Systemic association of newly diagnosed proliferative diabetic retinopathy among type 2 diabetes patients presented at a tertiary eye hospital of Nepal.

INTRODUCTION: Proliferative diabetic retinopathy (PDR) is the leading cause of blindness among the diabetics. OBJECTIVE: to study the systemic association of proliferative diabetic retinopathy. MATERIALS AND METHODS: A prospective, case-series study was conducted among the newly diagnosed proliferative diabetic retinopathy cases presenting at the Tilganga Institute of Ophthalmology (TIO) from January 2012 to January 2013. Diabetic retinopathy was classified using the Early Treatment Diabetic Retinopathy Study criteria. Blood pressure, fasting and postprandial blood sugar, glycosylated hemoglobin, lipid profile, urine for microalbumin, urea, and creatinine were evaluated at the time of diagnosis. RESULTS: A total of 104 type 2 diabetic patients with newly diagnosed PDR presented during the study period. Concurrent macular edema was present in 93 cases (89.42 %). The mean age was 56.96 ± 9.394 (range 32 - 78) years. Males and females comprised of 75.7 % and 24.3 % respectively. The majority (37.5 %) were involved in business, followed by government service (17.30 %), and housewives (16.34 %). Mean duration of diabetes was 11.42 ± 5.356 years (range 1 month - 26 years). Concurrent hypertension was found in 55.76 %, uncontrolled fasting and or postprandial blood sugar in 72.54 %, poor glycemic control (HbA1C > 7 %) in 73.97 %, abnormal lipid profile in 52.56 %, microalbuminuria in 67.85 %, and positive urine albumin in 50 % of the cases. CONCLUSION: Despite the short duration of diabetes, the concurrent hypertension, poor glycemic control, proteinuria and dyslipidemia were the main systemic associations for PDR at our clinical set-up. Awareness, identification and management of these systemic problems could reduce the rapid progression to PDR.

Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal.

INTRODUCTION: A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA). OBJECTIVE: To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal. MATERIALS AND METHODS: A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5. RESULTS: A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet's membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60. CONCLUSION: Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.

Causative organisms in microbial keratitis, their sensitivity pattern and treatment outcome in western Nepal.

INTRODUCTION: Corneal infection is one of the major causes of monocular blindness in developing countries. OBJECTIVE: To determine the epidemiological characteristics, predisposing factors, microbiological pattern, sensitivity pattern and treatment outcome of microbial keratitis. MATERIALS AND METHODS: A retrospective analysis of hospital records of 414 patients with diagnosed infective keratitis was done. The outcome measures were microbial isolates, their sensitivity to therapeutic agents and treatment outcome. RESULTS: Of the total, 312 (75.4 %) patients were farmers by profession, 138 (33.3 %) had a history of ocular trauma and 17(4.1 %) were using topical corticosteroids. Among the 138 cases of the corneal ulcer with trauma, 52 (37.68 %) had fungi isolated in culture (RR=0.54, 95% CI = 0.44 - 0.68) and 32 (23.19 %) had a bacterial growth. Cultures were positive in 300 (72.5 %) cases, having 138 (33.3 %) patients with pure fungal infection, 121 (29.2 %) with pure bacterial and 41 (9.9 %) with mixed infection. Fusarium spp was the most common fungal pathogen while Staphylococcus epidermidis was the commonest bacterial isolate. The most sensitive antibiotics for the Gram positive bacteria was cephazolin (84.92 %), while for Gram negative, ciprofloxacin and ofloxacin were the most effective (79.31 %). Of 414 cases of corneal ulcers, 363 (87.7 %) cases healed completely. CONCLUSION: Microbial keratitis is mostly seen in farmers in this part of the world. Fusarium and Staphylococcus epidermidis were the most common isolates. Cephazoline and ofloxacin were the most effective antibiotics for Gram positive and Gram negative organisms respectively.

Scleral buckle surgery for pseudophakic and aphakic retinal detachment in western Nepal.

INTRODUCTION: Retinal detachment remains one of the most serious complications of cataract surgery. Treatment of this condition has represented a challenge for vitreoretinal surgeons.Scleral buckle (SB) surgery is one of the treatment options in pseudophakic and aphakic retinal detachment (RD). AIMS: To find out the anatomical and visual outcome of SB in pseudophakic and aphakic RD. SUBJECTS AND METHODS: Retrospective case series of 46 consecutive eyes of 46 patients with RD (38 pseudophakic and 8 aphakic eyes) that had undergone conventional SB surgery were reviewed from patient files. Postoperative retinal status at 3 weeks, 6 weeks and 3 months were recorded to see the anatomical success rate after retinal reattachment surgery. Best corrected visual acuity (BCVA) at 3 months follow-up was noted. RESULTS: The mean age of the patients was 54.28 ± 13.49 years. Forty eyes (86.9 %) had primary attachment by 6 weeks duration. Five eyes had undergone repeat surgery within a six-week duration (pars plana vitrectomy). Forty patients had follow-up visit to 12 weeks, achieving retinal attachment in 37 eyes (80.5 %). Best corrected visual acuity (BCVA) at 3 months was better than 6/60 in 18 eyes (39.1%), BCVA better or equal to 1/60 but less than 6/60 in 18 eyes (39.1%) and BCVA less than 1/60 in 4 eyes (8.7 %). CONCLUSION: Conventional scleral buckling has good outcome for pseudophakic and aphakic RD and can be useful for patients in peripheral eye hospitals where patients cannot afford high cost surgeries.

Outcome of cluster endophthalmitis in western plain region of Nepal.

BACKGROUND: Post-operative endophthalmitis remains one of the most visually devastating complications of cataract surgery. Cluster endophthalmitis is defined as five or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. Excessive inflammation, particularly in the early post-operative phase, should be regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye as well as better visual outcome. OBJECTIVE: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis in high volume cataract surgical centre. MATERIALS AND METHODS: Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin, amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital's microbiology laboratory for culture and sensitivity testing. All patients received intravenous ciprofloxacin for 3 days and oral ciprofloxacin for 7 days. Topical Prednisolone acetate, Ofloxacin, Gentamycin and atropine were given to all patients. Patients were followed up till 6 weeks. RESULTS: 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2 cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60 to 5/60. CONCLUSION: Intravitreal antibiotics and steroid, along with systemic ciprofloxacin and subconjunctival vancomycin has good visual outcome for post operative cluster endophthalmitis.

Outcome of probing under topical anesthesia in children below 18 months of age with congenital nasolacrimal duct obstruction.

Congenital Nasolacrimal Duct Obstruction (CNLDO) is one of the commonest causes of Childhood epiphora. This study was carried outat Sagarmatha Chaudhary Eye Hospital (SCEH), Lahan to determine the success rate of probing and syringing in children below 18 months of age with CNLDO. A hospital based prospective interventional study of 106 children with age 4 to 18 months (Mean 7.67, SD 4.37) who underwent probing and syringing under topical anesthesia in minor procedure room of OPD. The children were divided into 3 age groups, Group A (age d" 6 months), Group B (age = 7-12 months) and Group C (age = 13-18 months). Success of probing was defined as complete relief of signs and symptoms on follow up at 3-6 weeks. Out of 106 children with CNLDO below 18 months of age, 97 (91.5%) children had better outcome with first attempt of probing. First attempt of probing resulted in resolution in 92.3% (108 out of 117) eyes; 95.6%, 92.7%, 87.1% in the age group less than 6 months, 7-12 and 13-18 months respectively. 9 eyes underwent a repeat procedure of which 6 eyes were cured. Probing and syringing below 6 months of life has shown to be very effective with almost 100% success. The overall success of probing and syringing among children less than 18 months was 97.4%.