Prevalence of Diabetes and Diabetic Retinopathy in Far-western Province of Nepal.

BACKGROUND: Although diabetes is emerging as growing public health problem, there is limited population based data about the prevalence of the disease in Nepal. METHODS: This cross-sectional population-based survey, conducted in the Far-western province of Nepal from April 2020 to April 2021, used standardized RAAB + DR methodology. Diabetes was diagnosed on the basis of treatment history and random blood sugar test results of greater than 200 mg/dl. Diabetic retinopathy screening was done by ophthalmologists. All relevant data were imported into the RAAB software package (RAAB V.6) for analysis. RESULTS: Among 4615 study population, 2.8 % (n=129) had diabetes, and 35.7% (n=46) of the diabetics were newly identified cases. Of the known diabetics, 61.4% (n=51) never had an eye examination, and only 27.7% (n=23) of cases had their eye checked for DR in the last year. Fundus examination showed 13.2 % (n=17) of the diabetic patients to have some form of diabetic retinopathy and 6.2% (n=8) had diabetic maculopathy. Only 0.8% (n=1) of the cases were categorized as sight-threatening DR but a greater number of diabetes patients had severe visual impairment or blindness (3.9%) as compared to non-diabetic patients (1.8%). CONCLUSIONS: Prevalence of diabetes and DR were relatively lower in Far-western Nepal. However poor coverage of screening examinations have left many of these cases undetected in the communities. Effective community-based diabetes and DR screening and referral programs can help to detect and treat diabetes and DR early on to prevent vision loss and other diabetic complications.

Evaluation of Resident Satisfaction Towards Cataract Surgery Training in Nepalese Ophthalmology Residency Programs.

INTRODUCTION: Although cataract surgery training is considered an integral part of all ophthalmology residency programs in Nepal, there is no literature about the training patterns and its effectiveness. The objective was to study the perspectives of young ophthalmologists towards the patterns and quality of cataract surgery training in their residency programs. MATERIALS AND METHODS: An anonymous web-based survey was conducted among MD Ophthalmology graduates completing their residency between January 2018 and December 2020 in Nepal. RESULTS: A total of 74 respondents included graduates from all 13 medical colleges under four universities/ academic bodies. All the respondents were primarily trained in Manual Small Incision Cataract Surgery technique (MSICS) with 28.4% (n=21) also having limited exposure to phacoemulsification. Overall, 62.1 % (n=46) of respondents had some exposure to wet lab training. Around 42% (n=31) had performed less than 25 cataract surgeries as a primary surgeon during residency and only 36.5 % (n=27) felt confident enough to perform cataract surgery independently after completion. More than 47 % (n=35) graded their cataract surgery training experience to be poor or below average. CONCLUSIONS: Ophthalmology residency programs may need to reassess their surgical training methods as the majority of recently graduated ophthalmologists from Nepal feel inadequately trained in cataract surgeries.

Outcomes of Cataract Surgeries Performed in Makeshift Operating Rooms in Rural Camps, Compared to Hospital-based Surgeries in Nepal.

PURPOSE: This study was undertaken to evaluate the complication rates and visual outcomes of outreach cataract surgeries done in makeshift operating rooms. METHOD: In this retrospective study, surgical outcomes of consecutive Manual Small Incision Cataract Surgeries (MSICS) done in 11 rural camps in Nepal were compared with the results of consecutive hospital surgeries (MSICS and phacoemulsification) done by the same surgeon. Surgeries were done from September 2018 to March 2020. RESULTS: Out of 1034 study population in each group, a significantly higher number (p < .001) of camp patients (27%, n = 279) were either blind or had severe visual impairment when compared to hospital patients (18.6%, n = 192). Around 88.9% (n = 919) of cases operated in camps and 85.7% (n = 886) in the hospital achieved uncorrected visual acuity (VA) of 6/18 or better on the first postoperative day. Poor outcome (VA<6/60) was seen in 3.7% (n = 38) of cases in camps and 3.9% (n = 40) in the hospital. The difference in visual outcomes was not significant (p = .162) when the results were controlled for other associated variables. There was no significant difference (p = .126) between complication rates in camps (1.9%, n = 20) and hospital surgeries (3.5%, n = 36) when preoperative conditions were statistically controlled. No cases of endophthalmitis were reported. CONCLUSIONS: Makeshift operating rooms can be used for cataract surgeries in rural areas where no standard operating rooms are available. If appropriate patient selection criteria and standard surgical protocols are followed, good surgical outcomes can be achieved in camps by an experienced surgical team.

Postoperative endophthalmitis with and without intracameral moxifloxacin prophylaxis in a high volume surgery setting.

OBJECTIVE: This study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery in an eye hospital with a high volume surgical load. METHODS AND ANALYSIS: In this single-centre, retrospective, clinical registry-based study, we compared the rates of postoperative endophthalmitis in 31 340 cataract surgery patients operated during 22 months after June 2018 who received intracameral moxifloxacin to 80 643 patients operated during 41 months before June 2018 who did not receive intracameral moxifloxacin. All patients received subconjunctival gentamycin and dexamethasone. Combined surgical procedures were excluded from the study. RESULTS: There was a significant reduction (p<0.001) of postoperative endophthalmitis rates in cataract surgeries from 0.144% (116/80 643) to 0.025% (8/31 340) after initiation of intracameral moxifloxacin. Endophthalmitis rates decreased from 0.120% (12/9942) to 0.009% (1/10 787) in phacoemulsification group and from 0.147% (104/70 701) to 0.034% (7/20 553) in manual small-incision cataract surgeries. Gram-positive organisms including Coagulase-negative staphylococci (37.9%, n=11) and Staphylococcus aureus (S. aureus 34.5%, n=10) were the most common organisms isolated out of 29 culture-positive cases. 24.1% (28/116) endophthalmitis cases in group without moxifloxacin were culture positive compared with 14.3% (1/7) of cases in moxifloxacin group. 72% (n=8) of the Coagulase-negative staphylococci and 80% of S. aureus isolates (n=8) showed in vitro sensitivity to moxifloxacin. CONCLUSION: Prophylactic use of intracameral moxifloxacin injection in addition to subconjunctival gentamycin in cataract surgery is associated with a significant decrease in rates of postoperative endophthalmitis when compared with the use of subconjunctival gentamycin alone in high volume settings.

Bilateral Cryptophthalmus: First Case Report from Nepal.

INTRODUCTION: Cryptophthalmus is characterized by a partial or complete casing of the eyeball by the skin. Cryptophthalmus alongside other systemic abnormalities is well-known as Fraser syndrome. It is an unusual genetic disorder with limited literature. The complexities of disease and limited experience pose challenges in its management. CASE: A two-day-male neonate was brought by his parents with a complaint of swelling in the right orbital region and deformed left eye since birth. Examination revealed bilobed globular swelling in the right orbital region covered by a continuous sheet of skin from forehead to cheek with no visible ocular tissue. On the left side, there was absence of upper lid margin and eyelashes and superior symblepharon. He also had bilateral ear abnormalities and right renal agenesis. Surgical intervention was done. On the right side, removal of the globe and cyst was done. On the left side, upper eyelid reconstruction with symblepharon release was done with amniotic membrane transplantation. CONCLUSIONS: The management of cryptophthalmus is challenging. Reconstructive surgeries allow cosmesis but useful vision is rarely gained. This is the first case report from Nepal to date to the best of our knowledge.

Visual outcomes of high-volume compared with low-volume manual small-incision cataract surgery in Nepal.

PURPOSE: To study whether manual small-incision cataract surgery (MSICS) in a high-volume setting gives acceptable postoperative visual outcomes. SETTINGS: Geta Eye Hospital, Kailali, Nepal. DESIGN: Single-center retrospective study. METHODS: One-year records of all MSICS in adult patients without any other ocular comorbidity were analyzed retrospectively. Surgical outcomes of cataract cases when surgeons performed more than 72 surgeries (high volume) in a single operating session (1 day) were compared with when fewer than 30 surgeries (low volume) were performed in a single operating session (1 day). RESULTS: Of 23 717 cases in the study, 20 574 patients (87%) had preoperative visual acuity of less than 3/60; 15 632 patients (66%) achieved good visual outcome (uncorrected distance visual acuity of 6/18 or better) postoperatively. Patients operated during high-volume months achieved good visual outcomes in 9930 cases (66.9%) as compared with 5702 (64.3%) in low-volume months. However, 6235 patients (61.7%) operated on during high-volume days had good visual outcomes as compared with 3053 (71.4%) during low-volume days; 175 patients in the high-volume group and 73 patients in the low-volume group (1.7% each) achieved visual acuity worse than 3/60. There were comparable posterior capsular rupture rates (423 [1.78%]) during high- and low-volume months, and 21 cases (0.09%) of postoperative endophthalmitis were noted. CONCLUSIONS: MSICS can be used to reduce large cataract backlogs in developing countries as good visual outcomes could be achieved in high-volume settings if standard protocols for quality control are followed.

Profile of Ophthalmic Tumors in Adult Nepalese Population in Central Nepal.

INTRODUCTION: Ophthalmic tumors cover benign and malignant tumors of eyelids, conjunctiva, globe, and orbit. There is limited literature on ophthalmic tumors in Nepal. The objective of the study was to find the relative frequency of various ophthalmic tumors in the adult Nepalese population in Central Nepal. MATERIAL AND METHODS: This is an observational descriptive study. A total of 100 consecutive patients, presenting with ophthalmic tumors to tertiary referral eye hospital were enrolled for the study. Demographic profile, detailed history, clinical features and diagnosis of the ophthalmic tumors were recorded. The tissue from incisional or excisional biopsy was then subjected to histopathological examination for confirmatory diagnosis. RESULTS: Mean age of subjects with ophthalmic tumors was 51.5 ± 18.2 years with a female to male ratio of 1.2:1. Benign tumors (64%) were the most common tumors followed by malignant (26%) and premalignant tumors (10%). Most common benign tumor was naevus (26.5%); most common premalignant tumor was conjunctival intraepithelial neoplasia (60%), and most common malignant tumor was sebaceous gland carcinoma (30.8%). Eyelid was most frequently involved with ophthalmic tumors (59%) followed by conjunctiva (21%). Clinical diagnosis correlated with histopathological diagnosis in 77% of cases. CONCLUSION: As different ophthalmic tumors present in a myriad of ways and a significant proportion of these cases presenting to hospital settings are malignant, it is prudent to confirm with a histopathological diagnosis for optimum management of such cases.

Ocular manifestations in tuberculosis cases with HIV in Nepal.

INTRODUCTION: TB has seen resurgence associated with HIV. Tuberculosis can affect any ocular tissue. The association of HIV with TB is supposed to increase the incidence and plethora of ocular manifestations in tuberculosis. OBJECTIVES: To study the various ocular manifestations seen in tuberculosis patients with associated HIV infection. MATERIAL AND METHODS: This hospital based, cross sectional descriptive study was conducted in Tribhuvan University, Teaching Hospital, Maharajgunj, Nepal and Geta Eye Hospital, Kailali from 2010 to 2015. Diagnosed cases of pulmonary and extra pulmonary tuberculosis with HIV co infection were evaluated for ocular manifestations after excluding other opportunistic infections. RESULTS: Of 70 cases eligible for the study, extra pulmonary tuberculosis was seen in60% of the cases. 5 patients (7.1 %) had ocular manifestations. CD4 counts were <50/mm3 in 3 cases. Ocular involvement was seen in the form of choroidal granulomas, papillitis, cranial nerve palsy, retinal vasculitis and central serous chorioretinopathy. CONCLUSION: This study demonstrated that ocular involvement is a frequent finding in cases with tuberculosis and HIV. Ocular findings are more common in cases with lesser CD4 counts. As ocular tuberculosis can be visually devastating, we recommend regular ocular evaluation of all patients with HIV and systemic tuberculosis.