Visual Outcome after Treatment with High Dose Intravenous Methylprednisolone in Indirect Traumatic Optic Neuropathy.

BACKGROUND: Traumatic optic neuropathy is an acute injury of the optic nerve due to trauma. It is an ocular emergency, requiring early treatment though there is no proven standard treatment protocol for the condition. Various studies have shown improvement in vision after intravenous steroids, but not statistically significant. Studies have revealed even optical decompression surgery is not the ultimate treatment because of no significant improvement of vision. Our study aims to assess visual outcome after high dose (1 gram) of intravenous methylprednisolone in cases with indirect optic neuropathy. METHODS: This was a non-randomized interventional study carried out in Kathmandu Medical College Teaching Hospital from May 1st 2013- June 1st 2014. RESULTS: There were 10 cases with indirect traumatic optic neuropathy included in the study. Four cases received IV methylprednisolone and six cases were observed without steroid treatment. Traumatic optic neuropathy was observed more in males[8 (80%)]with higher number in age group 21-30 years old. The visual recovery after intravenous steroid treatment was rapid and beneficial in cases with vision better than Non Perception of Light (NPL), even in cases presented 4 days after the trauma. CONCLUSIONS: There was rapid and beneficial improvement in visual acuity after high dose of intravenous steroid treatment in cases with indirect traumatic optic neuropathy with vision better than Non Perception of Light (NPL).

Diabetic retinopathy in tessellated fundus.

BACKGROUND: Duration of diabetes, poor control, age of the patient, frequent hypoglycemia, hypercholesterolemia, over-weight, smoking, alcohol, renal failure and pregnancy have all been suggested as factors which may influence the onset of diabetic retinopathy. However, there are cases without retinopathy in spite of duration of 30 to 40 years of diabetes and presence of one or other above mentioned risk factors, suggesting role of local factors to prevent angiopathy.Our study aims to assess whether tessellated fundus is a protective factor for diabetic retinopathy. METHODS: This was hospital based descriptive study. The patients included in the study were 40 years and above having diabetes for 10 years and beyond. Diabetic retinopathy was graded following Early treatment Diabetic retinopathy Study. RESULTS: Tigroid fundus was negatively associated with diabetic retinopathy (OR 0.49 with 95% confidence interval 0.21-1.11) and maculopathy (OR 0.43 with 95% confidence interval 0.15-1.3). Age 40-50 years (OR 0.67 with 95% confidence interval 0.24-1.83), female gender (OR 0.71 with confidence interval 0.31-1.61), HbA1c <6.5(OR 0.36 with confidence interval 0.99-1.31) and duration 10-15 years of onset of diabetes (OR 0.58 with confidence interval 0.22-1.37) was negatively associated with diabetic retinopathy in tigroid fundus diabetics. Age 40-50 years (OR 2.12 with confidence interval 0.43-10.5), female gender (OR 2.51 with confidence interval 0.38-10.88), HbA1c<6.5 (OR 3.12 with confidence interval 0.59-16.58) and duration 10-15 years of onset of diabetes (OR 1.5 with confidence interval 0.1-18.54) was positively associated with retinopathy in non-tigroid fundus. CONCLUSIONS: Tessellated fundus was observed as decreased risk for the development of diabetic retinopathy and maculopathy.

Hypertension in Primary Open Angle Glaucoma.

INTRODUCTION: The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG . METHODS: It was cross-sectional case-control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls). RESULTS: Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study. CONCLUSIONS: Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG.

Ocular morbidity among primary school children of Dhulikhel, Nepal.

BACKGROUND: Knowledge of disease pattern in children can help design preventive and curative strategies. OBJECTIVE: To study the pattern of ocular morbidity among the primary school children. SUBJECTS AND METHODS: All the children of randomly-selected five government primary schools of Dhulikhel were included in this study. A complete eye examination was done in all children including color vision, loupe examination, refraction and Schiotz tonometry. Funduscopy and automated perimetry were done in selected children. RESULTS: A total of 466 primary school children were included in the study, of which 466 children 47 (10.08 %) had ocular morbidity. Refractive error was the commonest type of ocular morbidity in 11 (2.36 %). Hypermetropia was the commonest type of refractive error (0.84 %) in contrast to myopia (0.64 %). Conjunctivitis was the second common type of ocular morbidity (1.71 %). Glaucoma suspects accounted for 1.28 %, xexophthalmia 1.07 %, blephatitis 0.85 %, amblyopia 0.43 %, color blindness 0.43 %, conjunctival nevus 0.43 %, glaucoma 0.43 %, and strabismus 0.43 %, while congenital abnormalities were less common. CONCLUSION: Refractive error is the commonest form of ocular morbidity in primary school children.

Association of primary glaucomas with retinal vein occlusion.

AIMS AND OBJECTIVES: To determine the association of Primary glaucoma with retinal vein occlusion. METHODOLOGY: A prospective cross-sectional study was carried out in B.P. Koirala Lions Centre for Ophthalmic Studies from April 2002-July 2003. All diagnosed cases of retinal vein occlusion were evaluated in detail for the presence of primary glaucoma. Detailed history was taken. Best corrected visual acuity was recorded, slit-lamp evaluation of anterior segment was performed, intraocular pressure was assessed with the help of applanation tonometer, gonioscopy was done and fundus evaluation was done under full mydriasis. RESULTS: Out of 50 patients, 19 (38%) were central retinal vein occlusion and 31(62%) were branch retinal vein occlusion. Majority of the retinal vein occlusion patients were in the age group of (61-70 years) 12 out of 50 patients (24%). There were 12 patients of primary glaucoma in 50 patients of retinal vein occlusion. Out of which 11 patients had primary open angle glaucoma and 1 patient had primary angle closure glaucoma. CONCLUSION: This study shows association of primary glaucoma as a risk factor of retinal vein occlusion. Evaluation of retinal vein occlusion patients for primary glaucoma would be worthwhile for early detection and prevention of blindness.

Association between axial length of the eye and primary angle closure glaucoma.

BACKGROUND: Angle closure glaucoma is emerging as a leading cause of blindness in Asia. OBJECTIVE: To compare the ocular axial length of normal individuals and the subjects with primary angle closure glaucoma. This study has been conducted to determine axial length of eye as a risk factor of primary angle closure glaucoma. MATERIALS AND METHODS: A cross-sectional comparative study was carried out in Mechi Eye Care Centre, Jhapa, Nepal including forty eyes of 20 diagnosed cases of primary angle closure glaucoma (40 eyes) and 40 eyes of 20 normal subjects selected by simple random sampling. A complete ocular examination of all the subjects was carried out. Axial length measurement was done using ultrasound A scan. RESULTS: Out of 80 eyes, there were 40 eyes of 20 diagnosed primary angle closure subjects and 40 eyes of 20 normal subjects. The mean axial length and standard deviation of primary angle closure glaucoma were 21.93 + 1.16 mm (95% CI = 21.41 - 22.45) and those of control group were 23.01 + 0.49 (95% CI = 22.79 - 23.23). The axial length of less than 23 mm was found as a risk factor for angle closure glaucoma (Relative risk =3.40; p = 0.0032). CONCLUSION: This study showed that patients with the axial length of less than 23 mm are at risk to develop primary angle closure glaucoma. This result can be confirmed by doing population based study in a larger sample size.