Clinical Assessment and Etiological Evaluation of Optic Nerve Atrophy https://www.nepjol.info/index.php/NEPJOPH/article/view/29035 <p><strong>Introduction: </strong><span style="font-weight: 400;">Optic atrophy results from the disease process that cause irreversible damage to the ganglion cells and the anterior visual pathway, but may also result from posterior visual pathway involvement. The etiology causing this condition is vast and regardless of underlying cause it carries bad visual prognosis and at times may be life threatening. The study aims to assess patients with optic nerve atrophy presenting to B.P. Koirala lions centre for ophthalmic studies and identify the underlying etiology.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">&nbsp;This is a descriptive study conducted at B.P. Koirala Lions Centre for Ophthalmic studies. All cases of optic atrophy who presented to our outpatient department from March 2016 to March 2017 were included in the study. In addition to detailed evaluation, assessment of visual acuity, color vision, contrast sensitivity and visual field were done if feasible. Other relevant investigations were conducted to establish the underlying etiological cause.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> A total of 62 patients were included in the study, with 35 patients having bilateral disease and 27 having unilateral disease accounting for 97 eyes with optic atrophy. The mean age of the affected was 40.63±17.36 years with male to female ratio of 1.2:1. The most common etiology for optic atrophy was traumatic neuropathy (n=16, 25.8%). Majority of eyes had pale disc (n=70, 72.2%) and the rest had temporal pallor (n=27, 27.8%).&nbsp;</span></p> <p><strong>Conclusion:</strong><span style="font-weight: 400;"> Traumatic optic neuropathy was the most common etiological cause of optic nerve atrophy. </span></p> Pranav Shrestha Sanjeeta Sitaula Ananda Kumar Sharma Purushottam Joshi Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 73 81 10.3126/nepjoph.v13i1.29035 Treatment Strategies in Acute Post-operative Endophthalmitis after Cataract Surgery at a Tertiary Eye Hospital in Nepal: A 5-year Retrospective Review https://www.nepjol.info/index.php/NEPJOPH/article/view/31077 <p><strong>Introduction: </strong><span style="font-weight: 400;">Despite best possible preventive measures, acute postoperative endophthalmitis (POE) is still the most devastating, sight-threatening complication after intraocular surgery and the most feared complication by treating surgeons.</span></p> <p><strong>Materials and methods: </strong><span style="font-weight: 400;">&nbsp;It is a retrospective study of 22 eyes diagnosed as acute POE following cataract surgery in the last 5 years (2015-2019), aimed to evaluate the treatment strategies used in its management. Main outcome measures evaluated were rates of repeat intravitreal injection, adjunctive therapeutic regimens, pars plana vitrectomy (PPV) and visual outcome.</span></p> <p><strong>Results: </strong><span style="font-weight: 400;">Twenty one eyes (95.45%) received repeated intravitreal injection. Adjuvant intravitreal steroid was used in 12 eyes (54.54%), oral steroid in 16 eyes (72.72%) and oral antibiotic in 8 eyes (36.36%). PPV was done in 8 eyes (34.78%) and all 8 eyes that underwent PPV had a vision of Hand Movement (HM) close to face. 7 eyes (87.5%) had early PPV within 1 week of diagnosis. The median best corrected visual acuity (BCVA) improved from 1.00 logMar to 0.8 logMar following treatment at 3 months follow up (p= 0.117).&nbsp;</span></p> <p><strong>Conclusion:&nbsp;</strong><span style="font-weight: 400;">Repeat intravitreal injections were commonly employed. Early PPV was performed more commonly regardless of the visual acuity at the time of diagnosis of acute POE.&nbsp;</span></p> Barsha Suwal Deepak Khadka Arjun Shrestha Rajan Shrestha Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 82 90 10.3126/nepjoph.v13i1.31077 Pathologic Risk Factor in Retinoblastoma: An Institutional Experience Based on Analysis of Enucleated Eyes https://www.nepjol.info/index.php/NEPJOPH/article/view/31139 <p><span style="font-weight: 400;"><strong>Background:</strong> </span><span style="font-weight: 400;">&nbsp;Mortality resulting from the metastasis of retinoblastoma is uncommon in the developed world, however it still constitutes a major problem in developing countries like Nepal. The cases of retinoblastoma with increased risk of metastasis even after enucleation can be predicted from the histopathological examination of the enucleated specimen. We conducted this study aiming to assess the frequency and spectrum of high-risk histological features in enucleated specimens of retinoblastoma.</span></p> <p><span style="font-weight: 400;">&nbsp;</span><span style="font-weight: 400;"><strong>Materials and methods:</strong> Forty-two specimens of primary enucleation done for treatment of retinoblastoma received in the Department of Pathology at UCMS from 1</span><span style="font-weight: 400;">st</span><span style="font-weight: 400;"> January 2016 to 31</span><span style="font-weight: 400;">st</span><span style="font-weight: 400;"> December 2018 were included in the study. All slides were reviewed for high-risk histological features along with tumor differentiation, tumor extension, necrosis, and staging. Correlation of high-risk histological features with age and tumor size was calculated using unpaired t-test and correlation with tumor differentiation, necrosis and staging was done using Pearson Chi square test.</span></p> <p><span style="font-weight: 400;">&nbsp;</span><span style="font-weight: 400;"><strong>Results:</strong> The median age at enucleation was 24 months. All patients had endophytic lesion with a mean tumor size of 1.8cm. One or more high-risk histological features were identified in 30.9% (13/42). The most common high-risk histological feature was retrolaminar optic nerve invasion (10/12, 71.4%). Statistically significant correlation of high risk histological features was noted with tumor size (p=0.011) and AJCC stage of tumor (p=0.0001).</span></p> <p><span style="font-weight: 400;">&nbsp;</span><span style="font-weight: 400;"><strong>Conclusion:</strong> Complete histopathological evaluation of retinoblastoma requires searching for high-risk histological features, the presence of which will guide the clinician in timely planning for subsequent neoadjuvant therapy.</span></p> Anita Shah Manisha Shrestha Saurav Man Shrestha Anadi Khatri Prateek Krishna Shrestha Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 91 97 10.3126/nepjoph.v13i1.31139 Profile of Secondary Glaucoma in a Tertiary Eye Hospital of Eastern Nepal https://www.nepjol.info/index.php/NEPJOPH/article/view/28968 <p><strong>Background: </strong><span style="font-weight: 400;">To determine the clinical profile and causes of various types of secondary glaucoma.</span></p> <p><strong>Materials and methods :</strong><span style="font-weight: 400;"> This was a hospital-based cross-sectional study conducted in a tertiary eye hospital of eastern Nepal from 1</span><span style="font-weight: 400;">st</span><span style="font-weight: 400;"> June to 30</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> November, 2017. Patients who met the criteria for secondary glaucoma underwent detailed ophthalmic examination.</span></p> <p><strong>Results :</strong><span style="font-weight: 400;"> Out of 7079 patients diagnosed with glaucoma or glaucoma suspects, 528 (7.4%) had secondary glaucoma. The mean age at presentation was 52 ±</span><span style="font-weight: 400;"> 17 years with</span><span style="font-weight: 400;"> male to female ratio of 1.5:1. The most common cause was lens induced 173 (32.8%) followed by neovascular 107 (20.3%), steroid induced 86 (16.3%), traumatic 76 (14.4%), post-vitrectomy 17 (3.2%), uveitic 11 (2.1%), pseudophakic 10 (1.9%), aphakic 8 (1.5%), post-keratoplasty 5 (0.9%) and miscellaneous included 35 (6.6%). Post-traumatic 31 (29.5%) was more prevalent below 41 years while lens induced glaucoma 86 (49%) above 60 years of age. At presentation, the average IOP was 40 ±</span> <span style="font-weight: 400;">11 mmHg. 36 (6.8%) had no light perception in the presenting eye and a large number of participants 307 (58.1%) presented with visual acuity of &lt;3/60 to perception of light. Glaucomatous optic atrophy was found in 22 (9.0%) cases.&nbsp;</span></p> <p><strong>Conclusion :</strong><span style="font-weight: 400;"> The causes of secondary glaucoma are diverse, lens induced glaucoma being most common. Most patients present late with poor vision, high IOP and even glaucomatous optic atrophy. So, early identification and treatment of the causes is important so that we can prevent the burden of blindness due to secondary glaucoma.</span></p> Jamuna Gurung Rakshya Pant Sitoula Anjani Kumar Singh Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 98 103 10.3126/nepjoph.v13i1.28968 Comparative Study of Dry Eye Indices Following Cataract Surgery https://www.nepjol.info/index.php/NEPJOPH/article/view/29313 <p><strong>Background: </strong><span style="font-weight: 400;">This study aims to assess dry eye indices following cataract surgery</span><span style="font-weight: 400;">.</span></p> <p><strong>Materials and Methods:&nbsp; </strong><span style="font-weight: 400;">A single center descriptive and comparative study was performed. A total of 100 eyes of 100 cases fulfilling the inclusion criteria from 1</span><span style="font-weight: 400;">st</span><span style="font-weight: 400;"> June 2017 to 30</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> May 2018 were enrolled. Out of 100 eyes, 50 eyes each went through manual small incision cataract surgery (MSICS) and phacoemulsification respectively. For objective analysis : schirmer 1 test(ST-I), tear breakup Time(TBUT) along with lissamine Green Surface Staining(LGSS) was performed on pre-operative day, 1</span><span style="font-weight: 400;">st</span><span style="font-weight: 400;">, 4</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> and 12</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> week respectively. Ocular Surface Disease Index (OSDI) was done for subjective analysis on pre-operative day and at 12</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;"> week.</span></p> <p><strong>Results:</strong><span style="font-weight: 400;"> The mean age of the patient was 53.66 ± 7.839 years with 34 (68%) being female in a small incision cataract surgery group.&nbsp; In the phacoemulsification group, mean age was 54.72 ± 7.985 years and 32 (64%) were female.&nbsp; On analyzing the objective dry eye indices: ST-I,TBUT and&nbsp; LGSS at 12</span><span style="font-weight: 400;">th</span><span style="font-weight: 400;">week was 18.80 ± 7.393 mm, 11.30 ± 5.456 seconds and 1.62 ± 1.193 in Small incision cataract surgery group and 27.10 ± 6.326 mm, 16.60 ± 4.699 seconds and 0.38 ± 0.602 in Phacoemulsification group respectively which was statistically significant. (p&lt; 0.001).&nbsp;</span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">Regardless of the type of cataract surgery, dry eye disease is unavoidable affecting both tear quality and quantity postoperatively. In our study, phacoemulsification had lesser effect in dry eye indices than small incision cataract surgery.</span></p> Bipin Bista Padam Raj Bista Sharad Gupta Raghunandan Byanju Simanta Khadka Surendra Mishra Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 104 111 10.3126/nepjoph.v13i1.29313 Guidelines to authors, Copyright Transfer Statement, Patient Consent form for Case Report, Acknowledgement https://www.nepjol.info/index.php/NEPJOPH/article/view/36368 <p>Guidelines to authors, Copyright Transfer Statement, Patient Consent form for Case Report, Acknowledgement</p> Eli Pradhan Copyright (c) 2021 2021-04-09 2021-04-09 13 1 173 178 Women Ophthalmologists in Nepal https://www.nepjol.info/index.php/NEPJOPH/article/view/35607 <p>Not available.</p> Samata Sharma Eli Pradhan Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 1 3 10.3126/nepjoph.v13i1.35607 The Battle Between Photocoagulation and AntiVEGFs in Retinopathy of Prematurity and the Road Ahead https://www.nepjol.info/index.php/NEPJOPH/article/view/36367 <p>Not available.</p> Gunjan Prasai Sabina Shrestha Copyright (c) 2021 2021-01-01 2021-01-01 13 1 171 172 Ocular Manifestations of Goldenhars syndrome- A case series https://www.nepjol.info/index.php/NEPJOPH/article/view/28316 <p>Goldenhars syndrome also known as facio auriculo vertebral dysplasia or first and&nbsp;second arch branchial syndrome has a prevalence of 1:3500 births to 1: 7500 births&nbsp;with male predisposition. We hereby present a case series of children presenting with&nbsp;Goldenhars syndrome.</p> Meenakshi Wadhwani Shubhangi Kursange Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 162 164 10.3126/nepjoph.v13i1.28316 Optical Coherence Tomography Angiography following Scleral Buckling Surgery https://www.nepjol.info/index.php/NEPJOPH/article/view/30652 <p><strong>Introduction:&nbsp;</strong><span style="font-weight: 400;">The retinal changes following scleral buckling surgery (SBS) for rhegmatogenous retinal detachment (RRD) have been rarely evaluated with optical coherence tomography angiography (OCTA).</span></p> <p><strong>Methods:</strong><span style="font-weight: 400;"> A 40 years old male presented with </span><span style="font-weight: 400;">subtotal RD involving the macula</span><span style="font-weight: 400;"> and had best corrected visual acuity of logmar 2.3 in the affected right eye. Five months after applying 120 degree scleral buckle, swept source optical coherence tomography (SSOCT) and swept source optical coherence tomography angiography (SS-OCTA) were done.&nbsp;&nbsp;</span></p> <p><strong>Result:</strong> <span style="font-weight: 400;">At five months post-surgery, despite a settled retina in the operated eye, the patient had&nbsp; vision of logmar 1 and thin retinal nerve fibre layer (115 micrometer).</span><span style="font-weight: 400;"> The SSOCT showed&nbsp; </span><span style="font-weight: 400;">inner</span><span style="font-weight: 400;"> segment-outer segment (IS-OS) junction disruption, </span><span style="font-weight: 400;">thinned</span><span style="font-weight: 400;"> retinal pigment epithelium, central macular thickness of 275 micrometer and subfoveal choroidal thickness of 222 micrometer. A 3x3 mm macular OCTA scan showed a normal </span><span style="font-weight: 400;">foveal avascular zone along</span><span style="font-weight: 400;"> with higher values for </span><span style="font-weight: 400;">vascular density in superficial capillary plexus</span><span style="font-weight: 400;"> in all </span><span style="font-weight: 400;">quadrants</span><span style="font-weight: 400;"> except temporal quadrant in </span><span style="font-weight: 400;">operated eye as compared to fellow eye</span><span style="font-weight: 400;">.&nbsp;</span></p> <p><strong>Conclusion:</strong> <span style="font-weight: 400;">The SBS with 120 degree buckle did not lead to a reduced vascular density in superficial capillary plexus in the operated eye with respect to fellow eye.&nbsp;</span></p> Punita Kumari Sodhi Anu Sharma Nasiq Hasan Copyright (c) 2021 Nepalese Journal of Ophthalmology 2021-01-01 2021-01-01 13 1 165 170 10.3126/nepjoph.v13i1.30652