Tilganga Institute of Ophthalmology

Background : Microsporidial keratoconjunctivitis (MKC) is relatively common, frequently misdiagnosed and occasionally persistent to conservative treatment. This paper aimed to report the outcome of treatment regimen in the management of microsporidial keratoconjunctivitis during Monsoon season in a tertiary eye hospital in Nepal. Methods : The study was a retrospective case series. Twenty-two patients with MKC were studied regarding the clinical response toward the combination of Moxifloxacin 0.5%, Voriconazole 1%, and oral Albendazole 400mg. Corneal epithelial debridement was done selectively in case with confluent and collective MKC lesions. Topical Prednisolone Acetate 1% was added when the MKC lesion resolved. All cases were observed during follow-up regarding the duration from treatment to the resolution of MKC lesions and the resolution of all corneal lesions. Results : Mean ± SD age of participants was 38.7 ± 13.1 years. Male and female participants accounted for 59.1% and 40.9%, respectively. Gram’s stain positive for microsporidial spores was presented in 72.7%. Exposure to topical steroid, rain water and mud were found only in 59.1%, 18.2% and 13.6%, respectively. Median duration to microsporidial lesions resolution (min to max) and medianduration to total resolution (min to max) were 5.0 (2.0 to 9.0) days and 14.0 (7 to 21) days, respectively. No patient with debridement had persistent epithelial defect or secondary infection. All patients did not have any adverse reaction. Conclusion : The combination of moxifloxacin, voriconazole, and albendazole is safe and effective in the treatment of MKC. Debridement might be effective in early removal of MKC lesion. However, its benefit does not outweigh the painful experience and the risk of secondary infection.

CLINICAL RELEVANCE:Patient-reported visual symptoms provide important information that may not be captured by clinical tests alone. Standardised symptom questionnaires can support the assessment of visual complaints associated with refractive, accommodative, and binocular vision dysfunctions in routine optometric practice. BACKGROUND:Patient-reported symptom questionnaires are valuable instruments for assessing visual symptoms associated with visual dysfunctions; however, cultural and linguistic adaptation is essential to ensure measurement validity. The Symptom Questionnaire for Visual Dysfunctions (SQVD) has demonstrated strong psychometric properties in previous validations but has not yet been validated in the Nepalese population. METHODS:A multicentre, cross-sectional validation study was conducted in six eye hospitals in Nepal. Adults aged 18-65 years completed the Nepali version of the SQVD and underwent comprehensive clinical examination to establish visual function status. Psychometric evaluation was performed using Rasch analysis. Diagnostic accuracy was assessed using receiver operating characteristic analysis. RESULTS:The study included 305 participants (mean age 32.9 ± 11.2 years; 60.7% male). Rasch analysis demonstrated good item fit, ordered response categories, unidimensionality, and adequate person (0.81) and item (0.84) reliability. No meaningful differential item functioning by gender was detected. Item-total correlations ranged from 0.326 to 0.613 (p < 0.001). The SQVD showed good diagnostic accuracy (area under the curve = 0.834), with an optimal cut-off score of ≥6, yielding sensitivity of 0.714 and specificity of 0.775. CONCLUSIONS:The Nepali version of SQVD demonstrates robust psychometric properties and good diagnostic performance, supporting its use as a standardised instrument for assessing visual symptoms associated with visual dysfunctions in adult clinical populations in Nepal.

Aim To find out the complications of first horizontal strabismus surgery at a tertiary eye hospital in Nepal Methods 194 patients with follow-up periods of 6 weeks to 3 months were retrieved from 2017 to 2020 from the electronic medical record. were reviewed retrospectively at Tilganga Institute of Ophthalmology (TIO) Results The majority of the patients were between the ages of 6 and 18 years old (59.6%), followed by those aged 18-53 years (40.4%). There was a female preponderance. Out of 194 patients, 19 (9.8%) persons (eyes: 23, 11.9%) developed complications. Five patients had conjunctival wound dehiscence. Four patients developed conjunctival cysts, raised IOP was seen in four patients. Four patients developed postoperative diplopia. Three had corneal epithelial defects, two had corneal dellen, and a single patient had suture granuloma. Conclusion Common complications, such as conjunctival injection, scarring, dellen, cysts, and pyogenic granulomas, usually resolve with conservative management over time. Vision-threatening complications are rare after strabismus surgery. Damage to ocular structures can be prevented by employing meticulous surgical techniques. Close monitoring and vigilant postoperative care are necessary.

ObjectiveThe global increase in life expectancy has led to more visual impairment, significantly impacting the quality of life and daily activities of individuals living across the world's continents. This study aims to develop an ICF Core Set Vision Loss for the adult life span, providing a global perspective on the functional challenges faced by individuals with vision impairment. As part of its development, the aim was to understand the impact of vision loss on the lives and functioning of individuals with vision impairment from their own perspectives.MethodA cross-sectional qualitative study was performed, using a thematic analysis of data that was gathered through an online survey across the six World Health Organization regions and in-depth interviews. Meaningful concepts were linked to the ICF categories based on available linking rules.ResultsAnalyses of the online surveys with 663 participants in 59 countries and 100 in-depth interviews in Nepal and India resulted in 7652 meaningful concepts that could be linked to 148 ICF categories: 9% related to body functions and structures, 49% to activities and participation and 42% to environmental factors. Key findings regarding body functions and structures included a focus on emotional functions, confidence and energy levels. For activities and participation, major concerns were recreation, transportation and employment. Environmental factors highlighted the importance of family and technology.ConclusionThis study underscores the complex challenges faced by individuals with vision loss, encompassing emotional, psychological, environmental and participation-related aspects. These insights highlight the need for tailored assessments, interventions and comprehensive support systems. By comparing these findings with those from other preparatory studies, these results contribute to a deeper understanding of the lived experience of vision loss and provide an essential step in the future development of the ICF Core Set for Vision Loss.

Purpose:To identify potential infectious agents in cases of seasonal hyperacute panuveitis syndrome (SHAPU) from vitreous biopsies of patients with this disorder. Design:A retrospective cohort analysis. Subjects:Vitreous biopsies were obtained during the course of care from 53 subjects with SHAPU. Methods:DNA extraction and whole genome shotgun sequencing was performed using Oxford Nanopore long read sequencing. Sequences were matched against microbial and human databases. Visual outcomes at presentation and at 6 months were recorded. Main Outcome Measures:Identification and characterization of metagenomic sequences in vitreous isolates from subjects with SHAPU. Results:Adequate DNA for sequencing was obtained from 32 SHAPU subjects. Fifteen samples yielded bacteria on culture, with 14 S. pneumoniae and 1 S. aureus isolate recovered. Bacterial DNA was detected by whole genome sequencing in 29 of 32 cases. S. pneumoniae was the predominant organism recovered. Bacterial genomic loads ranged up to 10 000 bacteria/human cell, indicating active infection. No pathogens were detected in control samples. Reconstruction of bacterial genome was possible in 7 SHAPU cases and indicated diverse S. pneumoniae subtypes associated with individual cases. Sufficient DNA remained for analysis of torque teno virus by qualitative polymerase chain reaction in 17 cases, of which 13 were positive. Visual outcomes were mixed, with 7 patients having hypotonous eyes at 6 months, but 8 patients having better than 20/200 vision. No relationship could be discerned between presenting bacterial load and visual outcome. Conclusions:The majority of SHAPU cases show molecular evidence for concurrent S. pneumoniae infection. Good visual results are possible in treating SHAPU as endophthalmitis. Financial Disclosures:The authors have no proprietary or commercial interest in any materials discussed in this article.