Seasonal Hyperacute Panuveitis (SHAPU) Outbreak Amidst COVID-19 Pandemic.

PURPOSE: To document the demographic profile of the SHAPU outbreak amidst the COVID-19 pandemic. METHODS: A multicentric cross-sectional study of the 2021 SHAPU outbreak during the second phase of the COVID-19 outbreak. RESULTS: A total of 135 patients were diagnosed with SHAPU from August to December 2021, 77 (57%) were children <16 years, males 54.8% and 34.8% had direct physical contact with white moths and 41.5% had severe type of SHAPU. Dramatic increment in the moth abundance was noted in these outbreak sites. Few cases presented with atypical ocular findings, unlike past outbreaks. Due to the ongoing COVID-19 pandemic with restrictions on travel and transportation, timely management was difficult and good visual outcome was achieved only in mild-moderate cases with an early presentation. CONCLUSION: The surge in the number of SHAPU patients, its occurrence in areas previously unreported, and some atypical presentation added raised suspicion of a possible link between COVID-19 and SHAPU.

Increase in SHAPU patients, incidence in unreported areas of Nepal, atypical ocular presentations and shift in disease affection from children towards adults population have raised doubt between connections between SHAPU, white moths and COVID pandemic.

Ultrasound Immersion Technique in the Management of Intra-lenticular Foreign Body in Low Resource Setting: A Case Series.

INTRODUCTION: The eye hospitals of low-income countries including Nepal are not equipped with imaging modalities including CT scan, UBM and Pentacam but most of them have ophthalmic ultrasound. We evaluate the utility of routine ultrasound for proper localization and confirmation of the intra-lenticular foreign body along with detection of the status of the posterior capsule using immersion technique. CASE: Four consecutive cases with intra-lenticular foreign bodies presenting to the vitreo-retina department of Lumbini Eye Institute were included in the study. Ultrasound immersion technique was used to detect the ILFB along with x-ray. Planned ILFB removal with phacoemulsification or lens aspiration and foldable IOL implantation as a single-stage procedure was done in all the patients. They were followed up to 3 months after the surgery. OBSERVATIONS: Intra-lenticular location of IOFB was confirmed by ultrasound immersion technique in all 4 eyes. Intactness of the posterior capsule was also detected preoperatively in all 4 eyes. ILFBs were removed with Utrata's capsulorrhexis forcep in all cases following capsulorrhexis. Phacoemulsification was performed to remove cataract in 2 cases whereas lens aspiration with Simcoe canula was performed in other two cases. Single piece acrylic foldable intraocular lens was implanted in all cases. Posterior capsule was intact in all 4 cases intra-operatively. Features of siderosis were observed in one case. Mild postoperative uveitis was seen in all cases and was controlled with topical steroids. Best corrected visual acuity at the last examination was 6/9 or better in all cases. CONCLUSIONS: Ultrasound immersion technique is very useful tool in management of intra-lenticular foreign body at least in low resource setting. Phacoemulsification /lens aspiration with ILFB removal and IOL implantation provides good visual outcome in these eyes.

Taenia solium in the Anterior Chamber: Surgical Management of a Rare Case of Live Free-Floating Parasite.

Ocular cysticercosis is a preventable cause of blindness. It is a parasitic infestation caused by Cysticercus cellulosae-which is the larval form of Taenia solium. In 1829, Soemmering reported the first case of a live anterior chamber cysticercosis. In the following, we report a rare case of a 13-year-old male who presented with a live adult Taenia solium in the anterior chamber without any systemic features and its successful management.

Posterior Segment Retained Intraocular Foreign Body: A Study from Western Nepal.

INTRODUCTION: Posterior segment retained Intraocular foreign body (IOFB) management is challenging. Facility of pars plana vitrectomy (PPV) and availability of well trained vitreo retina surgeons are the basic need to accomplish this work. Encircling band provide permanent 360° support to close the anterior retinal break and prevent traction on the retina. The objective of this study is to analyse the clinical characteristics and predictors of the final visual outcome and survival of the globe in cases of retained IOFB in the posterior eye segment. MATERIALS AND METHODS: A hospital based retrospective observational study was conducted. All the patients of retained IOFB in the posterior segment presented from January 2016 to June 2019 were enrolled. Patients presented with visual acuity of NPL were excluded. Statistical analysis was performed using a variety of tests using SPSS version 21. RESULTS: Forty eyes of 40 patients were included. The mean age was 27.08±10.68 years (range 5-66). 95% of our patients were male. Most of them (52.5%) worked on the farm. 26(65%) of 40 eyes had Zone I injury. The median time spent before presentation was 13.5 day. Retinal detachment, vitreous hemorrhage, and endophthalmitis were present in 15, 23 and 5 eyes, respectively, before IOFB removal. The mean LogMAR visual acuity was improved significantly from 2.50±0.87 to 1.33± 1.01 (p=0.003). Poor presenting visual acuity, retinal detachment and large diameter of IOFB were found as the predictor of poor final visual acuity. CONCLUSION: Pars plana vitrectomy by a vitreo retinal surgeon can give encouraging results in the cases of retained posterior segment IOFB. Poor presenting visual acuity, large diameter of IOFB and RD before IOFB removal are predictors of poor visual outcome.

Going green - treatment outcome and safety profile of chronic central serous chorioretinopathy treated with subthreshold green laser.

AIM: Subthreshold lasers have gained popularity in the treatment of chorioretinopathy central serous chorioretinopathy (CSCR) and yellow (577 nm) lasers have completely revolutionized the treatment. However, there is very little literature regarding the use of a more common and conventional - green (532 nm) subthreshold laser for the treatment of chronic CSCR. We report the use of green (532 nm) laser for the treatment of chronic CSCR and its outcome. METHODS: Eyes with nonresolving CSCR were treated with green subthreshold laser and evaluated at the end of 5 months. Visual acuity, central macular thickness (CMT), and macular volume (MV) at baseline and at 5 months following treatment were evaluated. RESULTS: Thirteen eyes with chronic CSCR were treated with green laser in SP-Mode™. The mean duration of CSCR was 7.64±3.77 months at the time of treatment. The median age of the patients was 41 (35-57) years. The baseline mean best-corrected visual acuity (BCVA) was 0.96 logMAR ± 0.17, with mean baseline CMT of 503.8 µm ± 181.9 and MV of 12.8 mm3 ± 3.81. The mean CMT at 5 months was 211 µm ± 31.7 and mean MV was 9.65 mm3 ± 0.60, correlating to a mean decrease of 292 µm ± 79 in CMT and mean decrease of 3.18 mm3 ± 1.87 in the MV from baseline (P<0.05). The mean BCVA after treatment was 0.18 logMAR±0.09 (P<0.05). Two cases of CSCR with pigment epithelial detachment (PED) also had complete resolution of both at 5 months. CONCLUSION: Subthreshold green laser (532 nm) is a safe and effective modality for the treatment of chronic CSCR with very good and stable outcomes. It may also be beneficial in the treatment of PEDs.

Assessment of visual morbidity amongst diabetic retinopathy at tertiary eye care center, Nepal: a cross-sectional descriptive study.

BACKGROUND: Diabetic retinopathy (DR) is one of the leading causes of preventable blindness in low and middle income countries. In Nepal, there are less studies regarding DR and they too are limited around Kathmandu valley. This study was done to assess visual morbidity in patients with DR at a peripheral tertiary eye care center of Nepal. METHODS: This was a prospective, hospital based, cross-sectional study in which all consecutive cases of DR were evaluated. DR was classified according to Early Treatment Diabetic Retinopathy Study Research Group - report no. 10 Table A5-1 (Modified Airlie House Classification). Data entry and analysis was done in an SPSS unit version 20. Wherever applicable, variables were set as 100 eyes. RESULTS: Total number of patients included in this study was 50. Commonest age group was 50-69 yrs. (43/77 yrs.; min/max) comprising 80% of the total population (n = 50) and the predominant population was male (76%). Non proliferative diabetic retinopathy (NPDR) was found in 69%, proliferative diabetic retinopathy (PDR) in 31% and advanced diabetic eye disease (ADED) in 3% (n = 100). CONCLUSIONS: All the stages of DR were present at significant proportions in this study, noteworthy was the percentage of PDR. This study shows an urgency to gather a national data on DR, raise awareness among diabetics and train effective man power at a local level to diagnose DR at an early stage.