{"title":"Topical Atropine Induced Acute Psychosis - A case report.","authors":"Rabindra Singh Thakuri, Deepak Dhakal, Sagar Tiwari, Polina Dahal, Kaushal Pokhrel, Sanjeeb Bhandari","doi":"10.3126/nepjoph.v16i1.76997","DOIUrl":"10.3126/nepjoph.v16i1.76997","url":null,"abstract":"<p><strong>Introduction: </strong>Atropine, an anticholinergic agent is widely used topical agent in ophthalmology practice. We present a case report on central anticholinergic syndrome in a patient receiving topical atropine. Case and observation: An eighty-two years old female who had received a penetrating keratoplasty five years ago in the left eye for non-healing corneal ulcer which had failed within 6 months presented with long standing pain in the eye. She was on topical carboxymethylcellulose 1% and moxifloxacin since the last two weeks and was against the advice for evisceration. We used 1% atropine sulphate eyedrops thrice daily for persistent pain of the left eye. Three days after using topical atropine, she developed acute psychomotor agitation, disorientation, confusion and lack of insight with visual hallucination and lowered level of consciousness. These symptoms resolved after cessation of topical atropine and reappeared on its use. A single dose rechallenge under the supervision of a psychiatrist confirmed that the acute psychosis was induced by topical atropine. The reaction was definite according to Naranjo's algorithm.</p><p><strong>Conclusion: </strong>The present case shows that a patient on topical atropine can experience central nervous system side effects seen with systemic absorption. The possibilities of such side effects warrants discussion in patients receiving the medication in routine ophthalmology practice.</p>","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"16 31","pages":"98-102"},"PeriodicalIF":0.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anadi Khatri, Shanti Gurung, Ranju Kharel Sitaula, Sweta Singh, Anh N T Tran, Amir Akhavanrezayat
{"title":"Beauty of Black and White: Autofluorescence-aided Differentiation of Serpiginous Choroiditis from Tubercular Serpiginous-Like Choroiditis.","authors":"Anadi Khatri, Shanti Gurung, Ranju Kharel Sitaula, Sweta Singh, Anh N T Tran, Amir Akhavanrezayat","doi":"10.3126/nepjoph.v16i1.76996","DOIUrl":"10.3126/nepjoph.v16i1.76996","url":null,"abstract":"<p><strong>Introduction: </strong>FAF is non-invasive, and important adjunctive tool to evaluate the progression of lesions in patients with SC. FAF can even help distinguish probable etiology by specific pattern recognition. The current index study analyzed and reported the strength of specific patterns to be more representative of SC or TB SLC.</p><p><strong>Objective: </strong>To characterize fundus autofluorescence (FAF) images for differentiating serpiginous choroiditis (SC) from tubercular serpiginous-like choroiditis (TB SLC).</p><p><strong>Methodology: </strong>The index study is a retrospective comparative analysis of FAF images of 25 consecutive patients, 11 with TB SLC and 14 with SC. The diagnosis of SC was made based on the clinical appearance and FAF findings, while TB SLC was additionally considered in patients with positive laboratory investigations and/or radiological tests for tuberculosis (TB) exposure or infection and therapeutic response to anti-tubercular therapy. The characteristic features evaluated on FAF images were centrality, multifocality, and parapapillary involvement of the lesion with or without extension.</p><p><strong>Result: </strong>Twenty-five patients (13 males, 12 females) with a mean age of 46.2 (SD 10.08) years were enrolled in the study. SC lesions were more central (ρ=0.92) and confluent (ρ=0.774). Parapapillary involvement was found to be associated with SC (ρ=0.690), and with extensions of the lesions along the arcades or the macular region, the association increased (ρ=0.786). Multifocality with peripheral lesions was negatively associated with SC (ρ=- 0.831).</p><p><strong>Conclusion: </strong>Centrally involving lesions with confluency on FAF is strongly associated with SC. Parapapillary involvement alone is considered characteristic for SC, but the current study has demonstrated that extension of this lesion along the arcades or the macular region is even more characteristic for SC.</p>","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"16 31","pages":"62-73"},"PeriodicalIF":0.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Treatment Outcome of Subthreshold Micropulse Green Laser SMGL (532 nm) in Chronic Central Serous Chorioretinopathy.","authors":"Ichhya Joshi, Lalit Agarwal, Deepti Pradhan, Archana Kumari Prasad","doi":"10.3126/nepjoph.v16i1.60266","DOIUrl":"10.3126/nepjoph.v16i1.60266","url":null,"abstract":"<p><strong>Introduction: </strong>Subthreshold micropulse green laser (532nm) is effective for treatment of chronic CSCR with promising results.</p><p><strong>Objectives: </strong>To assess the treatment outcome of a single session subthreshold micropulse green laser (SMGL) 532nm in chronic central serous chorioretinopathy (CSCR).</p><p><strong>Methods: </strong>This was a prospective noncomparative consecutive case series. Eyes with chronic CSCR were treated with SMGL and evaluated at 1- and 3-months post laser. Best Corrected Visual Acuity (BCVA) and Central Macular Thickness (CMT), and Subretinal Fluid Height (SFR) following laser were evaluated.</p><p><strong>Results: </strong>A total of 16 eyes of 13 patients with the diagnosis of chronic CSCR were enrolled in this study. The mean age of the patients was 45 years (range 31-60 years). All of the patients had a history of CSCR of more than 4 months duration (mean 7.9 months ± 3.01). The median baseline BCVA was 0.4 log MAR which improved to 0.25 log MAR. Of the 16 eyes, 1 eye had 3 lines of improvement (6.25%), 4 eyes had 2 lines of improvement (25%), and 3 eyes had 1 line of improvement (18.75%) and 8 eyes-maintained vision (50%). The mean SRF height pre and post laser was 191.813 µm and 54.93 µm, respectively (P<0.001). Similarly, the mean CMT pre and post laser was 328.18 µm and 242.87 µm, respectively (P<0.009). There was complete resolution of PED in 3 out of 5 eyes (60%).</p><p><strong>Conclusion: </strong>Subthreshold micropulse green laser (532nm) is effective for treatment of chronic CSCR with promising results.</p>","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"16 31","pages":"20-30"},"PeriodicalIF":0.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rozaliya Hristova, Nevyana Veleva, Alexander Oscar, Svetoslav Slavchev, Yani Zdravkov
{"title":"TIMP3 c.319C>T, p.(Arg107Cys): Novel Sequence Variant In Sorsby Fundus Dystrophy.","authors":"Rozaliya Hristova, Nevyana Veleva, Alexander Oscar, Svetoslav Slavchev, Yani Zdravkov","doi":"10.3126/nepjoph.v16i1.63004","DOIUrl":"10.3126/nepjoph.v16i1.63004","url":null,"abstract":"<p><strong>Introduction: </strong>Sorsby fundus dystrophy is a rare autosomal dominant inherited retinal disease. The purpose of this case report is providing evidence to link the novel variant TIMP3 c.319C>T, p.(Arg107Cys), classified as variant of uncertain significance, to the clinical phenotype and to consider assignment of pathogenicity.</p><p><strong>Case: </strong>Thorough history and comprehensive ophthalmological exam of a 51-year old female with presenile cataract and difficulty in night vision were conducted. Visual acuity was 0.15 logMAR and 0.05 logMAR in the right and left eye, respectively.</p><p><strong>Observations: </strong>The examination was remarkable for pseudophakia in the left eye and bilateral drusenoid deposits. Visual fields demonstrated reduced retinal sensitivity. Optical coherence tomography showed drusen in the periphery. Fundus autofluorescence demonstrated corresponding hyper-autofluorescence. Electroretinography depicted reduced bioelectrical activity for scotopic conditions. Genetic testing identified a heterozygous missense, splice region variant TIMP3 c.319C>T, p.(Arg107Cys), which is a variant of uncertain significance and no other possible disease causing mutations.</p><p><strong>Conclusion: </strong>Based on our findings we propose assignment of pathogenicity to the novel variant TIMP3 c.319C>T, p.(Arg107Cys) as likely pathogenic in Sorsby Fundus Dystrophy.</p>","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"16 31","pages":"87-93"},"PeriodicalIF":0.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is 0.01% Atropine Eye Drop Safe and Effective in Slowing Myopia Progression in Nepalese Children?","authors":"Safal Khanal, Nabin Paudel","doi":"10.3126/nepjoph.v16i1.62540","DOIUrl":"10.3126/nepjoph.v16i1.62540","url":null,"abstract":"","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"16 31","pages":""},"PeriodicalIF":0.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144718880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sumit Pandey, R. Kharel Sitaula, Sagun Narayan Joshi
{"title":"Changes in Central Corneal Thickness, Corrected Intraocular Pressure, and Iridocorneal Angle in Unilateral Acute Anterior Uveitis","authors":"Sumit Pandey, R. Kharel Sitaula, Sagun Narayan Joshi","doi":"10.3126/nepjoph.v15i1.49142","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49142","url":null,"abstract":"Introduction: The release of inflammatory mediators in the anterior chamber can lead to the structural alteration of the corneal and uveal tissue. Objectives: To compare the changes in Central Corneal Thickness (CCT), corrected Intraocular Pressure (cIOP) and Iridocorneal Angle (ICA) in unilateral acute anterior uveitis (AAU) before and after treatment. Materials and methods: The study was a hospital based comparative study conducted between July 2018 to June 2019. Newly diagnosed, untreated unilateral Acute Anterior Uveitis (AAU) adult cases above 16 years were included in the study. Ethical clearance was obtained from the Institutional Review Committee of Institute of Medicine. Eighty-two unilateral AAU cases (Total 164 eyes including 82 unaffected were analyzed) underwent Goldmann applanation tonometry (GAT) and corneal topography at presentation and three weeks after treatment. The cIOP was calculated by the Ehlers formula. Results: The mean CCT of affected eyes was greater (563.84±51.49μm) compared to unaffected eyes (535.99±31.48μm) before treatment (p=0.001) and was reduced (533.2±25.71μm) after treatment (p=0.01). There was no significant difference in IOP, cIOP, and ICA between the affected eyes (14.45±6.89mmHg, 13.14±7.14mmHg and 48.78±7.94°) and the unaffected eyes (14.02±2.36mmHg, 14.4±3.09mmHg, and 49.80°±8.21°) before treatment. There was no difference in IOP (14.04±2.76mmHg) and ICA (49.21°±6.72°) after treatment, however, there was a significant increase (p=0.01) in the cIOP (14.95±2.93mmHg). Conclusion: In the study, CCT of affected eyes was greater compared to unaffected eyes and reduced after treatment. There was no difference in cIOP and ICA in case eyes compared to control before treatment. However, cIOP increased after treatment.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"122 38","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Outcome of Optical Keratoplasty for Corneal Scar due to Infective Keratitis","authors":"L. Bajracharya","doi":"10.3126/nepjoph.v15i1.40632","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.40632","url":null,"abstract":"Introduction: Corneal opacity is an important cause of blindness in developing countries. Objectives: This study analyzes optical keratoplasty performed for corneal opacity due to infective keratitis. Materials and methods: This is a retrospective study of all consecutive cases of optical keratoplasty performed between 2011 and 2014 (four-year period) for healed infective keratitis. Cases with less than two months’ followup were excluded during outcome evaluation. Comparison was made between keratoplasty for Microbial and Viral (herpetic) Scar. Results: Ninety-three eyes of 93 patients were enrolled. Fifty-nine (63.4%) were male. Average age of patients was 38.9±19.5 years. Average donor endothelial cell count was 2713±434.5 cells/mm2. Fifty-four (58%) corneal scars were due to microbial keratitis and others were herpetic. Eighty-five (91.4%) had undergone penetrating keratoplasty. Eighty-eight (94.6%) cases were included for outcome analysis. Average follow-up duration was 37±27.5 months. Fifty-two (59%) had clear graft at their last visit. Twenty-three (26.1%) grafts had endothelial failure and 13 (14.7%) grafts failed due to late onset keratitis. Twenty-five (28.4%) had vision of ≥6/18. Rejection occurred in 24(27.2%) and glaucoma in 11(12.5%). Post-operatively viral keratitis in the graft occurred significantly more inViral Scar Group (38.6%, n=15) than in Microbial Scar Group (5.5%, n=3). But there was no significant difference in graft clarity, rejection, vision and secondary glaucoma between the two Groups. Conclusion: Outcome of keratoplasty for post-infectious scars was found fairly satisfactory. Although occurrence of viral keratitis was higher in case of keratoplasty done for Viral Scars, the final result was similar to that of microbial scar.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"113 32","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139134332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohan Karki, Y. Roka, A. Thapa, N. Bhattarai, S. R. Pandey
{"title":"Hyperostotic Sphenoid Wing Meningioma with Proptosis: A Rare Case Report with Literature Review","authors":"Mohan Karki, Y. Roka, A. Thapa, N. Bhattarai, S. R. Pandey","doi":"10.3126/nepjoph.v15i1.49459","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49459","url":null,"abstract":"Background: We present a case of proptosis with headache, decrease in vision and orbital pain where patient underwent sphenoid-orbital decompression, and excision of mass, resulting in significant improvement in her vision with complete resolution of proptosis, headache and orbital pain. This study was done to diagnose and evaluate clinical outcome of hyperostotic sphenoid wing meningioma with orbital involvement after surgery. Case: A 40 year-female presented with severe headache, right eye swelling, periorbital pain and decreasing in vision for two years, and right eye proptosis more severe for three months. Observations: She underwent right frontotemporal craniotomy with removal of hyperostotic sphenoid wing and excision of meningioma after magnetic resonance imaging demonstrated a right sphenoid wing meningioma extending orbital and middle cranial fossa. She had improvement of her symptoms post-operatively. Conclusion: Surgical decompression of orbit with total resection of meningioma and sphenoid wing hyperostosis can result in significant improvement in the vision and proptosis.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"122 21","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132772","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Safety and Efficacy of Low Dose Atropine in Nepalese Children with Progressive Myopia","authors":"Srijana Adhikari, Namrata Gupta, Birendra Mahat, Manish Poudel, Rojeeta Parajuli, Ang Jangmu Lama, Richa Poudel","doi":"10.3126/nepjoph.v15i1.49076","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49076","url":null,"abstract":"Introduction: Myopia is emerging as a public health emergency worldwide. Low dose atropine has been proven to be safe and efficacious in halting the progression of myopia. Objectives: Aim of this study was to evaluate safety and efficacy of low dose atropine in Nepalese children with progressive myopia. Materials and methods: It is a prospective non randomized interventional study. Children with myopia progression of >0.5D in the last six months with baseline myopia of -1.5 to -8 Diopter and astigmatism of 3 D or less were prescribed 0.01% atropine daily at bedtime for two years. Demography including age, gender, race, and examinations including anterior and posterior segment, axial length, near point of accommodation and near vision were recorded in all the children. Ocular and systemic side effects were documented. Results: A total of 200 children were enrolled in the study. Mean age was 11.9±2.97 years with 41% female. Baseline mean axial length was 24.47±1 and mean spherical equivalent was 3.69±1.33. Average increase in axial length was 0.18(±0.02), 0.17(±0.02), and 0.19(±0.04) mm in six months, one year, and two years respectively. The increase in spherical equivalence was 0.2 (±0.01), 0.3(±0.02), and 0.3(±0.02)) diopter in six months, one year, and two years respectively. The myopia progression was found more in the Mongolian race compared to the Aryan race. No ocular or systemic side effects were documented. Conclusion: Topical low dose atropine appears to be safe and efficacious in halting the progression of myopia in a cohort of Nepalese children. Further randomized control trial on various doses of atropine are recommended.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"121 49","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139132832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Radius-Maumenee Syndrome, A Rare Entity: A Case Report","authors":"Rakshya Basnet, Sanjay Kumar Singh","doi":"10.3126/nepjoph.v15i1.49617","DOIUrl":"https://doi.org/10.3126/nepjoph.v15i1.49617","url":null,"abstract":"Background: Radius–Maumenee syndrome (RMS) is a rare idiopathic condition characterized by the enlargement of episcleral vessels and an elevation in intraocular pressure (IOP) leading to secondary glaucoma. Case: In this report, we present a case of RMS in 23-year-old male who experienced redness in Right Eye (RE) and intermittent headaches for a duration of 10 years. The patient exhibited a best corrected visual acuity of 6/6 in both eyes. Observations: During slit lamp biomicroscopy, episcleral venous engorgement was observed in both eyes. Tonometry measured 28 mmHg in the RE and 14 mmHg in Left Eye (LE). In fundus photographs of RE and LE, there was evident cup asymmetry, along with retinal nerve fiber layer defects in superotemporal and inferotemporal regions of the right eye. Optical coherence tomography (OCT) Optic Nerve Head with hood report of RE showed loss of double hump pattern with asymmetric and severe retinal nerve fiber layer thinning in superior and inferior quadrant. Visual field testing of RE showed superior and inferior arcuate scotoma. Brain and orbit magnetic resonance angiography (MRI Angiogram) revealed no abnormal voids indicating cavernous fistula or other orbital lesions. The presence of secondary open angle glaucoma with episcleral venous engorgement and negative test results for other potential conditions led to the diagnosis of RMS in the patient. The patient is now under combination therapy with aqueous suppressants and uveoscleral outflow increasing drugs. Conclusion: This case serves as a reminder to ophthalmologists about potential association of glaucoma if there’s enlargement of episcleral vessels in eyes without inflammation.","PeriodicalId":44759,"journal":{"name":"Nepalese Journal of Ophthalmology","volume":"69 2","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139130751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}