Gauri S . Shrestha

Terrien’s marginal degeneration is an uncommon disease of the peripheral cornea occurring at any age that results in corneal thinning causing corneal irregular astigmatism. RoseK2 XL lens has an aspheric optical zone and employed in the fitting of irregular corneas for vision and comfort while maintaining corneal health. Rose K2 XL lens was fitted in a 17 year female presented to Contact lens clinic of B.P. Koirala Lions Center for Ophthalmic Studies, Kathmandu having RE Terrien’s marginal degeneration. Her presenting visual acuity was 6/60 in right eye and 6/6 in left eye with best subjective refraction OD: +2.00/-3.00X150 and OS: Plano. Her corneal topography revealed irregular corneal astigmatism as indicated by SimK49.85/41.63@137. RoseK2 XL which is a mini-scleral lens, showed an excellent fitting attaining visual acuity 6/6. RoseK2 XL lens provides not only good visual acuity also confirms comfort in patients with corneal marginal degeneration.

Terrien’s marginal degeneration is an uncommon disease of the peripheral cornea occurring at any age that results in corneal
thinning causing corneal irregular astigmatism. RoseK2 XL lens has an aspheric optical zone and employed in the fitting of
irregular corneas for vision and comfort while maintaining corneal health. Rose K2 XL lens was fitted in a 17 year female
presented to Contact lens clinic of B.P. Koirala Lions Center for Ophthalmic Studies, Kathmandu having RE Terrien’s
marginal degeneration. Her presenting visual acuity was 6/60 in right eye and 6/6 in left eye with best subjective refraction
OD: +2.00/-3.00X150 and OS: Plano. Her corneal topography revealed irregular corneal astigmatism as indicated by
SimK49.85/41.63@137. RoseK2 XL which is a mini-scleral lens, showed an excellent fitting attaining visual acuity 6/6.
RoseK2 XL lens provides not only good visual acuity also confirms comfort in patients with corneal marginal degeneration.

Introduction: A clinical audit of strabismus surgery in children in terms of functional
and cosmetic outcomes helps improve the quality of services in pediatric ophthalmology.
Objective: To evaluate the outcome of strabismus surgery and assess the satisfaction of
the patients’ parents with respect to the surgery outcome. Subjects and methods: A
study of an interventional series of cases that included 60 strabismic subjects was carried
out.The bilateral strabismus surgery under general anesthesia was performed on all
subjects using the fornix approach. The parents’ understanding about strabismus and
the cosmetic outcome was assessed through a set of interview questionnaires. The main
outcome measures were the amount of deviation,the parents’ knowledge about strabismus
and their satisfaction after the intervention. Results: Of the 60 subjects, 32 (53.3%)
were esotropic and 28 (46.7%) exotropic. The male to female ratio was 1:1. The mean
age with standard deviation was 16.6±8.5years,with a range of 3 to 35 years. The preoperative
mean esotropia with standard deviation was 48.2±14.8 pd, with a range of 22
to 114 pd). The pre-operative mean exotropia was 57.8±14.2 pd, with a range of 25 to
90 pd). In 93.47% of the subjects, the ocular deviation after surgery reduced significantly
(p=<0.00). After the strabismus surgery, orthophoria was achieved in 15 (25%) subjects,
and with excellent cosmetics.After surgery, gross binocular single vision was attained
in 39.3% of the exotropes and in 17.9% of the esotropes. Only 30 % of the parents were
aware about the strabismus and the treatment modalities. Nearly 90% of the parents
were satisfied with the cosmetic outcome. Conclusion: Horizontal and bilateral
strabismus has good surgical outcome with improved cosmetic acceptance.

Wilson’s disease is a hereditary disorder of copper metabolism which is characterized by neuropsychiatric and hepatic
manifestations as well as appearance of Kayser-Fleischer ring. This is a retrospective review of the records of the patients of
Wilson’s disease who attended Neuro-ophthalmic clinic for the identification of Kayser-Fleischer (K-F) ring from January
2010 to June 2012. Detailed eye examination included visual acuity assessment, slit lamp biomicroscopy and intra-ocular
pressure measurement. Data regarding clinical features, laboratory investigations and the status of K-F ring was recorded.
Seven cases of Wilson’s disease with age range of 9-15 years were included in the study. Among them four (57.1%) had neuropsychiatric
symptoms, two (28.5%) had hepatic disease and one (14.3%) was asymptomatic, diagnosed by positive family
history and laboratory tests. Among four subjects having K-F ring, three (75%) subjects had neuropsychiatric symptoms
and one subject had hepato-billiary disease. Besides K-F rings, other ophthalmic findings were sunflower cataract (14.3%)
and vernal keratoconjuctivitis (14.3%). The identification of K-F ring is a simple and cost effective screening test for the
diagnosis of Wilson’s disease. K-F is present in majority of the patients with neurological manifestations.

A case of congenital isolated coloboma of both the upper lids from just lateral to the lacrimal
punctum up to the medial half, with symblepharon in the region of lower eyelid, was studied in
a 7-year-old female child. She did not have any other associated anomalies. The birth and
family histories were normal. The puncta were normal in position and well apposed to the
globe. The closure of the lid coloboma was done by release of symblepharon along with
direct closure of the defect, for the right eye first, and one month later, for the left eye.

Background: It is reported that 0.2 to 5.3% of children suffer from amblyopia. The traditional treatment for amblyopia
has been to correct the refractive error and occlude the non-amblyopic eye. Compliance, however, with patching
is a significant problem. The aim of this study was to investigate the parental knowledge of amblyopia and its treatment.
We also wanted to explore the demographic and psychosocial impact of occlusion therapy on children with
amblyopia and their parents.
Methods: Fifty-two parents and their children ages 2 to 13, undergoing occlusion therapy for amblyopia, participated
in this study. Visual acuity at the initiation of occlusion therapy and the prescribed occlusion regimen were
obtained from patient files. The compliance with occlusion therapy was based on self report of the parents. The
emotional impact of occlusion therapy was determined by an emotional impact questionnaire. The experiences and
the difficulties expressed by parents and children were noted in their own words.
Results: Strabismic amblyopia was the most prevalent type of amblyopia, followed by isoametropic amblyopia. Only
42% of the parents had an understanding of amblyopia and its treatment. However, the compliance with occlusion
therapy was 78%. The occlusion therapy was a difficult experience for a majority of parents and their children. Many
parents reported undue distress, difficulty, and a psychosocial impact secondary to occlusion therapy. Behavioral
changes induced by occlusion therapy were also detected in 25% of children.
Conclusions: Parental understanding regarding amblyopia and occlusion therapy was lacking, but the compliance
was good despite the psychosocial impact on both child and parent.

Purpose
To evaluate visual problems, major symptoms, and their associations among VDT users in Nepal.

Methods
Among 76 hospital attendees, assessment included visual acuity, retinoscopy, convergence, accommodation, fusional vergence and Schirmer's II. Subjects’ symptoms were recorded in the structured 5 point intensity scale questionnaire.

Results
Mean age of subjects was 25.8±5 years with 6.9±2.6hours/day of computer use. Ocular changes were reported in 92.1% of the total subjects. The common ocular change was accommodative infacility. The most common symptoms (p<0 001 were tired eye and headache reduced tear secretion as indicated by schirmer s test ii was found to have a little role in manifesting the symptoms regression coefficient
Conclusions
Accommodative infacility and tired eye were the most common abnormalities and symptom reported. Schirmer's test II was slightly correlated with some ocular, visual, and systemic symptoms.

OBJECTIVE:
The study was conducted to evaluate tear film stability and tear secretion before and after laser in situ keratomileusis.

MATERIALS AND METHODS:
It was a prospective, longitudinal and non-comparative analysis of clinical data of 20 consecutive myopic patients (40 eyes) collected before and after laser in situ keratomileusis. Assessments included tear secretion (Schirmer I and II), fluorescein tear break up time and ocular surface staining.

STATISTICS:
The statistical package for social science (SPSS 10.0) was used for data analysis. The parameters of tear secretion and tear stability were analyzed using the paired and unpaired Student t-tests.

RESULTS:
Schirmer II was reduced at seven days (9.5 ± 4.30 mm) and one month (10.3 ± 3.06 mm, p=0.001) after operation from the pre-operative value of 16.12 ± 3.90 mm. Tear film stability significantly decreased at seven days (6.79 ± 3.05 sec, p Less than 0.001) and one month (8.03 ± 2.81secs, p less than 0.001) from its pre-operative value (12.68 ± 2.69 secs). 87.5% had tear film instability (FBUT less than 10secs) seven days after surgery; it was reduced to 75 % at one month and 27.5 % at three months. It was 7.5 % before surgery. Corneal staining score was increased significantly at seven days (1.42 ± 1. 58, p less than 0.01) and one month (0.95 ± 1.41, p=0.02), from the pre-operative score of 0.17 ± 0.44.

CONCLUSION:
Laser in situ keratomileusis significantly alters the tear film stability, Schirmer values and corneal staining at least for three months.

Purpose: To find out the type of visual defects, ocular defects or visual neglect occurring in
patients with stroke.
Methods: In this cross-sectional study including 40 subjects diagnosed as stroke, assessment
included visual acuity with the Sheridan-Gardner chart, objective and subjective refraction,
duction and version eye movement, cover test at distance and near, anterior segment examination
with the slit lamp, posterior segment examination after pupil dilatation, color vision test
with the Farnsworth D-15 test, diplopia charting, the Hess charting, and visual field examination
on Goldmann perimetry. 33 subjects (82.5%) having stroke underwent star cancellation test
for visual neglect evaluation. Chi-square test with Yate’s correction was performed to evaluate
associations between visual neglect and neurological findings.
Results: The mean age of the subjects was 52.1 ± 15.7 years with male/female ratio of 0.7.
Neurological findings included hemiplegia/hemiparesis in 84.8%, ischemic stroke in 80%, left
hemisphere involvement in 60%, and cortical area involvement in 65%. Ocular finding included
extraocular muscle palsy in 17.5%, exotropia in 12.5%, and ptosis in 7.5%. Co-morbid ocular findings
such as cataract, retinopathy, and age-related macular degeneration were also reported.
Visual neglect was present in 54.5% subjects predominantly affecting the left side.
Conclusion: This study reports the relationship between ocular---visual disorders and stroke.
There should be a formal screening for visual problems in stroke patients in hospital and
rehabilitation settings.

Background: The sixth cranial nerve has been found to be the most commonly affected in previous studies of cranial nerve palsies. This study was carried out to determine the most common nerve involved in extraocular muscle (EOM) palsies and the most common cause of EOM palsy in Nepal.
Methods: The diagnosed cases of third, fourth, or sixth nerve palsy for 10 years (2000-2010) at the B.P. Koirala Lions Center for Ophthalmic Studies outpatient department were included in the study. A retrospective review of patients’ records was performed, and the causes of EOM palsy were grouped as: vascular, trauma, tumor, aneurysm, undetermined, and others. Recovery of the palsy was evaluated by reviewing the records of the patients who were followed up one month after the initial visit.
Results: A total of 838 patients was included in the study. The average patient age was 37 years. The sixth nerve was most commonly affected (n=458, 54.65%), and the most common etiology was undetermined (n=408, 48.68%). Among the cases where the cause of palsy was known, the largest number of patients had trauma (n=188, 16.46%).
Conclusion: It was concluded that in Nepal, the most commonly affected cranial nerve is the sixth nerve, in accordance with the other studies done in the past in different parts of the world. Most of the cases of cranial nerve palsy were found to have no specific cause and were not associated with diagnosed systemic disease.
Keywords: cranial nerve palsy, etiology, extraocular muscle, Nepal, trauma