Biratnagar Eye Hospital Research Articles

Outcome of Cataract Surgery among Eye Camp Patients of Eastern Nepal

Background: Outreach camp is helpful for reducing the prevalence of blindness due to cataracts and refractive error. The objective was to evaluate the visual outcome of cataract surgery among camp patients operated at a high volume center of Eastern Nepal. Materials and Methods: Descriptive cross sectional study design was used. The comprehensive eye screening program was conducted and those having cataracts were referred to base hospital for cataract surgery, patients were reexamined at the base hospital again and a small incision cataract surgery with posterior chamber intraocular lens was implanted at Biratnagar Eye Hospital, Biratnagar and Sagarmatha Choudhary Eye Hospital, Lahan. The pre-operative vision was taken during screening and post-operative vision was taken after one-month by performing refraction by trained personnel. Data were extracted from the hospital record; analysis was done using SPSS version 17.0. Descriptive analysis by using frequency, parent age and association was done by using Chi square test with a P-value <0.05 considered as significant. Results: A total of 1426 camp patients were operated. Among them 1113 (78%) were visited after one month post operative follow up at the campsite. There were 744 (52%) female and bilateral affected eyes were 735(52%). Pre-operative presenting visual acuity was <3/60 (37%), which was reduced to (0.2%) after one month follows up of cataract surgery. There was a significant association in pre-operative VA with aided one month to follow up VA. Conclusion: The outcome of the cataract surgery of camp patients operated at base hospitals was good in high-volume hospitals. Follow up after one month was good practice to provide services and measure the outcome of cataract surgery.

Profile and Visual Outcome of Patients having Keratoconus Attending Tertiary Eye Hospital, Nepal

Background: Keratoconus is a bilateral, asymmetric, chronic, progressive ectasia of the cornea in which patients experience distorted vision that is usually treated with rigid contact lenses when spectacles no longer provide adequate vision. The aim of the study is to find out the clinical profile and visual outcome of the patient having Keratoconus. Materials and Methods: The hospital based cross sectional study was done at Biratnagar Eye Hospital, Biratnagar. All the diagnosed Keratoconus patients referred from cornea clinic to contact lens clinic for contact lens trial were included in this study between 1stJanuary 2017 to 31st December 2019. Diagnosis was done by using keratometry and pachymetry findings or by using corneal topography findings and slit lamp examination. Results: Total 133 patients were enrolled in the study among them the mean (±SD) age was 20.2 (±6.9) with a minimum of 9 and a maximum of 50 years of age. Most of them were male 89 (67%) and 78 (58.7%) patients were between 16 to 25 years of age group. Most of the eyes had moderate 161 (63.4%) type in which the amount of refractive was high 201 (79%) and RGP contact lens 245 (96.4%) was tried for vision correction. Normal vision (0.0 to 0.5 Log MAR) was found in 255 (96%) of eyes among them 194 (73%) of eyes got better than 0.2 log MAR visual acuity after the contact lens trial. Conclusion: Keratoconus was found mostly in younger male patients and gas permeable contact lenses were most commonly used treatment modality.

Prevalence of ocular morbidity among industrial workers of Eastern Nepal

Objectives: The study aimed to investigate the prevalence of ocular morbidity among industrial workers. Materials and Methods: A descriptive cross-sectional study was carried out in four industries of Koshi Province. The demographic information gathered encompassed details such as age and gender. Employment-related factors included the nature of work, years of experience, and the type of industry. Economic considerations, such as monthly pay scale and job responsibilities, were also explored. Educational background and awareness of ocular hazards in the workplace, along with knowledge about safety devices, constituted crucial components of the survey. Comprehensive ocular examinations, along with assessments for color vision, contrast sensitivity, and stereopsis, were carried out on-site in collaboration with the outreach team of Biratnagar Eye Hospital. A structured schedule was administered through face-to-face interviews and documented. Results: In the present study, A total of 359 industrial workers were screened; among them, 321 (89%) were male, and 38 (11%) were Female, with a mean age of 43.72 ± 10.18. The majority of them were from 40 to 49 years of age group 135 (37.6%). The overall prevalence of ocular morbidity among the workers was 289, (80.50%). The highest rate of ocular morbidity was seen in sugar industry 98, (89.9%) followed by the jute industry 85, (80.18%), the soap industry 59, (74.68%), and the dairy industry 47, (72.30%). Presbyopia 166, (46.23%) emerged as the most common ocular morbidity among all workers. A history of ocular injuries was found in 115, (32%) of workers, and only 19% of workers used ocular safety devices. The main reason for not using ocular safety devices was due to unavailability (65%). Conclusion: The research highlights a significant prevalence of ocular morbidity among industrial workers, with presbyopia emerging as the most common ocular disorder.

Prevalence of Refractive Error among Children of Koshi Rural Municipality of Sunsari District: Door-to-Door Screening

Background: Uncorrected refractive error is the commonest cause of preventable visual impairment and disability among children. This study aimed to find out the prevalence of refractive error among children in the Koshi Rural Municipality of Sunsari district. Methods: This cross-sectional study conducted from 1 November to 31 December 2020 involved children between the ages of 4 - 18 years from Koshi Rural Municipality. The variables recorded included gender, age, religion, school type, visual acuity, and types of refractive error. Ethical approval was taken from the rural municipality and institutional review committee of Biratnagar Eye Hospital. Results: A total of 7830 children were screened in the door-to-door campaign. The majority (n = 5508, 72%) were Hindu and 2232 (28%) were Muslims. Only 6575 (84%) children were enrolled in school. Among them 3130 (40%) were going to government schools, 2105(26.9%) were going to private schools and 1340 (17.1%) children were going to a Madrassa (Muslim school) for education. The prevalence of refractive errors among children of Koshi Rural Municipality was 131 (1.7%) (95% CI: 1.4 - 2.0). Hypermetropia was seen in 69 (53%) children, followed by Myopia 60 (46%). Conclusion: The prevalence of uncorrected refractive error among children of Koshi Rural Municipality was low. However, the prevalence of refractive error was high among Muslim children.

External Dacryocystorhinostomy Surgery at Biratnagar Eye Hospital, Nepal

Introduction: Nasolacrimal duct obstruction at the junction of the lacrimal sac and nasolacrimal duct causes acute or chronic dacryocystitis. Dacryocystorhinostomy (DCR) is the treatment of choice and has a high success rate. Objective: To analyze the success rate of external DCR surgery and its influencing factors at our hospital. Methods: It is a hospital-based descriptive study of cases that underwent external DCR surgery from June 2016 to February 2017 at Biratnagar eye hospital. The demographic data were recorded and the successful outcome of the surgery along with its influencing factors -tube status, operating surgeons, and gender was analyzed. The main outcome measure was defined as a patent lacrimal passage on syringing at 6 months postoperatively. Chi-square and Fisher’s exact test were used for statistical analysis. Results: In total 317 patients, the mean age of the patients was 38.46 (SD ± 13.6) years. The male to female ratio was 1:2.5. The commonest presenting symptom was watering with discharge in 224 (70.6%) patients. Of the total, 195(61.5%) had undergone the DCR surgery with intubation and 122 (38.5%) without intubation. Only 114 (35.9%) patients were followed up for 6 months. The success rate was 86.8%. Postoperative wound infection, bleeding or cheese wiring of the punctum was not seen. No statistically significant factors were seen to influence the success rate of DCR surgery. Conclusions: External DCR surgery has a high success rate and no significant influencing factors were found to define its success in this study.

Orbital Tumors and Tumor like Lesions: A Hospital Based Study.

Orbital tumors have rare incidence, still they play a significant role in terms of morbidity and mortality. Orbital tumors may be primary, secondary or metastatic. These consist of benign and malignant lesions with extreme variations in pediatric and adult groups. These lesions can have acute or chronic onset, slow to rapid progression with or without bony destructions leading to vision loss, deformity and sometimes death. This retrospective cross-sectional study was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine in Biratnagar Eye Hospital. Fifty-one patients who underwent histopathological evaluation for their orbital lesions from June 2018 to December 2019 were included in the study. Orbital tumor and tumor like lesions comprised 27 cases (52.94%) in adults and 24 (47.06%) in paediatrics. Histopathologically, the most common pediatric benign tumor was dermoid cyst and malignant was secondary to orbital extension of retinoblastoma. Also, the most common adult benign orbital tumor was cavernous hemangioma and malignant was non Hodgkins lymphoma. The clinico-pathological accuracy for diagnosis was 68.63%. Association between age groups and nature of orbital lesions and between clinical and histopathological diagnosis was found to be statistically significant (p<0.05). Orbital tumors and tumor like lesions are uncommonly encountered. These masses showed significant variation in incidence in children versus adults. Combined efforts by different specialties help in early and prompt management of the orbital tumors.

PROFILE OF CONTACT LENS PATIENTS ATTENDING TO BIRATNAGAR EYE HOSPITAL, NEPAL

Background: Contact lens is an artificial device whose front surface substitutes the anterior surface of the cornea. The contact lens can be worn to correct vision or for cosmetic or therapeutic reasons. The objective of the study was to determine the profile of contact lens patients attending Biratnagar Eye Hospital, Nepal. Methods: The hospital-based cross-sectional study was done. All the patients referred to the contact lens clinic of Biratnagar Eye Hospital, Nepal for a contact lens trial were included in this study between 1st January 2016 to 31st December 2019. Data were collected by an optometrist trained in contact lens care and descriptive analysis was performed by using SPSS -17 versions. Results: The mean age (±SD) of the patient was 22.9 (±9.6). Most of them were male 178 (55%) and from India 234 (72%). The majority of patients were in the age between 19 to 40 years 194 (60%). Keratoconus 253 (39%) was the most common ocular disorder found followed by myopia 138 (21%) and astigmatism 56 (9%). Most of the eyes had high refractive errors 287 (44%). Contact lens trial was done in 535 (82%) eyes and it was used for optical correction in 455 (70%) eyes. Rigid Gas Permeable 271 (51%) contact lens was mostly tried followed by soft contact lens 194 (36%). After using a contact lens, 548 (84%) eyes got normal visual acuity. Conclusions: Keratoconus was the most common ocular disorder found followed by myopia and Astigmatism. Rigid Gas Permeable contact lens was mostly prescribed for vision correction. There was a significant improvement in visual acuity after giving contact lenses.

Antibiotic resistance in patients with chronic ear discharge awaiting surgery in Nepal

SETTING:Biratnagar Eye Hospital, Biratnagar, Nepal, which offers ear surgery for chronic suppurative otitis media (CSOM).OBJECTIVE:In patients with CSOM awaiting surgery, to determine the 1) sociodemographic characteristics 2) bacterial isolates and their antibiotic resistance patterns and 3) characteristics of those refused surgery, including antibiotic resistance.DESIGN:A cohort study using hospital data, January 2018–January 2020.RESULTS:Of 117 patients with CSOM and awaiting surgery, 64% were in the 18–35 years age group, and 79% were cross-border from India. Of 118 bacterial isolates, 80% had Pseudomonas aeruginosa and 16% had Staphylococcus aureus. All isolates showed multidrug resistance to nine of the 12 antibiotics tested. The lowest antibiotic resistance in P. aeruginosa was for vancomycin (29%) and moxifloxacin (36%), and for S. aureus, this was vancomycin (9%) and amikacin (17%). Fourteen (12%) patients underwent surgery: myringoplasty (n = 7, 50%), cortical mastoidectomy with tympanostomy (n = 4, 29%) and modified radical mastoidectomy (n = 3, 21%). Those infected with P. aeruginosa and with resistance to over six antibiotics were significantly more likely to be refused for surgery.CONCLUSION:Patients awaiting ear surgery were predominantly infected with multidrug-resistant P. aeruginosa and were consequently refused surgery. This study can help inform efforts for improving surgical uptake and introducing cross-border antimicrobial resistance surveillance.

Vision screening among hearing-impaired school children in Biratnagar, Nepal

Background: The prevalence of hearing impairment in Nepal is 16.5%, affecting approximately 2.71 million people. Deaf children are visually dependent, and even a mild refractive error may cause visual discomfort. The goal of this study was to determine the need for vision screenings in schools for the hearing impaired in Biratnagar, Nepal.&#x0D; Methods: A cross-sectional study was conducted with permission from Birat Deaf Secondary School, Biratnagar, Nepal. A total of 130 hearing-impaired students were examined. Non-invasive, comprehensive optometric examinations were performed to detect visual disorders. When a more detailed evaluation was needed, the students were referred to the Pediatric Ophthalmology Department, Biratnagar Eye Hospital Biratnagar, Nepal.&#x0D; Results: Of the 130 hearing-impaired students, 58 (44.6%) were male and 72 (55.4%) were female. The mean ± standard deviation of age was 16.03 ± 3.8 years (range 6–25 years). Twenty-one (16.1%) students had refractive errors: 13 (10%) had myopia, 7 (5.4%) had hyperopia, and 1 (0.8%) had anisometropia. In the cover test, 88 (67.7%) had orthophoria, 19 (14.6%) had exophoria, 11 (8.5%) had esophoria, 5 (3.85%) had exotropia, and 3 (2.3%) had esotropia. Cover tests were not performed in 4 (3.1%) students, as they were unable to fixate due to nystagmus or decreased vision. On ocular examination, 20 (15.3%) students had anterior segment abnormalities, including lid abnormality, conjunctivitis, Bitot’s spots, pterygium, corneal opacity, and lenticular opacity. Posterior segment or retinal abnormalities were found in four students with one having Usher syndrome. Color vision defects, nystagmus, and amblyopia were found in 8 (6.1%), 2 (1.5 %), and 1 (0.8%), respectively.&#x0D; Conclusions: The findings of the present study reflect the need of periodic vision screenings in schools for the hearing impaired in Nepal. These children are at a high risk of vision impairment.&#x0D; &#x0D; How to cite this article: Sah SK, Thakur R, Adhikari PR. Vision screening among hearing-impaired school children in Biratnagar, Nepal. Med Hypothesis Discov Innov Optom. 2021 Spring; 2(1): 36-40. DOI: https://doi.org/10.51329/mehdioptometry123&#x0D; &#x0D;

Correlation of Fasting and Postprandial Glucose Levels with Glycosylated Hemoglobin in Diagnosis of Diabetes

Introduction: Diabetes Mellitus describes a group of metabolic disorders characterized by hyperglycemia. Uncontrolled glycemic state often leads to micro and macro vascular complications. Diabetes is the foremost cause of new blindness in adults. Constant screening of the diabetic profile through blood tests of the affected people and prompt actions to control them can help to improve the quality of life of these patients. The study was done to evaluate the correlation between fasting and postprandial plasma glucose levels with glycosylated hemoglobin for diagnosis of diabetes and to determine the prevalence of diabetes in different age groups with sex predilection.&#x0D; Methods: A descriptive cross sectional study was conducted and the data collection was carried out in the Department of Ophthalmic Pathology and Laboratory Medicine, Biratnagar Eye Hospital. Ethical approval was obtained from Institutional Review Committee of this hospital. All 275 patients who attended the laboratory from January 2019 to June 2019 for fasting plasma glucose, postprandial plasma glucose and glycosylated hemoglobin values estimation were included in this study. The data obtained were computed and analyzed using Statistical Package for the Social Sciences version 20.0&#x0D; Results: A significant correlation between fasting plasma glucose, postprandial plasma glucose and glycosylated hemoglobin was observed in this study (p value &lt;0.001). The correlation coefficient between fasting plasma glucose and glycosylated hemoglobin (r= 0.728) is stronger than the correlation coefficient between postprandial plasma glucose and glycosylated hemoglobin (r= 0.709).&#x0D; Conclusions: Fasting plasma glucose correlated better than postprandial plasma glucose with glycosylated hemoglobin. &#x0D;

Acceptance of Low Vision Aids in Visually Impaired Patients Attending to Tertiary Eye Hospital, Nepal

Introduction: Vision impairment is the degree of reduction in vision that makes a remarkable effect on personality, intelligence, social, mental and economic factors of individuals.&#x0D; Objective To analyze the acceptance of low vision aids with their respective occupations and needs in visually impaired patients atiending to Tertiary Eye Hospital.&#x0D; Methodology A cross-sectional study was done at the low vision clinic of Biratnagar Eye Hospital (BEH), Biratnagar, Nepal from January to March 2018. During the study period, a total of 51 visually impaired patients were included for the study who were eligible and willing to participate.&#x0D; Result The most common age group visited to low vision clinic were up to 20 years (43%). Males comprised a maximum study population of (88%) and most of them were from the neighboring country India (96%). The most common disease-causing low vision was Retinal Diseases (41%). Among all occupations, students accepted more optical low vision aids for both distance(31.5%) and near (47%). The most common demand was reading and writing (86%). At distance, the telescope was prescribed to (65%) and at near, spectacle magnifiers were prescribed to (72%).&#x0D; Conclusion: There is more acceptance of the low vision aids among the students for both distance and near work compare to other occupation. The low vision device should be prescribed concerning the education, occupation, and needs of the patients.

Clinico-pathological Analysis of Malignant Eyelid and Adnexal Tumors Presenting to a Tertiary Eye Hospital Of Eastern Nepal

Introduction: Eye lid and adnexal tumours are one of the major problems we see in the oculoplastic department. Malignant eye lid tumours are rare in comparison to benign and diversity in its clinical presentation makes it difficult to diagnose earlier. Eyelid malignancies can mimic a host of benign neoplasms and other less aggressive neoplastic or non-neoplastic inflammatory conditions and need differentiation before definitive therapy is planned. Out of 90% of all skin cancer occurring in head and neck region 10% occurs in the eyelid. A histopathological study confirms the diagnosis that can be correlated with patient history and other clinical data.&#x0D; Objectives: To study the clinicopathological correlation and its outcome in patients with malignant eyelid and adnexal tumours presenting at Biratnagar eye hospital.&#x0D; Methodology: Details of the cases of histopathologically proven malignant eyelid and adnexal tumours presenting to the department of oculoplasty from July 2016 to August 2019 were recorded. The duration of disease, presenting symptoms, risk factors, demographic data, clinicopathological correlation with its accuracy and mode of treatment were analyzed using SPSS 17.&#x0D; Results: Out of total 28 patients, male were 53.6% and female were 46.4%. The mean age of presentation was 60.5±11.8 years. 53.6% tumors were located in upper lid, 39.9% were located in lower lid and 7.1 % were located in medial canthus. Basal cell carcinoma and sebaceous gland carcinoma were the most common type of malignancies (35.7% each) followed by 28.6% of squamous cell carcinoma of eyelid. The clinicopathological correlation revealed 75% of clinical accuracy. Different types of reconstructions were done according to the size and site of the defect. Modified Hughes procedure for lower eyelid defect was the most common procedure performed (32.1%), followed by 14.3% Cutler beard, 28.6% Cutler beard with post auricular cartilage graft, 10.7% Glabellar flap rotation 7.1% had combined procedure and 4.3% direct closure .&#x0D; Conclusion: Sebaceous cell carcinoma and Basal cell carcinoma were the most common malignant tumors followed by squamous cell carcinoma. The upper lid was the most common site for such malignancy. Histopathological examination was useful for the establishment of complete and accurate diagnosis, which led to further management and follow up protocol for malignant eyelid tumours.

Surgical Outcome of Posterior Polar Cataract in Adults

Introduction: Posterior polar cataract (PPC) is a relatively uncommon form of congenital cataract accounting for around 0.5% to 2% of the total cataract. A posterior polar cataract presents a special challenge to the phaco surgeon because of its predisposition to posterior capsular dehiscence during surgery. Incidence of posterior polar cataract ranges from 3 to 5 in 1000. Methodology: Prospective descriptive study done at Biratnagar Eye Hospital from December 2016 to March 2017. A detailed slit-lamp biomicroscopy of the anterior segment, intraocular pressure and dilated fundus examination was performed in all patients after checking for visual acuity and refraction. Result: Total of 60 eyes of 59 patients was included in the study, out of which only 5% had posterior capsular rupture during surgery. Mean age of patients in our study was 49.35 +_ 9.5yrs (range 35-73yrs). There were 34 male patients and 26 female patients. Mean axial length was 23.40mm. Out of 60 eyes, 12 eyes had bilateral posterior polar cataract. Mean preoperative visual acuity was 0.949 while first post-operative day visual acuity was 0.5137, which was statistically significant (P &lt; 0.0001) (paired t test). Conclusion: Intraoperative complications during posterior polar cataract surgery can be minimized by careful and appropriate surgical procedure.

Study on satisfaction of patients visiting to Outpatients Department of Biratnagar Eye Hospital, Nepal

Study on satisfaction of patients visiting to Outpatients Department of Biratnagar Eye Hospital, Nepal

Ossicular chain status in cases of cholesteatomatous chronic otitis media in eastern Nepal

Background: Ossicular erosion and disruption of ossicular chain is a frequent complication of cholesteatomatous chronic otitis media leading to hearing loss.Aims and Objectives: To find out the status of ossicles and ossicular chain in patients of choleasteatomatous chronic otitis media undergoing surgery.Materials and Methods: This is a descriptive, cross sectional study conducted among 52 patients of chronic suppurative otitis media with cholesteatoma undergoing surgery at Biratnagar Eye Hospital, Ear Department over 3 years. In each patient the condition and the integrity of ossicular chain was evaluated in order to determine the presence and site of lesion of each ossicles. The data was analysed and expressed in numbers and percentage.Results: Among 52 cases, 27(51.92%) were male and 25(48.08%) were female. The age range was 16 to 50 years. The mean age was 25.6 years. The commonest age range was of 16-20 years, 21 (40.38%). The chief complaints of the patients were ear discharge seen in 52 (100%) cases and hearing loss in 45 (86.5%) cases. Malleus was found intact in 37 (71.1%) cases and absent in 7(13.5%). Handle erosion was found in 3(5.8%) cases. Head and handle erosion was found in 5(9.6%) cases. Incus was found intact in only 6 (11.5%) cases and absent in 11 (21.2%) cases. Long and lenticular process was eroded in 35(67.3%) cases. Intact suprastructure of Stapes was found in 27(51.92%) cases. Suprastructure erosion was found in 25(48.08%) cases. Intact ossicular chain was found only in 6(11.5%) cases. M+S+ was found in 17(32.7%) cases followed by M+S- in 14(26.9%). M-S+ was found in 4(7.8%) cases. All the ossicles eroded were found in 11(21.1%) cases.Conclusion: In this study of cholesteatomatous ears, the Malleus was found to be the most resistant ossicle to erosion, whereas, Incus was found to be the most susceptible. Asian Journal of Medical Sciences Vol.8(3) 2017 68-71

Amniotic membrane transplantation: Current indications in a tertiary eye hospital of eastern Nepal.

Amniotic membrane has unique properties that can be helpful to treat different ocular surface diseases. To report our experience with 100% glycerol preserved amniotic membrane at 4°C and fresh amniotic membrane transplantation (AMT) with and without limbal graft for ocular surface reconstruction. Retrospective case study of 211 eyes of 211 patients was conducted at Biratnagar Eye Hospital from June 2008 to March 2014. The cases were evaluated in terms of demographic parameters, preoperative diagnosis and the type of surgery performed. The most common indication for surgery was Pterygium (90 eyes, 42.65%), followed by symblepharon (57 eyes, 27.01%), chemical injury (35 eyes, 16.58%), socket reconstruction (9 eyes, 4.26%), shield ulcer (6 eyes, 2.84%), PED (4 eyes, 1.89%), Steven Jonson's syndrome (5 eyes, 2.36%), dry Eye (2 eyes, 0.94%), Corneal Degeneration (2 eyes, 0.94%), bullous keratopathy (1 eye, 0.47%). The mean age was 28.12 ±17.2 years (age range 3-78 years). More men (161, 76.30%) underwent surgery than women (50 eyes, 23.69%). Symblepharon (24 eyes, 36.36%) was the major cause of surgery in pediatric group. The mean follow-up was 7 months (range 2-36, months). Resurgery was needed in (18 eyes, 8.53%) of which symblepharon (7eyes, 39%) was the major cause. AMT was done in 189 (89.57%) eyes and AMT with conjunctival limbal graft was done in 22(10.42 %) cases. Infectious, inflammatory, or allergic reactions were not encountered in any patient. All patient experienced increased ocular comfort with anatomical restoration of corneal and conjunctival surfaces. AMT alone or in combination with limbal graft aids in ocular surface reconstruction.

The intraoperative pathological findings in cases of chronic suppurative otitis media with central perforation of tympanic membrane at a tertiary care centre in Eastern Nepal

Background: Chronic suppurative otitis media (CSOM) is the chronic inflammation of the middle ear cleft. The atticoantral type is called unsafe type because of the associated complications due to granulations and cholesteatoma which may be life-threatening. CSOM with central perforation (tubotympanic type) is usually not associated with major complications such as cholesteatoma formation.Aims and Objectives: To find out the intraoperative pathological findings in cases of CSOM with central perforation (tubotympanic type)Materials and Methods: This descriptive, cross sectional study has been conducted in the Department of Ear, Biratnagar Eye Hospital in Nepal over 2 years. Study group includes 172 patients having CSOM with central perforations in the tympanic membranes who underwent different types of procedures. Preoperatively, all the patients were evaluated with otoscopy, microscopy, pure-tone audiometry, and some patients with computed tomography scan. The pathological findings were confirmed with biopsy. The findings were tabulated and analysed.Results: 21(12.2%) patients were having dry central perforation with normal Eustachian tube function. 95 patients, i.e., 55.23% were having granulations in attic, aditus, antrum. 25 (14.53%) cases were having ossicular erosion.5 (2.9%) cases had tympanosclerosis in middle ear. 1 (0.58%) case had facial nerve dehiscence. 16 (9.3%) cases had oedema of middle ear mucosa/aural polyp from middle ear. Surprisingly 9 patients, i.e., 5.23% were having cholesteatoma which was confirmed by histopathological study.Conclusion: This study shows that cholesteatoma can be found in tubotympanic type of CSOM, along with other pathological findings. Hence it is on the part of the surgeon to be careful while planning surgery on their patients with CSOM (tubotympanic type), remembering that all safe CSOM might not always be safe. Asian Journal of Medical Sciences Vol.8(1) 2017 42-47

The outcome of vitrectomy with internal limiting membrane peeling for chronic macular hole at Biratnagar eye hospital: A tertiary eye care center in Nepal

Background: A macular hole is a full-thickness defect of retinal tissue involving the anatomic fovea, thereby affecting central visual acuity. Pars plana vitrectomy and gas tamponade is a recognised modality of treatment for macular hole.Larger holes are more likely to remain open after repair and late reopening after an initially closed macular hole is seen in macular holes larger than 400 μm.Aims and Objective: To evaluate the anatomical and functional outcome of pars plana vitrectomy with internal limiting membrane peeling for chronic stage 3 macular hole.Materials and Methods: Records of 15 patients with stage 3 chronic macular holes operated from 1st January 2013 to 30th June 2013 and completed 1 year of follow up were retrospectively evaluated and included in the study. Preoperative best distance corrected visual acuity (BCVA), preoperative macular hole size, final BCVA and macular hole status at 1 year follow up were recorded. Macular hole closure and visual improvement was calculated. Correlation of macular hole closure and visual improvement with various macular hole parameter was estimated.Results: Eleven (73.3%) macular holes closed at 1 year follow-up. Mean BCVA improved from 1.2 ± 0.27 to 0.89 ± 0.36 logarithm of minimum angle of resolution at 1 year (p&lt;0.001). Visual improvement was seen in only eight (53.3%) eyes. Both macular hole closure and visual improvement showed no correlation with minimum linear diameter, base diameter and hole height.Conclusion: Chronic stage 3 macular hole can be closed successfully in majority of patients with fairly good visual improvement. Macular hole parameters of stage 3 holes may not have any correlation with the anatomical and visual outcome.Asian Journal of Medical Sciences Vol.7(6) 2016 43-46

Outcome of Type 1 tympanoplasty: An experience at Biratnagar eye hospital in Eastern Nepal

Background: The history of tympanoplasty is well over a century. Type 1 tympanoplasty is an established procedure worldwide with a variation in the outcome.Aims and Objectives: To analyze the outcome of Type 1 tympanoplasty surgeries in terms of graft success and hearing improvement done at the Ear Department of Biratnagar eye hospital in eastern Nepal and discuss the various factors that might have influenced it.Materials and Methods: Retrospective analysis of records of the cases that underwent Type 1 tympanoplasty from August 2013 to January 2015 was done. The factors analysed were age, gender, the side of the affected ear and the perforation size. Appropriate Statistical test was applied and the results were discussed.Results: A total of 151 cases of type 1 Tympanoplasty were analysed were females had higher frequency than males, with higher incidence at younger age. The mean age of successful cases was 28.53. Females had a better success rate in terms of graft success compared to males. Moderate size perforations had the best outcome of graft success and least were of small size perforations. Of all cases analyzed, hearing improvement was observed in maximum cases.Conclusion: There was no significant influence of age or gender on the hearing outcome. The difference of hearing improvement according to size of perforation was also not significant.Asian Journal of Medical Sciences Vol.7(2) 2015 55-60

Epidemiology and etiological diagnosis of infective keratitis in eastern region of Nepal

Objective: This study aimed to determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in patients presenting to Biratnagar Eye Hospital (Nepal). Methods: All patients presenting to Biratnagar Eye Hospital between January 1 and December 31, 2011 with corneal ulceration were retrospectively reviewed. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined and corneal scrapping and cultures were carried out. Results: Over one year period 1644 patients with corneal ulcer were evaluated, out of which 76.6% of patients were in the age range of 30 to 69 years and 65% of patients had presenting visual acuity &lt; 3/60. Ocular trauma was the most common cause of keratitis accounting for 60.3% of corneal ulcer and majority of the patients (40%) presented after 2 weeks of symptoms. Among corneal scraping positive cases 1150 (70%) showed fungus, 73 (4.4%) showed bacteria and 20 (1.2%) showed both bacterial and fungus. Conclusion: Corneal ulcer continues to be one of the leading causes of preventable blindness in this region. Lack of awareness about gravity of this disease, financial constraints and geographic barriers remain the major reasons for delay in seeking proper medical help.