Madhu Thapa

Pattern of intraocular pressure fluctuation in uveitic eyes treated with corticosteroids.

Abstract Purpose: To determine IOP fluctuation in uveitic eyes treated with corticosteroids. Design: Prospective Observational Study. Method: Study of 116 consecutive new uveitis patients visiting Uveitis clinic, BPKLCOS. IOP was meticulously monitored. Data was analyzed in SPSS-16 using paired samples ‘t-test’. Results: The mean IOP in all patients at presentation, at 1 week, 3 weeks and 6 weeks were respectively 14.66 mmHg, 14.72 mmHg, 14.75 mmHg and 14.93 mmHg. This progressive IOP rise was not statistically significant. Ocular hypertension was seen in 20% eyes; 64.5% were due to corticosteroids. Steroid-induced ocular hypertension was seen in 37.03% of oral group, 14.28% of posterior subtenon group, 8.57% of topical group. Antiglaucoma medications were started in 61.2% of the cases with raised IOP. None had to undergo glaucoma filtering surgery. Conclusion: Incidence of ocular hypertension in uveitic eyes was 20% in this study.Majority of them was corticosteroid induced. Timely medical treatment averted the necessity of surgical intervention for IOP control.

Retinal nerve fibre layer thickness in a healthy Nepalese population by spectral domain optical coherence tomography

OBJECTIVE To determine the normal values for peripapillary retinal nerve fibre layer thickness (RNFL) measured by spectral domain optical coherence tomography (SD- OCT) in a healthy Nepalese population and to compare the RNFL thicknesses between the genders and among the various age groups. MATERIAL AND METHODS One hundred and fifty six eyes of 156 healthy Nepalese subjects (66 males and 88 females) of various age groups were enrolled in this observational, cross-sectional, hospital-based study. The peripapillary RNFL of the randomly chosen eye of each subject was imaged with a high resolution SD-OCT (Spectralis HRA+OCT, Heidelberg Engineering). The RNFL thickness was measured around the optic nerve head using 16 automatically averaged, consecutive, circular B scans with a 3.4 mm diameter and compared between the genders and among the various age groups. RESULTS The mean age of the subjects was 38.94±17.00 years (range-14 to 76 years). The average peripapillary RNFL was found to be 102.64±9.56 μm (95% CI 97.01-101.93). The mean±SD peripapillary RNFL measurements at the superior, nasal, inferior and temporal sectors in the study population were 129.51±15.09 μm, 76.55±12.02 μm, 134.53±17.19 μm and 70.74±15.53 μm respectively. The average RNFL thickness was 99.47±10.18 μm in the male whereas it was 105.09±8.31 μm in the female participants. The RNFL decreased by 2.26 μm per age per decade. CONCLUSION The Average RNFL thickness is 102.64±9.56 μm in the Nepalese population. Gender and age related variation in the RNFL could serve as a useful guideline in the diagnosis of glaucoma in our population.

Ocular injuries in the people’s uprising of April 2006 in Kathmandu, Nepal

INTRODUCTION In April 2006, the people of Nepal organised mass demonstrations demanding the restoration of democracy in the country. The ocular injuries that resulted during the riots that ensued, their pattern and the visual outcome of the injured have not yet been reported. OBJECTIVE To study the demographic profile, type, severity and the visual outcome of ocular injuries that occurred during the 2006 peoples uprising in Nepal. SUBJECTS AND METHODS This was a retrospective interventional series of cases involving 29 subjects. The main outcome measures were demography, laterality of injury, type of injury and the visual status before and after the trauma. RESULTS The age of the victims ranged from 14 to 32 years. Among the victims with eye injuries, 27 (93.1 %) were males, who were unemployed youth, students and construction workers. The left eye was injured more frequently than the right. Non-lethal bullets and explosive tear gas were the commonest agents of the major ocular injuries. The main types of injuries requiring hospitalization were closed globe injuries in eight victims and open globe in six. Surgical intervention was required in 57.2 % (n = 29) of the cases. The visual outcome was poor in cases of open globe injury with posterior segment involvement. CONCLUSION Non-lethal bullets and explosive tear gases can cause significant visual impairment. Severe open globe injury with a retained intra-ocular foreign body is associated with significant visual loss.

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.

Outcome of the patients with post-operative cluster endophthalmitis referred to a tertiary level eye care center in Nepal

INTRODUCTION The causative organism and treatment outcomes of post operative endophthalmitis may vary depending on several factors. OBJECTIVE To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis. MATERIALS AND METHODS An interventional prospective series of cases of clinically suspected endophthalmitis was studied. Eleven patients who presented within 48 hours after manual cataract surgery on the same day, by a one surgeon in a single center were enrolled in the study. They underwent both anterior chamber and vitreous aspiration and all of them received intravitreal Vancomycin, Amikacin and Dexamethasone. Samples were subjected to microbiological evaluation. All patients were followed up till 8 weeks for clinical and visual outcome. RESULTS Of the 11 eyes of suspected endopthalmitis, only one vitreous aspiration showed Gram negative bacilli on Gram stain and 3 vitreous aspirates showed Gram positive cocci. Of the 11 eyes, 3(42.85%) had culture positive on vitreous aspirate. In 2 cases E Coli was isolated and in 1 Staphylococcus aureus was isolated. After 48 hours of intravitreal injection, 10 out of 11 eyes improved and in one, intravitreal injection of vancomycin, amikacin and dexamethasone was repeated. The best corrected visual acuity of 6/9 was achieved in 2 patients, 5 had 6/18, 2 had 6/60 and 2 had 5/60 at the end of eight weeks. CONCLUSION Staphylococcus aureus and E coli can cause endophthalmitis immediately on the first day post-operatively. Clinically suspected endophthalmitis treated with antibiotics and steroid intravitreal injection can result in better visual outcome.

Recurrence of uveal malignant melanoma: a case report

BACKGROUND Malignant melanoma of uveal tract is a rare ocular malignancy. It is one of the significant causes of ocular morbidity and mortality which is less commonly seen in children. CASE We report an unusual case of orbital recurrence of malignant melanoma in a 14-year old boy who had previously undergone enucleation of the left painful blind eye 8 months ago. He was diagnosed to have uveal malignant melanoma elsewhere which was confirmed by histopathology. Orbital recurrence was managed with modified exenteration with adjuvant chemotherapy and radiotherapy. CONCLUSION In all treated cases of uveal melanoma, close follow up examination and monitoring is necessary for early diagnosis of the recurrence and to plan for further management.