Bilateral Congenital Cataract Associated with Multiple Epiphyseal Dysplasia: A case Report.

Cataract in children has varied etiology. It may be associated with systemic diseases including skeletal dysplasias. However cataract in Multiple Epiphyseal Dysplasia is a rare association. A child presented with bilateral dense posterior sub capsular cataract and multiple bony abnormalities. Clinical and radiographic findings suggested the disease to be Multiple Epiphyseal Dysplasia. The aim of presenting this case is to report a case of congenital cataract having a rare association with the Multipe Epiphyseal Dyspalsia.

Clinical Profile of Paediatric Cataract and Surgery in a Tertiary Eye Care Centre Nepal.

Introduction: Paediatric cataract is the opacification of lens and its capsule in children below 14 years of age. The management of paediatric cataract is lens aspiration with or without anterior vitrectomy, with or without intra-ocular lens implantation. The objective was to present the profile of pediatric cataract of operated eyes in children ≤14 years. Materials and Methods: This was a descriptive study in a hospital setting. A review of pediatric cataract cases operated between November 2007 and June 2009 in Tilganga Institute of Ophthalmology (TIO), a tertiary eye care centre in Nepal was carried out. The personal profile, preoperative and intra-operative details were noted. In the statistical analysis p value less than 0.05 is considered as significant. Results: A total of 175 eyes of 132 children had presented during study. The sex ratio was 1.6 male per female with mean age of 6.7 years (SD ±4.3). About one-third (32%) presented within the age of three years where as more than two-fifths (46%) presented at the age eight years and above. Seventy two cases were collected through door to door enumeration and screening clinics for children. The proportion of cataract was higher in males than in females (P>0.05). Visual acuity ranged from 6/18 to follows light. Conclusion: Nearly half of the paediatric cataract had presented after the age of eight years mainly from hilly region through the screening program. Most of the pediatric cataract cases presented with the whitish pupillary reflex with more than two-thirds of visual acuity of less than 3/60. The most common type of the cataract surgery performed was lens aspiration with anterior vitrectomy with lens implantation. The earlier the surgery better is the visual prognoses. Hence, community screening through as door to door screening and one day screening clinics will help for early referral and earlier surgery to reduce visual disabilities due to paediatric cataract.

Postoperative follow up Challenge in Paediatric Cataract Surgery in Nepal.

Introduction: Paediatric ophthalmology is a branch of specialty care for the health of the eyes of children. It focuses on the removal of paediatric cataracts and management of refractive error, strabismus etc. Perioperative and post-operative challenges related to paediatric cataract are known to all ophthalmologists worldwide. However, in a developing country like Nepal the main challenge of these patients are the post-operative follow up. The aim of the study is to find out the ways to reduce the post-operative follow up challenges in paediatric cataract surgery. Hence the ophthalmic assistants in the community eye centers need to be trained to examine the eyes of children. Materials and Methods: This was a retrospective study. A review of patient records, operated from July 2006 to December 2007, at Tilganga Institute of Ophthalmology was done. One hundred eyes of 69 patients were operated during the study period. Results: Follow-up assessment of visual acuity was available for 19 eyes only at the end of six weeks. Conclusion: At the end of six postoperative weeks, refractive status is important. This helps to prescribe the glasses to children as per need. If the post-operative visual status is not known, it is as equal as not performing the surgery. Ophthalmic assistants at community eye centers need to be trained to evaluate and record postoperative visual status of the paediatric age group. For this regular training and refreshers course on the pediatric eye care service is being conducted at the tertiary level for the ophthalmic assistants. This is more practical in the developing countries like Nepal.

Ruptured aneurysm of extracranial carotid artery.

Aneurysm of extracranial carotid artery is an uncommon clinical disease and that presenting as a ruptured aneurysm is extremely rare. This entity represents a challenge to treatment strategy. A 54 year old hypertensive male presented with painful, pulsatile mass in left neck. Duplex scan revealed the ruptured left carotid artery at its bifurcation. Angiogram depicted clear picture of ruptured carotid artery aneurysm. Resection of aneurysm was performed with placement of external carotid shunt. Continuity was maintained with interposition of Dacron graft.

Prevalence of rheumatic fever and rheumatic heart disease in school children in a rural community of the hill region of Nepal.

A survey of school children aged 5 to 16 years living in a rural community of the hill region of Nepal, situated about 15-22 km outside Kathmandu city, was conducted to determine the prevalence of rheumatic fever (RF) and rheumatic heart disease (RHD). Of the 4,816 eligible children enrolled in the selected schools, 4,452 (92.4%) were examined. WHO expert committee criteria (1966) was used for the diagnosis and classification of rheumatic fever. Chest x-ray, electro-cardiography, echocardiography and Doppler study were done in all suspected cases of rheumatic heart disease. Six cases of RHD (1 pure mitral stenosis, 3 mitral regurgitation and 2 combined mitral stenosis and regurgitation) were identified giving overall prevalence rate of 1.35 per thousand. No case with active rheumatic fever could be identified. This is the first study on prevalence of RF/RHD in Nepal. The prevalence rate is lower than that reported from neighbouring countries.