Pattern of fungal isolates in cases of corneal ulcer in the western periphery of Nepal.

PURPOSE: To find out the epidemiologic features in 686 consecutive cases of fungal keratitis presenting in a tertiary eye hospital in the western region of Nepal. MATERIALS AND METHODS: A prospective hospital - based study was carried out on 1880 consecutive patients presenting with corneal ulcer in the outpatient department and cornea clinic of Lumbini Eye Institute, Bhairawa, Nepal. The socio-demographic data, predisposing risk factors, prior treatment modalities, laboratory results and the distribution pattern of fungus species were analyzed. RESULTS: Diagnosis of fungus keratitis was established in 686 (36 %) out of the total study group of 1880 cases. The spectrum of fungi isolated were Fusarium species (Fusarium spp.) in 219 (31.9 %), followed by unidentified dematiaceous 151 (22 %), curvularia 122 (17.7 %) and unidentified hyaline in 111 cases (16.1 %). Men (59.3 %) were more commonly affected than women (40.6 %). The young adults age group of 31-40 years was most commonly involved (26.6 %). Corneal trauma (58 %) and topical steroids (12 %) were the most common predisposing risk factors noted. CONCLUSION: In contrast to the other studies done in Nepal, we found Fusarium to be the most common fungal isolate causing corneal ulcer followed by unidentified dematiaceous, unidentified hyaline and curvularia. Corneal trauma was the commonest predisposing risk factor in causing fungal keratitis.

Alport's syndrome.

Alport's syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed.

The role of the injection botulinum toxin A in cases of blepharospasm syndrome, hemifacial spasm and Meige's syndrome.

BACKGROUND: Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease. OBJECTIVES: To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies. METHODS: A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted. RESULTS: A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 3.61 (+/- Standard deviation 0.50, range 3-4), 3.21 (+/- Standard deviation 0.63, range 2-4) and 3.67 (+/- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 4.3 (+/- Standard deviation 1.6, range 2.0-6.5), 5.8 (+/- Standard deviation 1.4, range 3-8) and 4.5 (+/- Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications. CONCLUSIONS: The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige's syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.

An unusual presentation of alveolar type of rhabdomyosarcoma of orbit.

Orbital rhabdomyosarcoma is the commonest primary orbital malignancy in children. A case of alveolar type of orbital rhabdomyosarcoma with unusual presentation in a three and half years male child presented with painless nodular swelling in the left lower lid of one and half years duration and gradual protrusion of the left eyeball. Examination of the patient revealed a mass in the left lower lid region extending to other parts of orbit and lymphnode metastasis in the neck region along with non axial proptosis, rest of the systemic examination being normal. Patient underwent incisional biopsy of the mass and excisional biopsy of the lymphnodes which revealed alveolar type of primary orbital rhabdomyosarcoma with lymphnode metastasis.