Nepalese Journal of Ophthalmology 2024-05-29T14:39:15+00:00 Dr Eli Pradhan Open Journal Systems <p>Official journal of the Nepal Ophthalmic Society. Full text articles available on NepJOL.</p> <p>Nepalese Journal of Ophthalmology charges authors article processing fees once accepted for publication.</p> <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License"></a><br>Articles are licensed under a <a href="" rel="license">Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a> (CC BY-NC-ND).</p> <p>Nepalese Journal of Ophthalmology is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> Guidelines to Author, Copyright Transfer Form, Patient Consent form for Case Report 2024-05-29T14:39:15+00:00 Eli Pradhan <p>NA</p> 2024-05-01T00:00:00+00:00 Copyright (c) 2024 Bilateral Optic Neuritis in a Patient with Enteric Fever: A Case Report 2023-07-30T06:22:39+00:00 Sundip Dware Chhetri Keepa Vaidya Suman Lamichhane Sudeep Lal Rajbhandari Shailendra Katwal <p><strong>Background:</strong> Bilateral optic neuritis following enteric fever is a rare condition requiring early evaluation by an ophthalmologist and prompt treatment for visual rehabilitation.</p> <p><strong>Case:</strong> A 31-year-old female diagnosed with enteric fever presented to the Neuro-ophthalmology department with sudden painful loss of vision in both eyes for 10 days. </p> <p><strong>Observations:</strong> Her Best Corrected Visual Acuity (BCVA) was counting fingers close to face in left eye and 6/18 in right eye. Posterior segment examination showed blurring of disc margin on both eyes. On Magnetic Resonance Imaging (MRI) of brain and orbit there was mild thickening of retro-orbital portions of both optic nerves. She was started on steroid therapy which resulted in marked improvement of vision in both eyes.</p> <p><strong>Conclusion:</strong> Optic neuritis following enteric fever is a rare entity and requires early diagnosis with prompt treatment for improvement of visual acuity and prevention of visual impairment.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Fulminant Orbital Cellulitis – A Rare Presentation of Endogenous Endophthalmitis 2023-09-30T12:12:28+00:00 Unnati Sharma Itisha Goel Simran Chhabra Suresh Kumar Gupta Gayana Gupta <p><strong>Background</strong><span style="font-weight: 400;">: Endogenous endophthalmitis refers to the intraocular infection resulting via haematogenous spread from the distant foci. Dengue is an important health problem in India with varied ophthalmic manifestations either due to viremia, immunologic phenomenon, or haemorrhagic tendency. </span></p> <p><strong>Case</strong><span style="font-weight: 400;">: We report an unusual presentation of endogenous endophthalmitis as fulminant orbital cellulitis in a young adult patient having a history of dengue fever. </span></p> <p><strong>Observations</strong><span style="font-weight: 400;">: Young male having history of dengue fever presented with complaints of sudden pain, swelling, redness, and loss of vision in the left eye. His clinical features and radiographic examination were suggestive of orbital cellulitis with pan-ophthalmitis, which rapidly progressed to endophthalmitis. </span></p> <p><strong>Conclusion: </strong><span style="font-weight: 400;">This case highlights the role of orbital vessels as a possible route for occurrence of endophthalmitis in a case of orbital cellulitis. </span></p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology A Case Report on Unilateral Non-axial Proptosis of a Young Female: Lacrimal Gland Tumour 2023-10-08T10:14:40+00:00 Dikshya Bohara Gulshan Bahadur Shrestha Bhupendra Man Singh Shrestha <p><strong>Background</strong>: Lacrimal gland adenoma is a benign tumour of the lacrimal gland mostly involving the orbital part of the gland and composed of epithelial and myoepithelial components. It involves the third and fourth decade of life as a gradual painless enlargement of the lacrimal gland. </p> <p><strong>Case</strong>: This is a case report of a 30-year-old female presenting with the forward bulging of the right eye causing the eye to be displaced medio-inferiorly over the course of one year. After careful clinical examination and MRI, a clinical diagnosis of lacrimal gland adenoma was established and was planned for right lateral orbitotomy (without marginotomy) via eyelid crease incision and transcutaneous-transseptal approach with complete excision of the tumour under general anaesthesia. </p> <p><strong>Observations:</strong> This case was presented to the out patient department with mild painful non-axial proptosis of the right eye. After clinical examination, her MRI report showed a well-defined altered signal intensity enhancing lesion on the extraconal compartment of the right orbit in the antero-supero-lateral aspect. After complete surgical removal of the mass, it was sent for histopathological analysis and it confirmed it as a pleomorphic adenoma. The patient has been following up every 6 months for 2 years and is asymptomatic. </p> <p><strong>Conclusion</strong>: Being the most prevalent lacrimal gland tumour, pleomorphic adenoma affects the unilateral lacrimal gland causing non-axial proptosis. Complete removal of mass has an excellent prognosis with complete resolution of symptoms.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Intravitreal Bevacizumab in Management of Persistent Secondary Macular Hole with Epiretinal Proliferation 2023-07-27T02:54:45+00:00 Ugyen Zangmo Sushma Jayanna Mahesh P Shanmugam <p><strong>Background</strong>: Aetiology for non-closure of full-thickness macular hole (FTMH) becomes crucial in determining the method of effective mode of intervention. Association of epiretinal proliferation (ERP) along with full-thickness macular hole (FTMH) have shown poorer anatomic and visual outcomes after surgical intervention. Various surgical techniques have been described in literature for treatment of persistent MH.</p> <p><strong>Case:</strong> We report a A 60-year-old female patient with FTMH secondary to branched retinal vein occlusion (BRVO) initially associated with ERP.</p> <p><strong>Observations:</strong> She was successfully managed by treating with combination of intravitreal injection of off label bevacizumab (Avastin) (1.25 mg/0.05 ml) and pure gas of SF6 (1 cc) under topical anaesthesia after an initial surgical intervention. </p> <p><strong>Conclusion:</strong> Presence of ERP in retinal vein occlusion cases needs closer and frequent follow up. IVB can be used as an adjunct in treating secondary MH.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Bilateral Optic Neuritis in a Child with Acute Disseminated Encephalomyelitis: A Case Report 2023-08-02T08:27:13+00:00 Meenakshi Wadhwani Amit Kumar Dhulika Dhingra <p><strong>Background:</strong> Acute disseminated encephalomyelitis is an inflammatory demyelinating disease of the central nervous system following a viral illness or vaccination, which occurs most often in children as a monophasic event. The neurological signs typically appear days to weeks after an initial febrile infection (usually of the upper respiratory tract) or vaccine immunisation.</p> <p><strong>Case:</strong> An eight year old boy presented with painless progressive diminution of visual acuity for two days, On ophthalmic examination his visual acuity was hand movements at a close range in both the eyes. Posterior segment examination revealed bilateral optic disc swelling.</p> <p><strong>Observations:</strong> Magnetic Resonance Imaging (MRI) brain revealed multiple discrete ovoid hyperintense lesions in bilateral cerebral white matter. His contrast enhanced MRI orbit study revealed bilateral oedematous optic nerve.</p> <p><strong>Conclusion:</strong> Optic neuritis can present with different systemic conditions. Thorough ocular examinations (visual acuity, colour vision, contrast sensitivity, fundus examination) and neuroimaging should be done in all the cases. Early diagnosis and management is required for good visual prognosis.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Post-Coronavirus Disease-2019 Rhino-orbital Mucormycosis: A Case Report 2023-07-17T16:54:36+00:00 Tina Shrestha Sanket Parajuli Rajani Keshari Punyaram Kharbuja Sadhana Sharma Jeevan Kumar Shrestha <p><strong>Background:</strong> Rhino-orbital-cerebral mucormycosis (ROCM) is a rare, opportunistic, angio-invasive, and fatal infection caused by mold fungi of the genera Rhizopus, Mucor, and Rhizomucor. The global incidence of ROCM is 0.005-1.7 per million, with a fatality rate of 46%. Early diagnosis and treatment are crucial for this disease, as a delay of one week can increase the mortality rate to 66%.</p> <p><strong>Case:</strong> A 32-year-old male, a known case of coronavirus disease 2019 (COVID-19) for the past 15 days from Janakpur, Dhanusha, Nepal presented to the emergency department of Dhulikhel Hospital with a sudden onset of blurred vision in the left eye, left-sided ocular pain, and nasal bleeding for the last three days. </p> <p><strong>Observations:</strong> The patient was suspected of post-COVID-19 mucormycosis, and a nasal swab for potassium hydroxide (KOH) mount showed hyphae in microscopy. Intravenous and retrobulbar liposomal amphotericin B were administered as medical therapy, along with surgical debridement. A multidisciplinary approach was necessary for the treatment.</p> <p><strong>Conclusion:</strong> A long-term, multimodal treatment approach involving combined antifungal drug therapy (intravenous liposomal amphotericin B and retrobulbar amphotericin B), and timely surgical debridement leads to an improvement in both short-term and long-term outcomes.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Patient Safety in Eye Care Organisations 2024-04-09T05:17:41+00:00 Samina Zamindar <p>Not available.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2024 Surgeries and Outcomes in Subluxated and Dislocated Lens in Eastern Nepal 2023-07-25T02:50:19+00:00 Pranav Shrestha Sadhana Sharma Rinkal Suwal Purushottam Joshi Prava Subedi <p><strong>Introduction:</strong> Many ocular or systemic conditions can cause weakening of the zonules, leading to subluxation or complete dislocation of lens into the anterior chamber or vitreous cavity. </p> <p><strong>Objectives: </strong>To evaluate the outcome of surgery in cases with subluxated and dislocated lens.</p> <p><strong>Materials and methods:</strong> Retrospective chart review of all cases with subluxated and dislocated lens who underwent surgery in a one-year period from 2019 January to 2019 December was conducted. Demographic profile, systemic comorbidities, initial and final best corrected visual acuity (BCVA), surgical procedure were recorded along with all the intraoperative and post-operative complications.</p> <p><strong>Results:</strong> A total of 62 eyes of 60 patients with mean age of 50.18 ± 15.18 years (18 to 87 years) were included with the modal duration of presentation of one week. Among these, trauma was found to be the most common etiology. Subluxation was present in 55 eyes and seven eyes had dislocation. Intracapsular Cataract Extraction (ICCE) was performed in 41 while 21 underwent Extracapsular Cataract Extraction (ECCE); and surgical intervention elicited a statistically significant (p &lt; 0.05) improvement in the visual acuity. The BCVA was statistically better among the pseudophakic patient. Most common complication encountered intraoperatively was vitreous loss and post operatively was significant corneal edema.</p> <p><strong>Conclusion:</strong> Cataract extraction in cases with subluxated and dislocated lens due to different etiology results in the improvement in the visual acuity of the patient. In cases where ECCE cannot be performed, ICCE also results in comparable visual improvement.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2024 Nepalese Journal of Ophthalmology Assessment of Knowledge of Parents of Children with Cortical Visual Impairment: An Interventional Study 2023-09-13T16:56:51+00:00 Ang Jangmu Lama Srijana Adhikari Rojeeta Parajuli <p><strong>Introduction:</strong> The cornerstone of CVI management is developing methods to help the kid, caregiver and educator comprehend how the child uses their vision and how modifications may be made to help the child use it more effectively.</p> <p><strong>Objectives: </strong>To evaluate caregivers' and parents' understanding of cortical visual impairment and how it evolves after receiving educational materials in the form of video and handout.</p> <p><strong>Materials and methods:</strong> This prospective interventional study enrolled all children with CVI at a tertiary eye care center from 2020 February to 2021 January. Parents were interviewed about CVI visual behaviour using a Perkins website consulting interview. They were then sensitised with a Nepali video and handout describing CVI characteristics. A follow-up visit or call was scheduled six weeks later to reassess their knowledge.</p> <p><strong>Results:</strong> In the study, 37 parents participated. Before the intervention, 81.1% (n = 30) were unaware of CVI, which decreased significantly to 4.3% (n = 1) after intervention (p &lt;0.001). For the follow-up, 59.4% (n = 22) of parents participated or responded to calls. Initially, 43.2% (n = 16) of parents attributed issues to eye problems, increasing to 90.9% (n = 20) recognising the brain's role after education (p = 0.021). Notice of attraction to bright colors increased from 48.6% (n = 18) to 86.4% (n = 19) post-education. Awareness of children's favourite toys rose from 62.2% (n = 23) to 81.8% (n =19) in the follow-up. Additionally, noticing better vision in one room over another increased from 24.2% (n = 9) to 40.9% (n = 9) post-education. Movement was reported as good in familiar environments by 81.1% (n = 30), with 70.3% (n = 26) facing issues in unfamiliar ones, consistent in the follow-up.</p> <p><strong>Conclusion:</strong> The study found that educating primary caregivers with handouts and videos alone did not effectively improve their understanding of the disease, likely due to factors such as parental literacy and socio-economic status. Consequently, establishing nationwide CVI clinics is urgently needed.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Awareness Regarding Eye Donation among Doctors, Students, and Paramedics at a Tertiary Care Teaching Hospital 2023-01-22T13:14:25+00:00 Mohammed Saquib Bhavya Mehta Rahul Bhargava Anu Malik <p><strong>Introduction: </strong>In the sub-continent, there is a huge discrepancy between the cornea collected and the ever-increasing demand. Lack of awareness, faulty perceptions, and unwillingness to donate corneas are the major hurdles. </p> <p><strong>Objectives:</strong> To assess the level of awareness among doctors, students, and paramedics in a teaching hospital.</p> <p><strong>Materials and methods</strong>: An analytical cross-sectional, pre-tested, study design assessed the awareness, knowledge, and attitude among health care workers (medical students, nurses, doctors, and paramedics) in the context of eye donation through a administered self-administered semi-structured questionnaire. </p> <p><strong>Results</strong>: In our study, 692 (57.7%) of the respondents were aware that the ideal time for donation was within six hours of death. Our study revealed that 875 (72.9) of the respondents were willing to donate their eyes; out of these 305 (25.4%) were MBBS students and 223 (18.6%) were nursing students, (Chi-square tests, p &lt;0.001). Six-hundred and twenty-five (52.1%) respondents knew that the nearest eye bank should be contacted if they or any of their family members wished to donate their eyes. However, only 90 (7.5%) of the respondents’ family/ relatives had donated his/her eyes. A significant association between knowledge of eye donation and the age, gender, religion, or marital status and knowledge of eye donation of participants was observed.</p> <p><strong>Conclusion</strong>: The study highlights the need for creating awareness about eye donation among doctors, medical students, and paramedics, who can be an effective channel for planning, educating, and motivating the public to pledge for eye donation.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Role of Psychological Stress and Choroidal Thickness in Central Serous Chorioretinopathy 2023-07-15T14:48:39+00:00 Reshmi Mathews Saban Horo Deepa Jose Joel Antony Kavalakatt Grace Rebekah J Sheeja Susan John <p><strong>Introduction: </strong>Central serous chorioretinopathy (CSCR) is a disease with a multifactorial aetiology. </p> <p><strong>Objectives: </strong>To evaluate the role of psychological stress and choroidal thickness in patients with CSCR.</p> <p><strong>Materials and methods: </strong>This was a hospital-based, analytical cross-sectional study, conducted at Christian Medical College, Vellore, India, from 2018 February to 2019 September, after the approval of the Institutional Review Board and Ethics Committee. Patients who satisfied the eligibility criteria of the study, were selected from the outpatient clinics of the Department of Ophthalmology. Twenty-five patients with unilateral CSCR (Group 1 - cases), and 50 age and gender-matched patients without CSCR (Group 2 - controls), randomly selected in a 1:2 ratio, were enrolled after obtaining informed consent. Psychological stress was assessed using Cohen Perceived Stress Scale (PSS-10). All patients had a Swept Source optical coherence tomography scan of the macula. Subfoveal choroidal thickness (SFCT) of both eyes of all participants was measured using a standard protocol. The data were collated and analysed, using Independent samples t-test and Chi-square/ Fisher’s exact test, as appropriate, with IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). </p> <p><strong>Results: </strong>There was a significant difference between the two groups in mean stress scores (p &lt;0.01), as well as stress categories (p &lt;0.01). Although there was no significant difference in the prevalence of hypertension between the two groups (p = 0.33), there was a significant difference both in the mean systolic (p &lt;0.01) and diastolic (p &lt;0.01) blood pressure between the two groups. We found a significant difference between mean SFCT of CSCR eyes (421+/- 78.34 μm) and control eyes (314.24 +/- 52.48 μm, p &lt;0.01), as well as between fellow eyes (396.20 +/- 68.79 μm) and control eyes (314.24 +/- 52.48 μm, p &lt;0.01). However, there was no significant difference in the mean SFCT of CSCR eyes and fellow eyes (p =0.24).</p> <p><strong>Conclusion:</strong> The findings reiterate the concept that the underlying pathophysiological changes leading to CSCR involve both the eyes of the patient. Psychological stress and hypertension may be factors that play an important role in the etiopathogenesis of the pachychoroid-related changes leading to CSCR. Stress relief measures, with a holistic approach to management, should be an integral part of the therapeutic strategies for CSCR.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Comparability of Measurement of Astigmatism between URk-800F Auto Refracto-keratometer and MS-39 Anterior Segment Optical Coherence Tomography in Patients with Refractive Error 2023-08-15T15:46:51+00:00 Namrata Gupta Samrina Maharjan Suman Sapkota <p><strong>Introduction:</strong> Accurate refractive error assessment is the first and the most important step of ocular examination. A reliable screening method of refractive status is important for early detection and prevention of blinding complications of uncorrected refractive error.</p> <p><strong>Objectives</strong>: To evaluate the comparability of astigmatism measured by an auto-refractometer (URk-800F) with the measurements of the gold standard anterior segment optical coherence tomography (AS-OCT).</p> <p><strong>Materials and methods:</strong>This cross-sectional observational study was conducted in a tertiary eye centre in Kathmandu from February 2023 to June 2023. A total of 100 patients with best corrected visual acuity of ≥ 20/20, spherical refractive error with cylindrical error of more than and equal to -0.75 and no pathology detected on slit lamp examination were taken by consecutive sampling method. Ethical approval was taken for the study. The data were entered into Microsoft Excel and analysed using Bland-Altman analysis.</p> <p><strong>Results</strong>: The mean cylindrical power and axis was -2.33 D and 88 degrees for the right eye and -2.32 D and 122 degrees for the left eye respectively, as measured by MS-39 AS-OCT. For URK 800-F Auto-refracto Keratometer, the mean cylindrical power and axis was -2.31 D and 89 degrees for the right eye and -2.27 D and 124 degrees for the left eye. </p> <p><strong>Conclusion:</strong> The findings of this study conclude that an auto-refractometer can be used as an effective tool for identification of spherical refractive error as well as measurement of accurate cylindrical power and cylindrical axis in low resource primary care settings.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Patterns of Macular Edema in Branch Retinal Vein Occlusion Diagnosed by Optical Coherence Tomography 2022-02-03T10:35:21+00:00 Sharad Gupta Raba Thapa Eli Pradhan Sanyam Bajimaya Sanjita Sharma Sushma Duwal Govinda Poudyal <p><strong>Introduction:</strong> Branch Retinal vein occlusion is the most common retinal vascular disease after diabetic retinopathy in elderly populations.</p> <p><strong>Objectives: </strong>To describe morphological patterns of macular edema in branch retinal vein occlusion using optical coherence tomography.</p> <p><strong>Materials and methods: </strong>It is a hospital based; descriptive, cross-sectional study. All patients with macular edema secondary to branch retinal vein occlusion diagnosed by optical coherence tomography and fulfilling the inclusion criteria from 2017 July 1 to 2018 July 1 were studied.</p> <p><strong>Results:</strong> A total of 84 eyes of 84 patients were enrolled. The mean age of the patient was 68.0833 ± 11.22 years (range, 35-74 years). Forty-five (53.57%) were male. Forty-four eyes had right eye involvement. Major and macular branch retinal vein occlusion was found in 50 and 34 eyes respectively. Forty eight eyes had superior and 36 eyes had inferior branch retinal vein occlusion. Morphological patterns of macular edema were classified: cystoid macular edema, cystoid macular edema with serous retinal detachment, diffuse macular edema and diffuse macular edema with serous retinal detachment of which 68 (80.95%) had cystoid macular edema. Out of 84 eyes, 30 (35.71%) had inner and outer segment (IS/OS) junction disruption.</p> <p><strong>Conclusion</strong>: Optical coherence tomography is a safe and noninvasive technique. Serous retinal detachment and photoreceptors disruption may go unnoticed unless OCT is performed. It can measure the changes in retinal thickness and thus predict the visual outcomes in patients with macular edema.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Pterygium Surgery with Autologous Graft with Glue versus Sutures 2024-04-09T05:20:45+00:00 Dikshya Bohara <p>Not available.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology Orbital Infections and Infestations - A Narrative Review 2021-11-29T18:42:47+00:00 Apjit Kaur Ankita <p><strong>Introduction: </strong>Orbital infections and infestations present with varying clinical presentations and incidences ranging from benign ocular condition to disseminated systemic disease. The diagnosis is often difficult initially, due to similar ocular presentations. </p> <p><strong>Materials and methods:</strong> This review was compiled using articles available on PubMed using key words like orbital infections, orbital cellulitis, orbital infestations, orbital tuberculosis, orbital fungal infections. Clinical experience in presentation and management at our centre was also included. </p> <p><strong>Results:</strong> The varied presentations, management, complications and follow-ups have been summarised in this review. </p> <p><strong>Conclusion:</strong> As the management is cause-specific, thus lies the importance of early accurate diagnosis, both clinical and radiological. This article aims to review existing literature on orbital infections and infestations for aiding in early accurate diagnosis and management.</p> 2023-12-31T00:00:00+00:00 Copyright (c) 2023 Nepalese Journal of Ophthalmology