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Papers by ranju kharel

American Journal of Ophthalmology Case Reports

Annals of Medicine & Surgery

Annals of Medicine & Surgery

Ophthalmology Research: An International Journal, 2014

Ocular Immunology and Inflammation, 2011

Background: The high resolution computerized tomography of chest is an important diagnostic imagi... more Background: The high resolution computerized tomography of chest is an important diagnostic imaging tool to identify any pulmonary tubercular lesion. It's role in Eales' disease to identify any possible association with pulomonary tuberculosis has not been studied earlier. So, this study was conducted to assess the role of high resolution computerized tomography (HRCT) chest in identifying tuberculous etiology in Eales' disease. Results: It was a retrospective study conducted at a tertiary care eye hospital in South India between January 2009 and October 2014 were included. A total of 29 diagnosed cases of Eales' (24 male and 5 female) were included in the study. These patients were followed up for a mean period of 739.75 days. Out of them, 13 (44.8%) had bilateral and 16 (55.2%) had unilateral ocular involvement. Eight cases (34.5%) patients had vitreous inflammation. Mantoux test was positive in 12 (41.4%) cases and chest x-ray suggestive of TB was present in four cases (13.8%). QuantiFERON TB gold was positive in 15 (51.7%) and HRCT chest suggestive of TB was positive in 15 (51.7%) case. Out of 15 Eales' cases with positive HRCT scan suggestive of TB, the commonly noted lesions were calcified nodules 34.5%, mediastinal hilar lymphadenopathy 13.8%, parenchymal soft tissue lesions in 3.4%. Five (17.2%) cases underwent pars plana vitrectomy for non resolving vitreous hemorrhage and one case underwent retinal attachment surgery with encirclage. Six patients were started on 9 months regimen of ATT by the chest physician. Final visual outcome improved in 17(40.5%) eyes, maintained in 21(50%) eyes but vision deterioration in 7(16.7%) eyes. Conclusions: HRCT chest is an important diagnostic tool to rule out pulmonary tuberculosis in Eales' disease.

Journal of Clinical Research and Ophthalmology, 2019

Ocular tuberculosis is an exigent clinical entity-lacking a distinct clinical presentation and at... more Ocular tuberculosis is an exigent clinical entity-lacking a distinct clinical presentation and attributing the diagnostic conundrum. Nevertheless, the early-precise diagnosis with implicated anti-tubercular therapy may be sight-saving; diagnostic delays often encountered due to protean clinical presentations, the impracticability of obtaining tissue (in most case), limitation on sample volume extraction, and of wanting a sensitive diagnostic test. This article revises the current scenario of ocular tuberculosis, its clinicopathologic arrays, and diagnostic challenges for clinical management; Furthermore, advocates for compiling all such positive fi ndings of corroborative tests in a precise diagnosis.

TB is one of the leading causes of morbidity and mortality worldwide. The causative agent of tube... more TB is one of the leading causes of morbidity and mortality worldwide. The causative agent of tuberculosis is Mycobacterium tuberculosis (MTB), discovered by Robert Koch in the year 1882. The World Health Organization (WHO) declared TB as a global health emergency in the year 1993. India is the country with the highest burden of TB. The World Health Organization statistics for 2015 gave an estimated incidence figure of 2.2 million cases of TB for India out of a global incidence of 9.6 million. The estimated TB prevalence in India for the year 2015 is about 2.5 million cases.

Endophthalmitis is a serious intraocular inflammatory disorder affecting the vitreous cavity that... more Endophthalmitis is a serious intraocular inflammatory disorder affecting the vitreous cavity that can result from exogenous or endogenous spread of infecting organisms into the eye [1]. It may be categorized by clinical course (acute versus chronic), by etiology (infectious versus noninfectious), by the route of entry of the causative agent (exogenous versus endogenous), and by the organism(s) causing the infection (bacteria, fungi, parasites, and, rarely, viruses). Certain organisms tend to be associated with particular clinical settings, means of intraocular access, and types of inflammation (acute, chronic non-granulomatous, chronic granulomatous, or mixed cellular response) [2].

Journal of Ophthalmic Inflammation and Infection

Background To assess the change in vision-related quality of life and psychosocial well-being of ... more Background To assess the change in vision-related quality of life and psychosocial well-being of the patients with episcleritis and scleritis patients before and after treatment. Results This one-and-a-half-year prospective study was conducted among 76 eyes of 71 new patients of episcleritis and scleritis. A structured questionnaire was used to assess the visual and to analyze the change in effect size. The male-to-female ratio was 1:1.536. Episcleritis was seen in 41 cases (57.7%) while scleritis was seen in 30 cases (42.3%). Patients with episcleritis had statistically significant improvement in general function score (GF) (p

Indian Journal of Ophthalmology, 2018

We report a case of a 47-year-old male patient presenting with diminution of vision in the left e... more We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid choroiditis was established and was managed with anti-tubercular therapy and systemic steroids.

Gems of Ophthalmology—Diseases of Uvea

American Journal of Ophthalmology Case Reports

New Frontiers in Ophthalmology

Case Reports in Ophthalmological Medicine

Purpose. To study the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary eye c... more Purpose. To study the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary eye center in Nepal. Methods. Baseline demographic details and clinical features of six patients diagnosed as VKH in a tertiary eye center were retrospectively reviewed. Examinations included best corrected visual acuity, intraocular pressure, and slit lamp examination of anterior and posterior segments. Baseline blood investigations, chest X-ray, fundus photography, and fundus fluorescent angiography (FFA) were performed on all the patients. Results. The mean age at presentation was 46 ± 8.43 years with female predominance (83.3%). The disease was complete in 16.7%, incomplete in 16.7%, and probable in 66.7% of the patients. Most cases presented in acute uveitis stage (66.7%). The most common finding in acute cases was serous retinal detachment (66.7%), followed by disc edema (58.3%), whereas in chronic cases, depigmented fundus was the most common. All cases had bilateral presentation. Conc...

Journal of Nepal Health Research Council

Background: Computer vision syndrome is a common global problem among millions of computer users ... more Background: Computer vision syndrome is a common global problem among millions of computer users including medical students. Medical students are preferring soft copies rather than textbooks. The aim of this study was to assess the knowledge, attitude, and practice of MBBS students about Computer vision syndrome, and to identify its ocular morbidity among them.Methods: A descriptive cross-sectional survey based on the questionnaire was conducted among 1st- 4th year MBBS students of the Institute of Medicine and 80 students underwent detailed ocular evaluation. Results: A complete survey response was received from 236 students out of 299 students (Response Rate 80%). The mean age of MBBS students was 21.38 years ± 1.328 years and the range were 19-22 years; 76.2% were male and 23.8% were female. The majority (37.2%) spent 2-3 hours/day on the computer and had a higher risk (p-0.0001) of developing Computer vision syndrome. About 69.5% students used a computer at the level of the eye ...

Indian Journal of Ophthalmology

The American Journal of Tropical Medicine and Hygiene

American Journal of Ophthalmology Case Reports

Annals of Medicine & Surgery

Annals of Medicine & Surgery

Ophthalmology Research: An International Journal, 2014

Ocular Immunology and Inflammation, 2011

Background: The high resolution computerized tomography of chest is an important diagnostic imagi... more Background: The high resolution computerized tomography of chest is an important diagnostic imaging tool to identify any pulmonary tubercular lesion. It's role in Eales' disease to identify any possible association with pulomonary tuberculosis has not been studied earlier. So, this study was conducted to assess the role of high resolution computerized tomography (HRCT) chest in identifying tuberculous etiology in Eales' disease. Results: It was a retrospective study conducted at a tertiary care eye hospital in South India between January 2009 and October 2014 were included. A total of 29 diagnosed cases of Eales' (24 male and 5 female) were included in the study. These patients were followed up for a mean period of 739.75 days. Out of them, 13 (44.8%) had bilateral and 16 (55.2%) had unilateral ocular involvement. Eight cases (34.5%) patients had vitreous inflammation. Mantoux test was positive in 12 (41.4%) cases and chest x-ray suggestive of TB was present in four cases (13.8%). QuantiFERON TB gold was positive in 15 (51.7%) and HRCT chest suggestive of TB was positive in 15 (51.7%) case. Out of 15 Eales' cases with positive HRCT scan suggestive of TB, the commonly noted lesions were calcified nodules 34.5%, mediastinal hilar lymphadenopathy 13.8%, parenchymal soft tissue lesions in 3.4%. Five (17.2%) cases underwent pars plana vitrectomy for non resolving vitreous hemorrhage and one case underwent retinal attachment surgery with encirclage. Six patients were started on 9 months regimen of ATT by the chest physician. Final visual outcome improved in 17(40.5%) eyes, maintained in 21(50%) eyes but vision deterioration in 7(16.7%) eyes. Conclusions: HRCT chest is an important diagnostic tool to rule out pulmonary tuberculosis in Eales' disease.

Journal of Clinical Research and Ophthalmology, 2019

Ocular tuberculosis is an exigent clinical entity-lacking a distinct clinical presentation and at... more Ocular tuberculosis is an exigent clinical entity-lacking a distinct clinical presentation and attributing the diagnostic conundrum. Nevertheless, the early-precise diagnosis with implicated anti-tubercular therapy may be sight-saving; diagnostic delays often encountered due to protean clinical presentations, the impracticability of obtaining tissue (in most case), limitation on sample volume extraction, and of wanting a sensitive diagnostic test. This article revises the current scenario of ocular tuberculosis, its clinicopathologic arrays, and diagnostic challenges for clinical management; Furthermore, advocates for compiling all such positive fi ndings of corroborative tests in a precise diagnosis.

TB is one of the leading causes of morbidity and mortality worldwide. The causative agent of tube... more TB is one of the leading causes of morbidity and mortality worldwide. The causative agent of tuberculosis is Mycobacterium tuberculosis (MTB), discovered by Robert Koch in the year 1882. The World Health Organization (WHO) declared TB as a global health emergency in the year 1993. India is the country with the highest burden of TB. The World Health Organization statistics for 2015 gave an estimated incidence figure of 2.2 million cases of TB for India out of a global incidence of 9.6 million. The estimated TB prevalence in India for the year 2015 is about 2.5 million cases.

Endophthalmitis is a serious intraocular inflammatory disorder affecting the vitreous cavity that... more Endophthalmitis is a serious intraocular inflammatory disorder affecting the vitreous cavity that can result from exogenous or endogenous spread of infecting organisms into the eye [1]. It may be categorized by clinical course (acute versus chronic), by etiology (infectious versus noninfectious), by the route of entry of the causative agent (exogenous versus endogenous), and by the organism(s) causing the infection (bacteria, fungi, parasites, and, rarely, viruses). Certain organisms tend to be associated with particular clinical settings, means of intraocular access, and types of inflammation (acute, chronic non-granulomatous, chronic granulomatous, or mixed cellular response) [2].

Journal of Ophthalmic Inflammation and Infection

Background To assess the change in vision-related quality of life and psychosocial well-being of ... more Background To assess the change in vision-related quality of life and psychosocial well-being of the patients with episcleritis and scleritis patients before and after treatment. Results This one-and-a-half-year prospective study was conducted among 76 eyes of 71 new patients of episcleritis and scleritis. A structured questionnaire was used to assess the visual and to analyze the change in effect size. The male-to-female ratio was 1:1.536. Episcleritis was seen in 41 cases (57.7%) while scleritis was seen in 30 cases (42.3%). Patients with episcleritis had statistically significant improvement in general function score (GF) (p

Indian Journal of Ophthalmology, 2018

We report a case of a 47-year-old male patient presenting with diminution of vision in the left e... more We report a case of a 47-year-old male patient presenting with diminution of vision in the left eye. The left eye fundus showed yellowish lesions with indistinct geographical margin extending over the posterior pole just abutting the macula, suggestive of diffuse choroiditis. The patient gave a history of testicular swelling for the past 2 years. Aqueous tap for polymerase chain reaction analysis was positive for IS6110 mycobacterial tuberculosis (TB) genome, and a biopsy of testicular sac was suggestive of tubercular epididymitis. A diagnosis of TB-multifocal serpiginoid choroiditis was established and was managed with anti-tubercular therapy and systemic steroids.

Gems of Ophthalmology—Diseases of Uvea

American Journal of Ophthalmology Case Reports

New Frontiers in Ophthalmology

Case Reports in Ophthalmological Medicine

Purpose. To study the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary eye c... more Purpose. To study the clinical spectrum of Vogt-Koyanagi-Harada (VKH) disease in a tertiary eye center in Nepal. Methods. Baseline demographic details and clinical features of six patients diagnosed as VKH in a tertiary eye center were retrospectively reviewed. Examinations included best corrected visual acuity, intraocular pressure, and slit lamp examination of anterior and posterior segments. Baseline blood investigations, chest X-ray, fundus photography, and fundus fluorescent angiography (FFA) were performed on all the patients. Results. The mean age at presentation was 46 ± 8.43 years with female predominance (83.3%). The disease was complete in 16.7%, incomplete in 16.7%, and probable in 66.7% of the patients. Most cases presented in acute uveitis stage (66.7%). The most common finding in acute cases was serous retinal detachment (66.7%), followed by disc edema (58.3%), whereas in chronic cases, depigmented fundus was the most common. All cases had bilateral presentation. Conc...

Journal of Nepal Health Research Council

Background: Computer vision syndrome is a common global problem among millions of computer users ... more Background: Computer vision syndrome is a common global problem among millions of computer users including medical students. Medical students are preferring soft copies rather than textbooks. The aim of this study was to assess the knowledge, attitude, and practice of MBBS students about Computer vision syndrome, and to identify its ocular morbidity among them.Methods: A descriptive cross-sectional survey based on the questionnaire was conducted among 1st- 4th year MBBS students of the Institute of Medicine and 80 students underwent detailed ocular evaluation. Results: A complete survey response was received from 236 students out of 299 students (Response Rate 80%). The mean age of MBBS students was 21.38 years ± 1.328 years and the range were 19-22 years; 76.2% were male and 23.8% were female. The majority (37.2%) spent 2-3 hours/day on the computer and had a higher risk (p-0.0001) of developing Computer vision syndrome. About 69.5% students used a computer at the level of the eye ...

Indian Journal of Ophthalmology

The American Journal of Tropical Medicine and Hygiene