Cutaneous melanin and glaucoma: a case control study

Objective: The aim is to evaluate the anatomical and functional outcomes of retinal detachment (RD) surgery in the pediatric population in a tertiary eye hospital in Nepal. Methods: This study is a hospital-based, retrospective cross-sectional study, including patients under 18 years of age, diagnosed with rhegmatogenous RD (RRD) for 5 years from January 2015 to December 2019, who underwent RD surgery. Results: Twenty patients were included in the study (mean age of 10.75 ± 2.63). Male patients were 19 (95%). A history of trauma was seen in 13 (65%) patients. Phakic RRD was observed in 18 (90%) patients and the rest 2 (10%) patients were pseudophakic. Type B proliferative vitreoretinopathy changes were observed in 3 (15%) patients, type C was observed in single patient (5%). Scleral buckling was performed in 7 (35%) patients, while 12 (60%) patients underwent three-port pars plana vitrectomy (PPV) and silicon oil instillation and the remaining single patient (5%) underwent PPV with gas exchange. Lensectomy was performed in 8 (40%) patients. Retinal attachment with a single surgical procedure was seen in 8 (40%) patients, while 12 (60%) patients required multiple surgeries. The mean duration of silicon oil removal was 5 ± 2.78 months (1–11 months). At the end of 6 months, 11 (55%) patients had improved visual acuity of 6/60. Six months postoperatively, 18 (90%) patients had attached retina. Conclusion: Visual improvement and retinal reattachment could be achieved with early diagnosis and intervention in pediatric RRD.

PurposeTo study the causes of moderate and severe visual impairment (VI) and blindness and its changing trends in Nepalese children.Patients and MethodsA cross-sectional descriptive study was conducted. Participants, aged 7 to 17 years were recruited from integrated schools for the blind and the outpatient department of a tertiary eye hospital in Kathmandu. VI and blindness were categorized according to World Health Organization (WHO) categories and its protocol for eye examination of children with blindness and VI was followed. Findings were compared to former studies from Nepal.ResultsA total of 200 children were included, of whom 45% had moderate VI, 5% had severe VI, and 50% were blind. Mean age of children with VI and blindness was 11.1 (SD = 3.3) and 12.9 (SD = 3) years, respectively. Forty percent of children with VI and 38% of blind children were female. In our study, retina (39%) and whole globe (32%) were the most common anatomical site of involvement in children with VI and blindness, respectively, while cornea was the most common anatomical site of involvement in former studies. Heredity (43%) was the most common etiological factor although in 24.5% of all children, etiology was unknown. In 43.5% of children, blindness and VI was due to avoidable causes.ConclusionIn relatively many children, the etiology of VI and blindness could be either prevented or treated. Compared to former studies from Nepal, there is a changing trend in the etiology of severe VI and blindness.

Relevance of HBSAG and HIV Screening in Patients Presenting for Ocular Surgery at Tertiary Eye Hospital in Nepal

PURPOSE:The purpose of the study is to evaluate the prevalence and severity of diabetic retinopathy (DR) among all diabetic patients presenting to a tertiary eye care center in Nepal over a 3-year period.MATERIALS AND METHODS:This was a retrospective review of all clinical records from the initial presentations of diabetic patients at the Tilganga Institute of Ophthalmology (TIO) from 2012 to 2014.RESULTS:In total, 8855 patients were identified who presented to TIO with a prior diagnosis of diabetic mellitus (DM) during the study period. DR was found in 1714 patients (19.4%) at the time of initial presentation, 1305 (14.7%) of which had nonproliferative DR (PDR), while 617 (6.9%) demonstrated diabetic macular edema (DME) and 409 (4.6%) demonstrated PDR. Of the 1714 patients with DR, 825 (48.1%) required treatment at initial presentation for DME and/or PDR. Male gender, hypertension, age at presentation, and interval from diagnosis of DM to initial eye consultation were significantly associated with the presence of DR (P < 0.05).CONCLUSIONS:The prevalence of DR among patients with DM was 19.4%, which is lower than previously published estimates. However, among patients diagnosed with DR, over half presented with a vision-threatening complication warranting some measure of initial treatment.

Surgical outcome of pediatric dacryocystorhinostomy in Nepal

Posterior Capsular Plaque: A Common Feature of Cataract Surgery in the Developing World

Background: Vision is a very important sense for human life which is directly related with education, performance of work and quality of life. Worldwide cataract is considered one of the leading causes of blindness and visual impairment. Cataract surgery is one of the most commonly performed procedures in ophthalmology. Cataract extraction with intraocular lens (IOL) implantation is the only surgical approach available mostly in developing countries. Objective: This study aimed to evaluate the visual outcome who have had their cataract surgery in a tertiary level eye hospital. Method: Prospective interventional study was conducted from 1st January 2019 to 31st December 2019 at Sheikh Fazilatunnesa Mujib Eye Hospital &amp; Training Institute (SFMEHTI), Gopalganj. It was a hospital based study of consecutive cataract-operated patients who had age-related cataract with vision 6/24 or less before surgery. For surgery all the patients were evaluated including their relevant investigations with trained ophthalmologist and allowed as fit for surgery. Total 8776 patients who admitted in this hospital and fulfill the eligibility criteria were included in this study. Patients in age of 40 - 80 years were included in the study. The most common procedure was phacoemulsification (PE) with posterior chamber intraocular lens (PCIOL) 4704 (53.6%) followed by small incision cataract surgery (SICS) with posterior chamber intraocular lens (PCIOL) implantation, operated in4072 (46.4%) eyes. Most of the surgery was done by well-trained ophthalmologists; whereas few surgeries were done by young ophthalmologists under the supervision of senior ophthalmologist. Result: Among 8776 patients operated, the most common group was 40-60 years (65.5%). The mean age of the patients was 60.47 years. Male patients were more (52.8%). In post cataract surgery patients, 5967 (68%) eyes had presenting vision &gt;6/18. Visual acuity (VA) &lt;6/60 was found in 176 (2%) eyes. In 8600 (98%) eyes visual acuity (VA) was improved after best correction. Poor visual outcome was significantly associated with the patients who were in older age, gender female, literacy, hearing impairment and SICS&amp; PE surgery techniques. Conclusion: This study observed that good visual acuity can achieved in cataract surgery. More attention should be given towards monitoring of cataract surgical outcomes and correction of refractive error after surgery. It is also important to meet the WHO standard of visual outcome after cataract surgery. Central Medical College Journal Vol 8 No 1 January 2024 Page: 7-11

The Eye Care in Nepal was in rudimentary state till 1971 with the number of cataract surgery being less than 500 cases per year including the mobile Eye camps. The Bir hospital was the only eye hospital at that period, however, it was without slit lamp nor operating microscope and the waiting list of bilateral cataract was more than one year. Those elderly people who came with bilateral cataract with a big hope could not be operated due to less number of eye beds and operation theater. Prof Ram Prasad Pokhrael visited various mobile eye camps in remote hills and saw the tremendous problem of blindness. With a lot of struggle of creating awareness amongst the public for the need of eye hospital and with the support from few stakeholders, Nepal Eye Hospital was created in 1974.

AIM: To assess the seasonal pattern of patients' presentation at the tertiary eye hospital and leading sites of ocular abnormality. METHODS: This was a retrospective descriptive observational study. The medical records of 1200 patients were reviewed. Only the first-time visiting patients were included in this study. Patients were categorized into paying and non-paying groups to determine the prevalence of visual impairment (VI) in both groups. VI was categorized according to WHO VI categories. Seasons were classified using seasonal classification by Indian Metrological Department. RESULT: Of the patients, 487 (50.2%) were males, and 483 (49.8%) were females. The abnormal anatomical site with maximum frequency for the right eye was the lens (451, 46.6%), followed by the refractive error (182, 18.8%), cornea (53, 5.5%), and conjunctiva (49, 5%), and a similar pattern was observed in the left eye. The majority of the patients (610, 62.9%) had no VI. The monsoon season has the highest footfall (319, 32.9%). CONCLUSION: A significant number of patients who visited eye hospitals had different grades of VI. The cataract and refractive errors are the leading causes of visual impairment. The monsoon season has maximum patient footfall. The findings of this study will help improve patient care process management in eye hospitals.

Background: Glaucoma is a major cause of irreversible blindness worldwide, with a variety of subtypes such as primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and secondary glaucomas, each with distinct pathophysiological mechanisms and treatment challenges. The prevalence and patterns of glaucoma vary geographically, with PACG being more common in Asian populations. Early detection and management are crucial in preventing blindness, particularly in resource-limited settings where delayed diagnosis is common. Objective: This study aims to analyze the patterns of glaucoma among patients at a tertiary eye hospital in southern Bangladesh, focusing on the distribution of different glaucoma subtypes, demographic trends, and clinical characteristics. Methodology: A prospective observational study was conducted at the outpatient department of Sheikh Fazilatunnessa Mujib Eye Hospital &amp; Training Institute (SFMEHTI), Gopalganj, Bangladesh, from January to December 2019. All patients presenting with glaucoma or suspected glaucoma were included. Data were collected on age, clinical diagnoses, symptoms, ocular examination findings, intraocular pressure (IOP), gonioscopic findings, and visual field tests. The glaucoma subtypes were classified based on the clinical presentation and diagnostic results. Results: The most common types of glaucoma were PACG (45%), POAG (32%), and lens-induced glaucoma (LIG) (12%). Other types included normal tension glaucoma (NTG) (6%), juvenile glaucoma (2%), congenital glaucoma (1%), neovascular glaucoma (NVG) (1%), and aphakic and others glaucoma (1%). At the time of presentation, 47% of patients had normal vision, 30% had visual impairment, 14% were severely visually impaired, and 5% were blind. The mean IOP was 26.29 mmHg in the right eye and 26.37 mmHg in the left eye. Gonioscopy revealed that the majority of patients had narrow angles, with a smaller percentage showing open or closed angles. Conclusion: Primary ...

Long term surgical outcomes of orbital cavernous haemangiomas (low-flow venous malformations) as performed in a tertiary eye hospital in China

Examining Potential Modifiers of Human Skin and Plasma Carotenoid Responses in a Randomized Trial of a Carotenoid-Containing Juice Intervention

The clinical features of cytomegalovirus (CMV) retinitis have not been well-characterized in India, despite the likely high burden of disease. Tertiary eye hospital in Madurai, India. All patients with a diagnosis of CMV retinitis seen at a single eye hospital from 2007 to 2023 were identified from Uvea, Retina, and Microbiology registries and the hospital administrative database. A standardized chart review was performed. Among 343 patients diagnosed with CMV retinitis, 322 (94%) were HIV-positive. Of 213 patients with a documented date of HIV diagnosis, 54 (25%) were unaware of their HIV status until after being diagnosed with CMV retinitis. Of the 159 HIV-positive patients aware of their diagnosis, 33 (21%) were not yet taking antiretroviral therapy at the time of retinitis diagnosis. At the time of CMV retinitis diagnosis a total of 52 (16%) patients were bilaterally blind and 57 (18%) had retinal detachment in one or both eyes. The number of patients presenting with CMV retinitis each year did not change substantially between 2007 and 2023. Patients diagnosed with CMV retinitis at an eye hospital in South India presented with advanced disease, and were frequently unaware of their HIV diagnosis.

Retinitis Pigmentosa (RP) is a group of diffuse retinal degenerative diseases predominantly affecting the rod and cone photoreceptors. The prevalence of retinitis pigmentosa seen in literature is approximately 1:4000. Retinitis Pigmentosa is one of the the most common causes of blindness in the age group of 20 to 40 years. The objective of this study was to determine the profile of retinitis pigmentosa in Terai and Nepal-India border region considering patients seeking care at a Tertiary level Eye Hospital in the terai region (southern part) of Nepal. A hospital-based, retrospective study was carried out at R. M. Kedia Eye Hospital. A total of 385 (83 males and 107 females from Nepal and 109 males and 86 females from India) diagnosed patients of Retinitis Pigmentosa were included in the study. Data was collected over a period of eleven years from 2008-2018. Out of 385 diagnosed Retinitis Pigmentosa patients, 192 (49.87%) were male and 193 (50.13%) were female with slightly female predominance. The prevalence of RP seen in our study was 0.03%. About 51% of the patients visited here were from India and nearby border areas/ villages which cover most of the rural areas of India. In this study it was found that 49.34% of the RP cases were from Nepal, of which 43.63% of cases were from Hindu community and 5.71% from Muslim community and about 50.66% cases of RP were from India, of which 37.67% from Hindu and 12.98% from Muslim community. The peak age of presentation of RP was at 30-39 years (29.09%), followed by 20-29 years (26.75%). The common marriage pattern of consanguinity was found in Muslim community in between the first cousins. In this study the hospital record did not show any evaluation for the syndromic disease in the hospital record, though RP is usually non syndromic and there are literatures where many syndromic forms have been identified. The prevalence of RP seen in the study was 0.03% (A total of 1101299 sample population of which 385 patients had RP). Since RP is an inherited disease and is one of the non-treatable causes of blindness which runs in the families, a role of counseling to reduce consanguineous marriages should be brought forward to reduce the disease process.

Age changes in human skin pigmentation have been observed by Garn et al. (1956), Walsh (1964), Huizinga (1965), Omoto (1965), Mazess(1967),Tiwari & Kalla (1968 and 1969), Kalla (1969) and Conway & Baker (1972). Though these investigations were confined to only few populations, the informations yielded by them are quite interesting and proclaim careful further studies of this problem in different populations. Recently it has been suggested (Kalla & Tiwari, 1970) that the phenomenon of ageing may also be an important factor in influencing the sex differences in human skin pigmentation. The present article tends to focus some light on this aspect of the problem. The data consists of skin reflectances obtained at 685 milimicron wavelength from the medial arm site of 414 Aggarwal boys and 371 Aggarwal girls be tween 10 and 16 years of age. Aggarwal is an endogamous group of north India. The sample is drawn from Delhi. The skin reflectances were obtained with the help of an EEL spectrophotometer (Weiner, 1951), with due precautions (Kalla, 1968). The EEL spectrophotometer employs nine wavelengths. 685 mili-micron wavelength was selcted because the skin reflectance at this wavelength is found to bear a linear reciprocal relationship with the amount of melanin in skin (Harrison & Owen, 1956/57), and it is melanin which is chiefly responsible for variation in human skin colour (Edwards & Duntley, 1939). As suggested by Harrison & Owen (1964), the skin reflectance at 685 mili-micron wavelength is transformed into its anti-log. The agewise anti-log reflectance values and their variances have been set out in Tab. 1, and the age curves through the mean values have been drawn in Fig. 1. Comparable parts of the curves for the Tibetans (Tiwari & Kalla, 1968) have been superimposed in this figure to enable a comparative evaluation.