Pediatric cataract surgery with hydrophilic acrylic intraocular lens implantation in Nepalese children.

PURPOSE: To assess the outcome of cataract surgery with hydrophilic acrylic intraocular lens (IOL) implantation in children with congenital and developmental cataracts. METHOD: A retrospective review of medical records of children with congenital or developmental cataracts who underwent cataract surgery with hydrophilic IOL implantation, from January 2011 to December 2014 in a tertiary eye hospital in Nepal. Primary posterior capsulotomy, anterior vitrectomy, and IOL implantation was done in children 8 years or younger, while older children underwent only lens aspiration and IOL implantation. RESULTS: A total of 178 eyes of 120 children underwent cataract surgery with primary IOL implantation. Mean age at the time of surgery was 6.9 years (range: 3 months to 15 years). Average follow-up time was 13.7 (±5.9) months. Associated ocular anomalies were present in 84 (47.1%) eyes. Postoperative complications were found in 33 eyes (18.13%) with inflammatory membrane being the most common (10.1%). Two eyes (1.1%) developed endophthalmitis. Second intervention was needed in 12 (6.5%) eyes. Preoperative vision of less than 6/60 was present in 105 eyes (57.69%). Final best corrected visual acuity of 6/12 or better was found in 81 (44.5%) eyes. CONCLUSION: Our study shows that hydrophilic IOL is suitable for use in children. Results of this study are comparable with other studies on pediatric cataract surgeries using hydrophobic acrylic intraocular lenses. Low cost hydrophilic lens implantation is an effective approach in managing pediatric cataract surgery in developing countries like Nepal.

Causes of visual impairment and blindness in children in three ecological regions of Nepal: Nepal Pediatric Ocular Diseases Study.

PURPOSE: To study the causes of blindness and visual impairment in children in three ecologically diverse regions of Nepal. MATERIALS AND METHODS: This is a baseline survey report of a 3-year longitudinal population-based study. One district each from the three ecological regions - Terai, Hills, and Mountains - was selected for the study. Village Development Committees from each district were selected by random sampling. Three community health workers were given training on vision screening and identification of abnormal ocular conditions in children. Health workers who examined children and collected data using pretested questionnaire performed house-to-house surveys. Children with abnormal vision or ocular conditions were referred to and examined by pediatric ophthalmologists. RESULTS: A total of 10,950 children aged 0-10 years, 5,403 from Terai, 3,204 from Hills, and 2,343 from Mountains, were enrolled in the study. Of them, 681 (6.2%) were nonresponders. The ratio of boys to girls was 1.03:1. Prevalence of blindness was 0.068% (95% confidence interval [CI] 0.02%-0.12%) and visual impairment was 0.097% (95% CI 0.04%-0.15%). Blindness was relatively more prevalent in Terai region (0.08%, 95% CI 0.02%-0.13%). The most common cause of blindness was amblyopia (42.9%) followed by congenital cataract. Corneal opacity (39%) was the most common cause of unilateral blindness. CONCLUSION: More than two-thirds of the causes that lead to blindness and visual impairment were potentially preventable. Further, nutritional and genetic studies are needed to determine the factors associated with ocular morbidity and blindness in these regions.

Ocular findings in leprosy patients in Nepal in the era of multidrug therapy.

PURPOSE: Detailed ophthalmic evaluation was performed to determine the prevalence of ocular complications among leprosy patients on multidrug therapy and those released from multidrug treatment. DESIGN: Observational case series. METHODS: Leprosy patients at Tribhuvan University Teaching Hospital from April 1, 2001, through September 30, 2002, underwent detailed ophthalmic evaluation including slit-lamp biomicroscopy, dilated funduscopy, and applanation tonometry. RESULTS: We evaluated 58 leprosy patients. A majority (72%) was receiving treatment for multibacillary leprosy; 14% belonged to posttreatment multibacillary and paucibacillary groups. Ocular involvement was found in 57% of patients. In the multibacillary group, 55% had ocular involvement, which was more than double that found in the paucibacillary group (25%), although this finding was not statistically significant (P =.187). Among patients with ocular complications, 48% had visual disability and another 45% had threatened vision; 9% met World Health Organization guidelines for blindness. Uveitis and its complications were the predominant causes of visual disability (88%). CONCLUSION: Ocular complications and visual disability are high among leprosy patients in Nepal even after completing multidrug therapy.