Sanjeeta Sitaula | Tribhuvan University (IOM) (original) (raw)

Papers by Sanjeeta Sitaula

Research paper thumbnail of Orbital apex syndrome secondary to myocysticercosis: A case report from Nepal

Annals of Medicine and Surgery

Research paper thumbnail of Binocular vision findings in normally-sighted school aged children who used digital devices

PLOS ONE, Apr 7, 2022

To determine the binocular vision status in normally-sighted school aged children who used digita... more To determine the binocular vision status in normally-sighted school aged children who used digital devices. Methods A cross-sectional study was conducted at B.P. Koirala Lions Center for Ophthalmic Studies, Kathmandu, Nepal for a duration of one year. One hundred and eighty school aged children (71 female and 109 male) aged 7 to 17 years were included in the study. All the children underwent detailed ophthalmic and binocular vision examinations. The duration of the use of digital devices by the children were asked to either the parents or guardians present at the time of the study. The study participants were divided into two groups: children who used digital devices for the last six months (users group) and those who hadn't used digital devices for the last six months (non users group). The users group was again divided into two subgroups: children who used digital devices for less than 3 hours per day and a day per week (low digital device users subgroup) and children who used digital devices for more than 3 hours per day and all days in a week (high digital device users subgroup). Results Accommodative amplitudes, accommodative facility, and positive fusional vergence for both near and distance were significantly reduced in the high digital device users group than in the low digital device users subgroup (p <0.01). Stereo acuity, near point of convergence, and negative fusional vergences for both near and distance were not statistically significantly different between the two subgroups. Prevalence of accommodative and vergence anomalies (except convergence insufficiency) was more in the high digital device users subgroup than in the low digital device users subgroup (p<0.01).

Research paper thumbnail of Management of unusual missed diagnosis of a Intra-orbital wooden foreign body: A case report and review of literature

Annals of Medicine and Surgery

Research paper thumbnail of Panophthalmitis secondary to retained intraocular foreign body amidst a national lockdown during the COVID-19 pandemic: A case series and review of literature

Annals of Medicine and Surgery

Research paper thumbnail of Optic neuropathy induced by ethambutol: A rare case from Nepal

Annals of Medicine and Surgery

Research paper thumbnail of Clinical Evaluation and Treatment Outcome of Traumatic Optic Neuropathy in Nepal: A Retrospective Case Series

Neuro-Ophthalmology, 2017

This study aims to report the clinical features and role of different treatment modalities in fin... more This study aims to report the clinical features and role of different treatment modalities in final visual outcome in traumatic optic neuropathy (TON). The authors retrospectively reviewed the records of patients with TON over 4 years. There were 37 patients of unilateral TON. Mean age was 28.70 ± 15.20 years (range: 8-90) and 89% (n = 33) were males. Road traffic accident was the common cause (43.2%), followed by fall injury (35.1%). There was improvement of visual acuity in 51.4% (n = 19) cases. Out of different treatment modalities, high-dose intravenous methylprednisolone (1 g/day) led to significant improvement in final visual acuity (p = 0.013). There was no significant improvement in final visual outcome in patients with poor initial visual acuity and those with intracranial injuries.

Research paper thumbnail of Kayser-Fleischer Ring evaluation in Wilson's Disease in a tertiary eye care centre of Nepal

Journal of Chitwan Medical College, 2015

Wilson’s disease is a hereditary disorder of copper metabolism which is characterized by neuropsy... more 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 January2010 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-bill...

Research paper thumbnail of A Combined Intervention of Single Vision Plus Lens and Tropicamide in the Treatment of Pseudomyopia: A perspective Case Report from Nepal

Research paper thumbnail of Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

Nepalese Medical Journal, 2021

Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairmen... more Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center. Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up. Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and > 30 cm H20 in 37.5%. 15 Idiopathic Intracrani...

Research paper thumbnail of Delayed Visual Loss in a Patient with Snake Bite: Case Report of an Unusual Neuro-Ophthalmic Presentation

Case Reports in Neurology, Mar 24, 2022

Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a... more Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a 70-year-old female who developed bilateral painless loss of vision after she received treatment with anti-snake venom (ASV). She had only perception of light on assessment of visual acuity on admission which then improved drastically after administration of intravenous methylprednisolone (MP) after making the provisional diagnosis of ON on the basis of history and clinical findings of the patient. Imaging and visual-evoked potential could not be done initially, and they were done after the administration of intravenous MP which had normal findings. ASV, though being a lifesaving treatment, has been sometimes associated with ON.

Research paper thumbnail of A clinicAl ApproAch to oculAr myAstheniA grAvis

Myasthenia gravis is an autoimmune disease characterized clinically by muscle weakness and fatiga... more Myasthenia gravis is an autoimmune disease characterized clinically by muscle weakness and fatigability, caused by a reduction in the number of available acetylcholine receptors at neuromuscular junctions. The prevalence of myasthenia is 150 to 200 per million. 1 Incidence in female to male subjects is in 3:2 ratio. However, the greatest incidence in women is in the third decade in life whereas in men it is in the sixth or seventh decade. Onset may be at any age from birth to the ninth decade. 2 Ocular myasthenia accounts for 15% of all cases. Two thirds of those with initial ocular involvement develop systemic symptoms within 2 years. 3

Research paper thumbnail of Systemic Lupus Erythematosus with Antiphospholipid Syndrome Presenting as Seizure Disorder and Retinopathy

Journal of Institute of Medicine, 2015

Research paper thumbnail of Clinical Manifestation of Ocular Motor Nerve Palsies in a Tertiary Eye Hospital of Kathmandu, Nepal

Journal of Institute of Medicine, 2015

Research paper thumbnail of Recurrent Bilateral Optic Neuritis Associated with Myelin Oligodendrocyte Glycoprotein Antibody: A Case Report from Nepal

Case Reports in Neurological Medicine

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated inflammatory condition invol... more Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated inflammatory condition involving spinal cord and optic nerves. Diagnosis of NMOSD is done by aquaporin-4 antibody (AQP4) in patients with optic neuritis. Myelin oligodendrocyte glycoprotein (MOG) expressed on the oligodendrocyte cell surface and on the outermost cell surface of the myelin sheath may also be present in patients with NMOSD bilateral optic neuritis. Here, we describe a case of a thirty-nine-year-old-female with recurrent bilateral optic neuritis with positive anti-MOG antibody, and anti-MOG syndrome has not previously been reported from Nepal.

Research paper thumbnail of A Clinical Study of Optic Disc Edema in a Tertiary Eye Center of Nepal

Nepalese Journal of Ophthalmology

Purpose: To evaluate the etiology and clinical presentation of cases with optic disc edema presen... more Purpose: To evaluate the etiology and clinical presentation of cases with optic disc edema presenting to a tertiary eye center of Nepal. Background: The etiology of optic disc edema ranges from relatively benign to potentially sight and life threatening conditions. Till date very few studies have been done on disc edema in Nepal. Method: The authors conducted a prospective, descriptive study at B.P. Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Nepal. All cases with disc edema presenting to the out patient department (OPD) from January 1, 2014 to June 30, 2015 were included in the study. Results: Total 112 patients were included in the study, out of which diagnosis could be established in 99. The mean age of the patients was 32.54 ± 13.97 years with the majority being female. The most common cause of disc edema was idiopathic intracranial hypertension (IIH) (37.5%,). Majority of the patients complained of isolated diminution of vision (38.4%). Among the eyes affected, 78.3%...

Research paper thumbnail of Clinical Features and Visual outcome in Acute and Recurrent Case of Optic Neuritis

Nepal Medical Journal

Introduction: Optic neuritis is an inflammation of the optic nerve that usually affects young fem... more Introduction: Optic neuritis is an inflammation of the optic nerve that usually affects young females. In Western countries, natural history and treatment of optic neuritis(ON) has been studied extensively. However aetiology, natural history, clinical features of ON and their relation to multiple sclerosis in Asian population needs to be defined yet. Methods: 30 patients who were diagnosed as optic neuritis were included between June 2013 to December 2014 at BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). A detailed history was obtained followed by examination of anterior and posterior segment. Assessment of visual acuity, color vision, contrast sensitivity, visual evoked potential (VEP),visual field and MRI of orbit and brain was done in all cases. All patients were treated with intravenous Methylprednisolone 500mg twice daily for 3 days followed by oral steroid for 11 days which was tapered in the next 4 days.The patients were reassessed at 2 weeks, 1 month and 3months. ...

Research paper thumbnail of Bilateral viral keratitis following corneal collagen crosslinking for progressive keratoconus

Journal of Ophthalmic Inflammation and Infection

Purpose: Corneal collagen crosslinking has been proven to be a useful technique to slow the progr... more Purpose: Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus. Case report: An 18-year-old boy underwent corneal collagen crosslinking in both the eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in 5 days. Seven days later, the patient returned with severe pain, redness, and photophobia for the last 2 days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both the eyes and the corneal sensation was reduced. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment, and the cornea had a faint scar at 1 month follow-up with best-corrected visual acuity of 6/9 in both eyes with a rigid gas permeable lens. Discussion and conclusion: Ultraviolet A light could be a stimulus to trigger reactivation of latent HSV infections even in patients with no history of clinically evident herpes virus ocular infections. Early diagnosis and timely treatment can have good visual outcome. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.

Research paper thumbnail of <p>Corneal deposition of fluoroquinolones after penetrating keratoplasty: case series</p>

International Medical Case Reports Journal

Purpose: To report three cases of fluroquinolone deposition in the cornea after topical administr... more Purpose: To report three cases of fluroquinolone deposition in the cornea after topical administration post-penetrating keratoplasty. Case reports: Herein we report three patients ranging in age from 42-65 years who underwent keratoplasty with cataract extraction, with intraocular lens implantation in the first two cases and left aphakic due to a posterior capsular tear in the third case. The first two patients received ciprofloxacin-dexamethasone combination drops, and developed drug deposition, which was observed at the first follow-up after 7 and 10 days respectively. The third patient received prednisolone acetate and ofloxacin eyedrops postoperatively, and developed drug deposits in the cornea after 20 days. In all of the three patients, the fluroquinolone group of drugs was discontinued and the cornea cleared gradually over the next 3-4 weeks. Although the cornea cleared, the first two grafts failed due to recurrent viral infection in one case, and graft rejection in the other case. Conclusion: Deposition of many different fluroquinolones in the cornea has been reported after a variety of surgeries, including penetrating keratoplasty. Drug deposition postpenetrating keratoplasty may seem innocuous due to self-resolution on cessation of the drugs, but it may have deleterious effects on graft survival. Hence, fluroquinolones, especially ciprofloxacin, should be cautiously used in patients undergoing penetrating keratoplasty if frequent dosing is prescribed or if used concurrently with other topical medications containing preservatives.

Research paper thumbnail of Visual Outcome of Descemet Membrane Endothelial Keratoplasty during the Learning Curve in Initial Fifty Cases

Journal of Ophthalmology

This study was performed to evaluate the clinical outcomes of the first fifty patients who underw... more This study was performed to evaluate the clinical outcomes of the first fifty patients who underwent Descemet membrane endothelial keratoplasty (DMEK) during the 3-month postoperative period and to describe the challenges encountered during the learning curve. In this retrospective study, we reviewed the charts of patients who underwent DMEK. All information regarding patient demographics, indication for surgery, preoperative and postoperative visual acuity at 3 months, donor age, and complications encountered intraoperatively and postoperatively was recorded. Donor endothelial cell count at the time of surgery and during the 3-month follow-up was noted. Data were analyzed using SPSS version 17. Fifty eyes of 49 patients were included in the study with majority being female patients (male : female = 2 : 3). Mean age of patients was 56.8 ± 11.4 years with the age range of 22–78 years. The common indications for DMEK were pseudophakic bullous keratopathy –57.1%, Fuchs endothelial dyst...

Research paper thumbnail of Optic disc drusen presenting as papilledema: a case report

Journal of Chitwan Medical College, 2014

Optic disc drusens, which are congenital anomalies of optic nerve head, are depositions of mucopo... more Optic disc drusens, which are congenital anomalies of optic nerve head, are depositions of mucopolysaccharides and proteinaceous material within the optic nerve head. They are usually bilateral and diagnosed incidentally during routine fundus examination where they may be mistaken for papilledema. We report a case of 63 year old female referred to the neuroophthalmology department with the clinical suspicion of disc edema. Simple noninvasive investigations like ultrasound B-scan, fundus autofluorescene along with the newer test like spectral domain optical coherence tomography helped us to diagnose it as a case of pseudopapilledema, as optic disc drusen. Thus, a high index of suspicion along with the ancillary tests is helpful in differentiating optic disc drusen from true papilledema.

Research paper thumbnail of Orbital apex syndrome secondary to myocysticercosis: A case report from Nepal

Annals of Medicine and Surgery

Research paper thumbnail of Binocular vision findings in normally-sighted school aged children who used digital devices

PLOS ONE, Apr 7, 2022

To determine the binocular vision status in normally-sighted school aged children who used digita... more To determine the binocular vision status in normally-sighted school aged children who used digital devices. Methods A cross-sectional study was conducted at B.P. Koirala Lions Center for Ophthalmic Studies, Kathmandu, Nepal for a duration of one year. One hundred and eighty school aged children (71 female and 109 male) aged 7 to 17 years were included in the study. All the children underwent detailed ophthalmic and binocular vision examinations. The duration of the use of digital devices by the children were asked to either the parents or guardians present at the time of the study. The study participants were divided into two groups: children who used digital devices for the last six months (users group) and those who hadn't used digital devices for the last six months (non users group). The users group was again divided into two subgroups: children who used digital devices for less than 3 hours per day and a day per week (low digital device users subgroup) and children who used digital devices for more than 3 hours per day and all days in a week (high digital device users subgroup). Results Accommodative amplitudes, accommodative facility, and positive fusional vergence for both near and distance were significantly reduced in the high digital device users group than in the low digital device users subgroup (p <0.01). Stereo acuity, near point of convergence, and negative fusional vergences for both near and distance were not statistically significantly different between the two subgroups. Prevalence of accommodative and vergence anomalies (except convergence insufficiency) was more in the high digital device users subgroup than in the low digital device users subgroup (p<0.01).

Research paper thumbnail of Management of unusual missed diagnosis of a Intra-orbital wooden foreign body: A case report and review of literature

Annals of Medicine and Surgery

Research paper thumbnail of Panophthalmitis secondary to retained intraocular foreign body amidst a national lockdown during the COVID-19 pandemic: A case series and review of literature

Annals of Medicine and Surgery

Research paper thumbnail of Optic neuropathy induced by ethambutol: A rare case from Nepal

Annals of Medicine and Surgery

Research paper thumbnail of Clinical Evaluation and Treatment Outcome of Traumatic Optic Neuropathy in Nepal: A Retrospective Case Series

Neuro-Ophthalmology, 2017

This study aims to report the clinical features and role of different treatment modalities in fin... more This study aims to report the clinical features and role of different treatment modalities in final visual outcome in traumatic optic neuropathy (TON). The authors retrospectively reviewed the records of patients with TON over 4 years. There were 37 patients of unilateral TON. Mean age was 28.70 ± 15.20 years (range: 8-90) and 89% (n = 33) were males. Road traffic accident was the common cause (43.2%), followed by fall injury (35.1%). There was improvement of visual acuity in 51.4% (n = 19) cases. Out of different treatment modalities, high-dose intravenous methylprednisolone (1 g/day) led to significant improvement in final visual acuity (p = 0.013). There was no significant improvement in final visual outcome in patients with poor initial visual acuity and those with intracranial injuries.

Research paper thumbnail of Kayser-Fleischer Ring evaluation in Wilson's Disease in a tertiary eye care centre of Nepal

Journal of Chitwan Medical College, 2015

Wilson’s disease is a hereditary disorder of copper metabolism which is characterized by neuropsy... more 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 January2010 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-bill...

Research paper thumbnail of A Combined Intervention of Single Vision Plus Lens and Tropicamide in the Treatment of Pseudomyopia: A perspective Case Report from Nepal

Research paper thumbnail of Clinical Manifestations, Neuroimaging Findings, and Treatment of Idiopathic Intracranial Hypertension in a Nepalese Tertiary Centre

Nepalese Medical Journal, 2021

Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairmen... more Introduction: Idiopathic Intracranial Hypertension is characterized by headache, visual impairment, papilledema, and increased cerebrospinal fluid opening pressure. We aim to evaluate clinical manifestations, neuroimaging findings, and treatment of Idiopathic Intracranial Hypertension in a Nepalese tertiary center. Materials and Methods: We retrospectively included patients with the diagnosis of Idiopathic Intracranial Hypertension who were admitted to the Neurology department of Tribhuvan University Teaching Hospital from 2019 June to 2021 May and presented to the Neuro-ophthalmology outpatient clinic of the hospital for follow-up. Results: Out of 16 Idiopathic Intracranial Hypertension patients, 12(75%) patients had either headache or ocular pain. Reduced visual acuity and progressive visual loss were found in 44% of patients. Normal CSF opening pressure was found in 19%, 44% had CSF opening pressure at a range of 20-30 cm H20 and > 30 cm H20 in 37.5%. 15 Idiopathic Intracrani...

Research paper thumbnail of Delayed Visual Loss in a Patient with Snake Bite: Case Report of an Unusual Neuro-Ophthalmic Presentation

Case Reports in Neurology, Mar 24, 2022

Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a... more Neurotoxin-related optic neuritis (ON) after snake bite is uncommon. Here, we present a case of a 70-year-old female who developed bilateral painless loss of vision after she received treatment with anti-snake venom (ASV). She had only perception of light on assessment of visual acuity on admission which then improved drastically after administration of intravenous methylprednisolone (MP) after making the provisional diagnosis of ON on the basis of history and clinical findings of the patient. Imaging and visual-evoked potential could not be done initially, and they were done after the administration of intravenous MP which had normal findings. ASV, though being a lifesaving treatment, has been sometimes associated with ON.

Research paper thumbnail of A clinicAl ApproAch to oculAr myAstheniA grAvis

Myasthenia gravis is an autoimmune disease characterized clinically by muscle weakness and fatiga... more Myasthenia gravis is an autoimmune disease characterized clinically by muscle weakness and fatigability, caused by a reduction in the number of available acetylcholine receptors at neuromuscular junctions. The prevalence of myasthenia is 150 to 200 per million. 1 Incidence in female to male subjects is in 3:2 ratio. However, the greatest incidence in women is in the third decade in life whereas in men it is in the sixth or seventh decade. Onset may be at any age from birth to the ninth decade. 2 Ocular myasthenia accounts for 15% of all cases. Two thirds of those with initial ocular involvement develop systemic symptoms within 2 years. 3

Research paper thumbnail of Systemic Lupus Erythematosus with Antiphospholipid Syndrome Presenting as Seizure Disorder and Retinopathy

Journal of Institute of Medicine, 2015

Research paper thumbnail of Clinical Manifestation of Ocular Motor Nerve Palsies in a Tertiary Eye Hospital of Kathmandu, Nepal

Journal of Institute of Medicine, 2015

Research paper thumbnail of Recurrent Bilateral Optic Neuritis Associated with Myelin Oligodendrocyte Glycoprotein Antibody: A Case Report from Nepal

Case Reports in Neurological Medicine

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated inflammatory condition invol... more Neuromyelitis optica spectrum disorder (NMOSD) is an immune-mediated inflammatory condition involving spinal cord and optic nerves. Diagnosis of NMOSD is done by aquaporin-4 antibody (AQP4) in patients with optic neuritis. Myelin oligodendrocyte glycoprotein (MOG) expressed on the oligodendrocyte cell surface and on the outermost cell surface of the myelin sheath may also be present in patients with NMOSD bilateral optic neuritis. Here, we describe a case of a thirty-nine-year-old-female with recurrent bilateral optic neuritis with positive anti-MOG antibody, and anti-MOG syndrome has not previously been reported from Nepal.

Research paper thumbnail of A Clinical Study of Optic Disc Edema in a Tertiary Eye Center of Nepal

Nepalese Journal of Ophthalmology

Purpose: To evaluate the etiology and clinical presentation of cases with optic disc edema presen... more Purpose: To evaluate the etiology and clinical presentation of cases with optic disc edema presenting to a tertiary eye center of Nepal. Background: The etiology of optic disc edema ranges from relatively benign to potentially sight and life threatening conditions. Till date very few studies have been done on disc edema in Nepal. Method: The authors conducted a prospective, descriptive study at B.P. Koirala Lions Center for Ophthalmic Studies (BPKLCOS), Nepal. All cases with disc edema presenting to the out patient department (OPD) from January 1, 2014 to June 30, 2015 were included in the study. Results: Total 112 patients were included in the study, out of which diagnosis could be established in 99. The mean age of the patients was 32.54 ± 13.97 years with the majority being female. The most common cause of disc edema was idiopathic intracranial hypertension (IIH) (37.5%,). Majority of the patients complained of isolated diminution of vision (38.4%). Among the eyes affected, 78.3%...

Research paper thumbnail of Clinical Features and Visual outcome in Acute and Recurrent Case of Optic Neuritis

Nepal Medical Journal

Introduction: Optic neuritis is an inflammation of the optic nerve that usually affects young fem... more Introduction: Optic neuritis is an inflammation of the optic nerve that usually affects young females. In Western countries, natural history and treatment of optic neuritis(ON) has been studied extensively. However aetiology, natural history, clinical features of ON and their relation to multiple sclerosis in Asian population needs to be defined yet. Methods: 30 patients who were diagnosed as optic neuritis were included between June 2013 to December 2014 at BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). A detailed history was obtained followed by examination of anterior and posterior segment. Assessment of visual acuity, color vision, contrast sensitivity, visual evoked potential (VEP),visual field and MRI of orbit and brain was done in all cases. All patients were treated with intravenous Methylprednisolone 500mg twice daily for 3 days followed by oral steroid for 11 days which was tapered in the next 4 days.The patients were reassessed at 2 weeks, 1 month and 3months. ...

Research paper thumbnail of Bilateral viral keratitis following corneal collagen crosslinking for progressive keratoconus

Journal of Ophthalmic Inflammation and Infection

Purpose: Corneal collagen crosslinking has been proven to be a useful technique to slow the progr... more Purpose: Corneal collagen crosslinking has been proven to be a useful technique to slow the progression of keratoconus. With its increasing use, we are encountering rare complications. We describe a case that developed bilateral viral keratitis after corneal collagen crosslinking with riboflavin and ultraviolet A for progressive keratoconus. Case report: An 18-year-old boy underwent corneal collagen crosslinking in both the eyes at the same setting for bilateral progressive keratoconus. He was discharged with a soft bandage contact lens and asked to follow up in 5 days. Seven days later, the patient returned with severe pain, redness, and photophobia for the last 2 days. The bandage contact lens was removed. There was a central corneal lesion in a branching dendritic pattern in both the eyes and the corneal sensation was reduced. Based on the findings, a clinical diagnosis of bilateral viral keratitis was made. The dendrite healed completely in 10 days with oral and topical acyclovir treatment, and the cornea had a faint scar at 1 month follow-up with best-corrected visual acuity of 6/9 in both eyes with a rigid gas permeable lens. Discussion and conclusion: Ultraviolet A light could be a stimulus to trigger reactivation of latent HSV infections even in patients with no history of clinically evident herpes virus ocular infections. Early diagnosis and timely treatment can have good visual outcome. Prophylactic antiviral medication may be useful to prevent this complication in individuals with prior history of viral keratitis.

Research paper thumbnail of <p>Corneal deposition of fluoroquinolones after penetrating keratoplasty: case series</p>

International Medical Case Reports Journal

Purpose: To report three cases of fluroquinolone deposition in the cornea after topical administr... more Purpose: To report three cases of fluroquinolone deposition in the cornea after topical administration post-penetrating keratoplasty. Case reports: Herein we report three patients ranging in age from 42-65 years who underwent keratoplasty with cataract extraction, with intraocular lens implantation in the first two cases and left aphakic due to a posterior capsular tear in the third case. The first two patients received ciprofloxacin-dexamethasone combination drops, and developed drug deposition, which was observed at the first follow-up after 7 and 10 days respectively. The third patient received prednisolone acetate and ofloxacin eyedrops postoperatively, and developed drug deposits in the cornea after 20 days. In all of the three patients, the fluroquinolone group of drugs was discontinued and the cornea cleared gradually over the next 3-4 weeks. Although the cornea cleared, the first two grafts failed due to recurrent viral infection in one case, and graft rejection in the other case. Conclusion: Deposition of many different fluroquinolones in the cornea has been reported after a variety of surgeries, including penetrating keratoplasty. Drug deposition postpenetrating keratoplasty may seem innocuous due to self-resolution on cessation of the drugs, but it may have deleterious effects on graft survival. Hence, fluroquinolones, especially ciprofloxacin, should be cautiously used in patients undergoing penetrating keratoplasty if frequent dosing is prescribed or if used concurrently with other topical medications containing preservatives.

Research paper thumbnail of Visual Outcome of Descemet Membrane Endothelial Keratoplasty during the Learning Curve in Initial Fifty Cases

Journal of Ophthalmology

This study was performed to evaluate the clinical outcomes of the first fifty patients who underw... more This study was performed to evaluate the clinical outcomes of the first fifty patients who underwent Descemet membrane endothelial keratoplasty (DMEK) during the 3-month postoperative period and to describe the challenges encountered during the learning curve. In this retrospective study, we reviewed the charts of patients who underwent DMEK. All information regarding patient demographics, indication for surgery, preoperative and postoperative visual acuity at 3 months, donor age, and complications encountered intraoperatively and postoperatively was recorded. Donor endothelial cell count at the time of surgery and during the 3-month follow-up was noted. Data were analyzed using SPSS version 17. Fifty eyes of 49 patients were included in the study with majority being female patients (male : female = 2 : 3). Mean age of patients was 56.8 ± 11.4 years with the age range of 22–78 years. The common indications for DMEK were pseudophakic bullous keratopathy –57.1%, Fuchs endothelial dyst...

Research paper thumbnail of Optic disc drusen presenting as papilledema: a case report

Journal of Chitwan Medical College, 2014

Optic disc drusens, which are congenital anomalies of optic nerve head, are depositions of mucopo... more Optic disc drusens, which are congenital anomalies of optic nerve head, are depositions of mucopolysaccharides and proteinaceous material within the optic nerve head. They are usually bilateral and diagnosed incidentally during routine fundus examination where they may be mistaken for papilledema. We report a case of 63 year old female referred to the neuroophthalmology department with the clinical suspicion of disc edema. Simple noninvasive investigations like ultrasound B-scan, fundus autofluorescene along with the newer test like spectral domain optical coherence tomography helped us to diagnose it as a case of pseudopapilledema, as optic disc drusen. Thus, a high index of suspicion along with the ancillary tests is helpful in differentiating optic disc drusen from true papilledema.