Study of Intraocular Pressure following Neodynium Yttrium Aluminium Garnet Laser Capsulotomy with the Use of Brimonidine: A Descriptive Cross-sectional Study.

INTRODUCTION: Posterior capsular opacification is a common complication after cataract surgery. Neodynium Yttrium Aluminium Garnet laser capsulotomy is still the preferred treatment for posterior capsular opacification. This study was done to determine the use of Brimonidine eye drop in preventing the rise of intraocular pressure post-Neodynium Yttrium Aluminium Garnet laser capsulotomy. METHODS: A descriptive cross-sectional study was conducted in Lumbini eye institute and research center, Bhairahawa, Nepal, in 200 eyes with posterior capsular opacification using Brimonidine from Feb 1, 2019, to July 30, 2019. The Institutional Review Committee approved the study with approval number 0237. A convenient sampling method was used. Pre-capsulotomy best-corrected visual acuity, slit-lamp examination of the anterior segment, and dilated fundus examination were done. Intraocular pressure was measured with Goldmann Applanation Tonometer. Post capsulotomy patients were evaluated after one hour, two hours, and two weeks for intraocular pressure and any complications. The statistical analysis was done using Statistical Package of Social Sciences version 20.0 statistical analysis software. The descriptive statistical analysis of the study was done after the collection of the data. RESULTS: Mean age of patients at presentation was 61.61±SD 1.09. The mean intraocular pressure following Neodynium Yttrium aluminum garnet laser capsulotomy using brimonidine at 1 hour was 12.73±3.3 mmHg.and two hours was 11.98±3.2 mmHg. The mean energy per pulse was 2.3±SD 0.3 mJ. The mean duration of posterior capsular opacification from cataract surgery was 22.28 weeks. CONCLUSIONS: Neodynium Yttrium Aluminium Garnet laser capsulotomy had lower intraocular pressure after the Brimonidine eye drop procedure. The maximum mean reduction in intraocular pressure was observed after two hours.

Lens induced glaucoma in a tertiary eye care centre in Western Nepal.

INTRODUCTION: Lens induced glaucoma due to hypermature cataracts is an important cause of secondary glaucoma in the developing world. The most common etiology of lens induced glaucoma is phacomorphic glaucoma from untreated senile cataract. OBJECTIVES: To study the demographics, clinical presentations and surgical outcome of lens induced glaucoma (LIG). MATERIALS AND METHODS: It is the prospective case series of fifty three patients eyes with LIG over a 6 months period from June 2015 to November 2015. All cases of lens induced glaucoma underwent cataract surgery. Data including demographics, clinical presentations, surgical outcome were analysed using Statistical Package for Social Studies 20.0. RESULTS: The mean age was 61.5 years (Standard deviation 8.9) with predominantly women (30, 56.6%) were affected. Phacomorphic glaucoma (38, 71.7%) was the main cause of lens induced glaucoma, followed by phacolytic glaucoma (15, 28.3%). The main clinical symptoms were reduced vision (100%), eye pain (96.2%) and redness of eyes (62.3%). All patients (100%) presented with visual acuity of <3/60 or worse and intraocular pressure (IOP) more than 40 mm Hg (34, 64.2%). All 53(100%) patients underwent cataract surgery and all of them had tremendously reduced intraocular pressure with a mean 13.9 mmHg and vision had improved from >6/18 as noted in 16(30.2%) cases. CONCLUSIONS: The main clinical presentations of LIG are triad of acute reduced vision, eye pain and redness. The better final BCVA is found when there is an early presentation and less IOP at the time of presentation Public awareness, early detection and early intervention aids in good visual recovery and control of intraocular pressure in LIG.

Correlation of Peripapillary Retinal Nerve Fibre Layer Thickness and Visual Evoked Potential in Optic Neuritis in a Tertiary Eye Care Centre.

INTRODUCTION: Optic neuritis (ON) is the involvement of the optic nerve as a result of inflammation, demyelination or infection. OBJECTIVE: To study the correlation between peripapillary retinal nerve fibre layer thickness (pRNFL) and visual evoked potential (VEP) in ON cases. MATERIALS AND METHOD: A non-interventional, descriptive, cross sectional study enrolling 66 eyes of 49 patients with ON was done. pRNFL thickness was measured by Optical Coherence Tomography (OCT) and VEP was also done. OCT and VEP findings were compared with the control group. In addition correlation between pRNFL thickness and VEP was done. RESULTS: The mean pRNFL in affected eyes were significantly higher than the control superiorly (p-value<0.001), inferiorly (p-value <0.001), temporally (p-value 0.005) and nasally (p-value <0.001). The mean P100 latency in the affected eyes were significantly prolonged than the control eyes both at 1º (p-value<0.001) and at 15' (p-value=0.05). The mean N75-P100 amplitude in the affected eyes were significantly reduced than the control eyes both at 1º (p-value<0.001) and at 15' (p-value<0.001). The mean pRNFL thickness in all four quadrants and VEP findings of the affected eyes showed no significant correlation. CONCLUSION: The increased thickness in non-myelinated pRNFL has no correlation with the increased latency or decreased amplitude in cases of ON. However, OCT is seen as a useful tool in detecting and quantifying even subtle pRNFL changes in cases of optic neuritis.

Demographic pattern and clinical characteristics of optic neuritis in a tertiary eye care centre.

PURPOSE: To study the demographic pattern and clinical characteristics of optic neuritis cases in a tertiary eye care centre in Nepal. DESIGN: Descriptive, cross-sectional study. METHODOLOGY: Complete ocular examination was done in all the newly diagnosed cases of optic neuritis presenting from January 1st 2012 to June 30th 2013. Demographic pattern, clinical features, visual acuity, colour vision, contrast sensitivity and visual field defects were studied. RESULTS: Sixty seven eyes of 50 patients (28 females and 22 males) with optic neuritis were included in the study. The mean age was 34.32 years ± 13.72 years. The male: female ratio was 1:1.27. All the cases presented with complaint of blurring of vision. Painful ocular movement was noted in 58%. On ophthalmoscopic examination around 2/3rd of eyes suffered from papillitis (72%) and 1/3rd from retrobulbar optic neuritis (27%). Only one case of neuroretinitis (1%) was seen in the study. The colour vision pattern was variable. Contrast sensitivity was reduced in 94%. Centrocaecal scotoma was seen in 10.5%. CONCLUSION: Females were predominantly affected. Unilateral involvement was the most common presenting as papillitis.