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.

Corneal edema after phacoemulsification surgery in patients with type II diabetes mellitus.

INTRODUCTION: Corneal edema delays early visual recovery after phacoemulsification surgery in diabetes mellitus. OBJECTIVE: To compare corneal edema of eyes in patients with type II diabetes mellitus and in non-diabetics after phacoemusification surgery. MATERIALS AND METHODS: A hospital-based, retrospective study involving 96 eyes that underwent phacoemulsification surgery for immature cataract at the Department of Ophthalmology, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal was carried out. Evaluation was performed of 33 eyes in patients with diabetes mellitus (diabetic group) and of 63 eyes in patients without diabetes mellitus (non-diabetic group). All diabetic patients had controlled blood glucose for at least one week prior to the surgery. The operated eye was examined before surgery and on one day, one week, and one month after surgery. Intraocular pressure was measured on each visit. MAIN OUTCOME MEASURES: The findings of post-operative corneal edema and visual acuity between the diabetic and non-diabetic groups were studied and compared. RESULTS: There was no difference clinically in any pre-operative corneal examination between the diabetic and non-diabetic groups. The corneal edema after surgery was significantly higher in the diabetic group than in the non-diabetic group (p less than 0.001). The number of patients with corneal edema one day and one week after surgery was significantly higher in the diabetic group than in the non-diabetic group (after 1 day, OR = 62.5; 95 % CI = 15.31 - 255.11, p less than 0.000) and after 1 week, OR = 6.77; 95 % CI = 1.28 - 35.76, p less than 0.006). CONCLUSION: Corneal edema following phacoemusification surgery in diabetic eyes is likely to be more frequent than in non-diabetic eyes.

Retinal detachment surgery at Nepal Eye Hospital.

INTRODUCTION: Retinal diseases are one of the important causes of blindness in Nepal. This study is done with objectives of finding the outcome of retinal detachment surgery. METHODS: A retrospective analysis of 110 patients who underwent retinal detachment surgery over five year period was conducted in Nepal. RESULTS: Retinal re-attachment was achieved in 94.4% and postoperative visual acuity of 6/36 to 6/6 was achieved in 52.7% (As possible risk factors, myopia was present in 34.5% ophkia in 29%, trauma in 9%, and lattice) degeneration was 5.4%. CONCLUSIONS: The study has shown a promising result for the retinal detachment surgery.

A pattern of age-related macular degeneration.

INTRODUCTION: Age related macular degeneration is a disorder of the macula most often clinically apparent affecting central vision and is one of the leading causes of blindness in the population above 50 years. The aim of this study is to determine clinical profile of AMD in Nepalese presenting to a Teaching Hospital in Kathmandu. METHODS: It was a hospital-based cross-sectional study. The subjects included in the study were those presenting to the Ophthalmology department of Kathmandu Medical College Teaching Hospital from July 2007- Dec 2007.The total number of individuals included in the study were 402 and total number of eyes were 804. RESULTS: AMD was observed in 5.2% out of 402 subjects of 40 years and above age group with prevalence increasing with age. The prevalence of AMD was 0.7% within 40-50 years of age-group individuals increasing to 2.6% in 51-60 years, 6.5% in 61-70 years and to 19.3% among subjects above 71 years. This study revealed that the prevalence of AMD in females was higher with female preponderance in ratio of 2.5:1. 52.5 % AMD subjects in our study had visual impairment with 6/246/60 vision and 15% had vision <3/60-PL. Our study revealed statistically significant increased risk for AMD with aging (p=0.00). Increased risk was observed in female gender and diabetics though the Odds ratio (OR) was statistically insignificant (p=>0.01). CONCLUSIONS: Prevalence of AMD in Nepalese presenting to Kathmandu Medical College Teaching Hospital was 5% with female preponderance in ratio of 2.5:1. Aging showed statistically significant increased risk for AMD development in this study.

Visual outcome of laser treatment in diabetic retinopathy.

OBJECTIVE: To determine the visual outcome of laser treatment in diabetic retinopathy. DESIGN: Prospective, non-comparative case series. MATERIALS AND METHODS: A total of 80 eyes of 50 patients with diabetic retinopathy in different stages were photocoagulated using diode green laser. Focal laser only was given in 46 eyes and pan retinal photocoagulation only was given in 29 eyes while 3 eyes received focal laser and pan retinal photocoagulation. One eye was given grid laser only and one eye received both grid and focal laser. The best corrected visual acuity was noted and fundus examination was carried out prior to laser therapy and at the last follow-up and results were compared. RESULTS: Non- proliferative diabetic retinopathy was present in 76%. Following laser treatment, best corrected visual acuity improved in 52.50%, remained static in 35% and deteriorated in 12.5%. Maculopathy improved in 52%, remained static in 6% and deteriorated in 2% in right eyes while there was no maculopathy in 40% in right eyes. Similarly, maculopathy improved in 38% and remained same in 10% while 52% had no maculopathy in left eyes. After laser treatment, NVD (OD) regressed in 6% and remained unchanged in 4%. Similarly, NVE (OD) regressed in 18% and remained unchanged in 4% and NVE (OS) regressed in 18% and remained unchanged in 2% following laser therapy. CONCLUSION: Timely and adequate laser treatment helps in saving the vision in patients with diabetic retinopathy.

Retinopathy in a diabetic population.

AIMS AND OBJECTIVES: The study was conducted with the aim to find out the prevalence of diabetic retinopathy among diabetics on treatment, to find out the presence of associated risk factors and to determine the knowledge of diabetic retinopathy among patients with diabetic mellitus. METHODOLOGY: Cross sectional screening of 316 diabetic patients on treatment presenting to Kalimati Diabetic Clinic and Kathmandu Medical College was done over a period of 8 months for the presence of diabetic retinopathy, associated risk factors and the knowledge of diabetic retinopathy. RESULTS: 21% of the known diabetics had evidence of various grades of diabetic retinopathy although 75.3% of the enrolled patients had history of diabetes mellitus of less than 10 years. Associated risk factors were present in 66.46%. However, only 50% diabetics had the knowledge of diabetic retinopathy. CONCLUSION: As 21% of the diabetic patients on treatment had various grades of diabetic retinopathy and 50% of the diabetic patients were not aware of diabetic retinopathy, emphasis has to be given for the awareness of ocular involvement in diabetes mellitus such that blindness from retinopathy can be prevented. The responsibility lies on treating physicians or Diabetic Centres for referral of diabetic patients for ophthalmic evaluation. Similarly, control of associated risk factors like hypertension, hyperlipidemia is equally important.

Intermediate uveitis: a hospital based study.

UNLABELLED: Intermediate uveitis affecting pars plana, peripheral retina and underlying choroid affects primarily healthy children and young adults. OBJECTIVE: To study the components of intermediate uveitis at Nepal Eye Hospital in the year 2003 August to 2004 March. MATERIALS AND METHODS: A prospective study was done in patients with intermediate uveitis visiting Nepal Eye Hospital. Sample size was 50. Specially designed proforma of intermediate uveitis was used to collect particulars of the patients, history, clinical examination findings, investigation reports, management protocols used and the final visual outcome. RESULTS: Intermediate uveitis was seen more in 20 to 29 years age group (38%) and more prevalent in males (52%). Among the study population farmers constituted maximum proportion (36%) and Mongoloid origin was mostly affected (30%). High number of patients were from the central development region with highest proportion from Dhading district (34%). Anterior segment affection with keratic precipitates and anterior chamber cells were noted in 72% of involved eyes. Vitreous cells were noted in all affected eyes while 4% had vitreous snow banking and 3% had vitreous snow balls. Most of the patients (52%) received between topical steroid and posterior subtenon injection of Triamcinolone. Visual Acuity was improved in 52% of cases and remained static in 46%.while deteriorated in 2%. CONCLUSION: Significantly high number of patients with intermediate uveitis has been reported from the central development region mainly from Dhading Kathmandu and Nuwakot districts People in their third decade were found to be commonly involved and Mongloid origin were more commonly affected Anterior chamber spill over was seen in higher percentage of patients than described in literature As the patients presented in milder forms visual acuity improved is of cases with the treatment protocol followed.

Analysis of 400 cases of posterior segment diseases visiting retina clinic of Nepal Eye hospital.

OBJECTIVE: To determine the disease pattern of 400 patients attending Nepal Eye Hospital for strategic planning. MATERIALS AND METHODS: A retrospective hospital based analysis of 400 cases visiting Retina Clinic of Nepal Eye Hospital (NEH) over a period of one year was carried out in order to know the disease pattern for planning purpose. RESULTS: Males slightly outnumbered females (58% versus 42%). The diseases were more common in age group 50 to 59 years. Diabetes mellitus with or without retinopathy was the commonest cause (20.25 %) for attendance in retina clinic followed by hypertensive retinopathy and venous occlusive disorders.

Case of xeroderma pigmentosum with well differentiated squamous cell carcinoma in the eye.

A seven year old female child presented with complaints of increased freckling over the face since the age of two years and a rapidly growing mass over the right eye. She underwent excisional biopsy of the mass over the eye which on histopathological examination was diagnosed as squamous cell carcinoma.

Blindness from cataract formation in leprosy.

Of 744 leprous patients, 61 (8.2%) had cataract-induced blindness; 46 patients (6.2%) were unilaterally blind and 15 (2.0%) were bilaterally blind. The mean age of patients with cataracts was 63.4 years in the tuberculoid-type leprosy and 56.4 years in the lepromatous type. The appearance of cataracts in lepromatous patients at an earlier age than in tuberculoid patients is significant (p less than 0.005). Of 41 cataractous eyes with posterior iris synechiae, 42.1% were observed in patients with tuberculoid-type leprosy and 59.1% in patients with the lepromatous type. Histopathological examination of 24 lenses showed that irregularities of the lens epithelium were present in 79.2%. Posterior iris synechiae were seen in 66.7% and fibrous pseudometaplasia in 41.7%. Posterior migration of the lens epithelium in the posterior subcapsular area was observed in 54.2%. In view of these clinical and histopathological findings, we discuss the probability that most cataracts in leprous patients are complicated in nature.