Profile of Corneal Ulcer in a Month of harvesting Season in a Tertiary Level Eye Hospital of Eastern Nepal.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSION: Awareness of agriculture related corneal injuries due to trauma by vegetative materials and methods to prevent such injuries is very important.

Direct microscopy in suppurative keratitis: a report from tertiary level hospital in Nepal.

INTRODUCTION: Infective keratitis is an ocular emergency that requires prompt diagnosis for appropriate management. This study was done todetermine the sensitivity, specificity and predictive values of Gram stain and potassium hydroxide (KOH) wet mount in the diagnosis of suppurative keratitis. MATERIALS AND METHODS: A prospective hospital based study of all patients with clinically diagnosed suppurative keratitis presenting between January 2011 and June 2012 was carried out. Corneal scrapes were taken and subjected to direct microscopy and culture. RESULTS: Corneal scrapings were obtained from 108 eyes with suppurative keratitis. Direct microscopy was positive in 39.2% of cases and organisms were grown in 50.9 % of the cases. Bacteria were responsible in 76.4% and fungi in 23.6%. Of the bacterial isolates, 66.7% was Staphylococcus aureus and of the fungal isolates, 30.7% was Aspergillus species. Sensitivity in vitro showed that Cefazolin, Chloramphenicol and Ofloxacin were most effective against bacteria. Sensitivity of Gram stain in detecting bacteria was 50% (95% CI, 34.43 to 65.56) and specificity was 77.3% (95% CI, 65.0 to86.3) and sensitivity of KOH wet mount in detecting fungi was 53.8% (95% CI, 26.12 to79.6) and specificity was 98.9% (95% CI, 93.44 to 99.9). Positivity of direct smear (65.1%) was found to be higher among eyes with larger ulcers (>2mm) than eyes with smaller ulcers ( less than 2mm). CONCLUSION: Direct microscopy is of great diagnostic value in the management of suppurative keratitis and it is recommended in all ophthalmic clinics without exception for establishing timely, appropriate and effective treatment.

Childhood corneal blindness: a retrospective study in a tertiary eye hospital of eastern region of Nepal.

INTRODUCTION: Studies from Nepal show that most of the cases of unilateral childhood blindness are due to corneal causes. It was also observed that these corneal causes were mostly preventable or treatable. OBJECTIVE: to study the patterns of corneal diseases in a pediatric out-patient department of a hospital in the eastern region of Nepal. METHODS: A retrospective study of the patients who presented to the pediatric department of our hospital in the year 2014 was done with the help of the data received from the hospital recording system. Detail examination of every case was done in the out-patient-department of the hospital by pediatric ophthalmologists. Patients with only corneal disease were included, and those with corneal disease along with other ocular disease were excluded from the study. RESULTS: Of 20,250 patients examined in the pediatric department over a one year period, 1911(9.4%) presented with isolated corneal problems. Keratitis and corneal ulcer were found in 47.8% of them. Corneal trauma was present in 5.6% and vitamin A deficiency leading to corneal opacity and keratomalacia was seen in 0.06% of the cases. Corneal blindness was observed in 66 eyes (bilateral in 3 cases). No case of trachoma or congenital corneal disease was observed. CONCLUSION: Childhood corneal blindness is mostly due to preventable and treatable causes.

Topographic corneal changes in children with vernal keratoconjunctivitis: A report from Kathmandu, Nepal.

PURPOSE: The present study was conducted to determine corneal topographic characteristics of children with vernal keratoconjunctivitis (VKC) and compare the corneal topographic indices in VKC subjects with normal subjects MATERIAL AND METHOD: In the hospital based comparative study, 115 consecutive subjects with VKC and 102 age and sex matched normal subjects were selected for the videokeratography with NIDEK ophthalmic operating system. Keratoconus-like topography was determined based on the expert classifier system. Other assessments included visual acuity testing with LogMAR chart, slit lamp biomicroscopy, dilated fundus examination, measurement of central corneal thickness and intraocular pressure. Topographic indices were analyzed and compared using unpaired t-test among different groups. Sensitivity and specificity was estimated by the ROC curve. RESULT: Among 115 subjects with VKC, males comprised of 86 subjects (66.1%) and mean age of presentation was 10.9 (SD 4.9) years with mixed VKC in 56.5%. Keratoconus-like topography was present in 13 subjects (11.3%). The keratoconus predictiv index (sensitivity 92.3%, specificity 98.5%), the opposite sectoral index (sensitivity 84.6%; specificity 93.2%), the differential sectoral index (sensitivity 92.3%; specificity 90.8%) were found to be signficantly associated with VKC subjects having keratoconus-like topography. CONCLUSION: A high prevalence of keratoconus-like topography was observed in patients with VKC.