Browsing by Author "Chaudhary, M"
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Publication Alport’s syndrome(Kathmandu University, 2010) Bastola, P; Joshi, SN; Chaudhary, M; Shah, DNAbstract Alport’s syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed. Key words: Alport’s syndrome, Anterior lenticonus, Oil droplet sign, Anterior capsular cataract, Perimacular flecksPublication Clinical and Epidemiological Profile of Herpetic Eye Disease in a Tertiary eye Care Center(Institute of Medicine, 2016) Chaudhary, MAbstract Introduction: Herpes simplex virus (HSV) is the most common infective cause of blindness in developed countries, with a reported incidence of between 5.9 and 20.7 episodes per 100,000 persons each year. It remains the most common cause of unilateral corneal blindness worldwide. HSV ocular infections include conjunctivitis, blepharitis, epithelial infections like dendritic ulcer, geographic ulcer and punctate epithelial keratitis, stromal infections like disciform and necrotizing stromal keratitis, and iritis. Visual loss usually occurs from the cumulative effect of multiple recurrences. Methodology: Hospital based prospective study was conducted for a period of one year (1st Jan 2015- 31st Dec 2015) at B.P.koirala Lions Center for Ophthalmic Studies, IOM, Kathmandu, Nepal. All patients. with symptoms and signs suggestive of herpes eye disease having decreased comeal sensation were included. Performa included demographic profile of patients, clinical pattern, presenting symptoms, visual acuity on presentation and treatment received. Results: Incidence of Herpetic Eye Disease was 10.3%. Patients presented with mean age of 36.63 ± 16.94years.59.23% patients presented in productive young adult age group of 16-45 years.Patients presented with chief complain of redness 38%, Diminution of vision 33%, Pain 12%, foreign body sensation 13% and photophobia in (4%) of cases. Clinical pattern was Blepheroconjunctivitis in 26%. Filamentary keratitis in 1%, dendritic ulcer in 22%, Geographical ulcer in 4%, disciform keratitis in 28%, Stromal keratitis in 11% and recurrent keratitis in 3% cases. Treatment received included topical Acyclovir in 54% cases, oral Acyclovir and topical steroids in 43% cases and topical, oral acyclovir with topical steroids in 3%cases. Visual acuity on presentation was 6/6-6/18 in 59.23% of patients and only 8.47%cases had visual acuity >3/60. Conclusion: Herpetic eye disease is a corneal blinding disease with varying clinical presentation. The recurrence rate was low in our study. But, recurrent nature of this disease and the treatment required to decrease this recurrence needs to be further studied Keywords: Herpes simplex virus, dendritic ulcer, cornea, disciform keratitis, acyclovirPublication Ocular Manifestations of Meningitis in Children(Nepal Paediatric Society (JNPS), 2012) Chaudhary, M; Shah, DN; Sharma, PRAbstract: Introduction: Meningitis is the most common central nervous system disease affecting children leading to focal neurological deficits and various oculovisual anomalies including blindness in children. The objective of this study was to evaluate the oculovisual anomalies occurring in Nepalese children suffering from different types of bacterial meningitis. Materials and Methods: A Prospective, study was undertaken for 18 months at B.P.Koirala Lion’s Center for ophthalmic studies, TU Teaching Hospital to study the children suffering from bacterial meningitis admitted at Kanti Children’s Hospital for ocular involvement. A through history, anterior and posterior segment ocular examination and investigations like blood, CSF and CT scan were done. Results: A total of 182 cases of bacterial meningitis were screened. Tubercular meningitis cases were 40 (21.97%) and Pyogenic were 142 (78.02%). Oculovisual anomalies were seen in 70 (38.46%) cases. The ocular abnormalities included pupillary changes (34.28%), Cranial Nerve Palsy (22.86%), Fundus changes (35.72%), Cortical Blindness (4.28%), Panophthalmitis and Proptosis (1.43%). Third nerve involvement was seen in 17.14% cases, sixth nerve in 4.29% cases, Papilledema in 11.43 % and Optic atrophy in 22.86 %. Risk factors included late presentation; hydrocephalous and increased CSF cell count and protein level. Conclusion: Oculovisual anomalies formed an important group of clinical manifestations of bacterial meningitis. Incidence of oculovisual anomalies was more frequently seen in Tubercular meningitis (55%).Children with early presentation and intervention had better prognosis. Hence, timely intervention and health education is important.Publication Prevalence and types of corneal astigmatism in patients undergoing cataract surgery(Institute of Medicine, 2017) Chaudhary, M; Dahal, HNAbstract Introduction: Cataract surgery is one of the most commonly performed ophthalmic surgical procedures worldwide, with a high rate of successful and rapid anatomical and functional visual recovery. Goal of cataract surgery is to achieve a desirable induction of refractive outcome with minimal astigmatism after surgery. This brings to interest the question of influence of preoperative and surgically induced corneal astigmatism on the final postoperative unaided visual acuity. Pre-existing corneal astigmatism is an important limiting factor for optimal results of cataract surgery in a significant number of patients. It has been estimated that 15% to 29% of patients with cataract have more than 1.50 dioptres (D) of pre-existing astigmatism. Methods: Prospective study was carried out to investigate the prevalence and pattern of pre-existing corneal astigmatism in patients undergoing cataract surgery at B.P. Koirala Lions Center for Ophthalmic Studies, T.U. Teaching Hospital for a period of 2 years. All patients underwent complete ophthalmic examination including visual acuity, refraction, slit lamp examination, applanation tonometry and dilated fundus evaluation, biometry and ultrasound B-scan examination. Corneal astigmatism was measured by Keratometer at least two times for each patient. Astigmatism was calculated from dioptric difference between vertical reading and horizontal reading. With the rule (WTR) astigmatism was considered when steep meridian was at 900 ± 300. Against the rule (ATR) astigmatism was considered when steep meridian was at 1800 ± 300. Results: Study included 225 eyes of 185 subjects, out of which 38.7% were male eyes and 61.3% were female eyes. The mean age of the subjects was 64.45±12.89 years. Mean amount of corneal astigmatism in our study was 0.84±0.80 D. 16.9% had no significant corneal astigmatism while 65.3% had corneal astigmatism between 0.25 and 1.50 diopter and 17.8% had corneal astigmatism of 1.50D or higher. With-the-rule astigmatism (axis of correcting cylinder 180±30 degrees) was present in 44.4% eyes, 40.04% of the eyes had against-the-rule (ATR) astigmatism (correcting minus cylinder 90±30 degrees), and 12.9% of the eyes had oblique astigmatism. Conclusion: Approximately two thirds of pre-operative cataract patients had 1D or less astigmatism. Corneal astigmatism increases with age. Hence, it is important to analyze the magnitude and pattern of pre-existing corneal astigmatism in aging population due to higher demand for improved vision and use of suitable methods for best visual results. Keywords: Cataract, corneal astigmatism, Keratometer, with the rule, against the rulePublication The role of the injection Botulinum Toxin A in cases of Essential Blepharospasm Syndrome, Hemifacial Spasm and Meige’s Syndrome(Kathmandu University, 2010) Bastola, P; Chaudhary, M; Agrawal, JP; Shah, DNABSTRACT Background Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease. Objectives To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies. Methods A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige’s syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted. Results A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 3.61 (+ Standard deviation 0.50, range 3-4), 3.21 (+Standard deviation 0.63, range 2-4) and 3.67 (+- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige’s syndrome was 4.3 (+ Standard deviation 1.6, range 2.0-6.5), 5.8 (+Standard deviation 1.4, range 3-8) and 4.5 (+ Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications. Conclusions The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige’s syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal. Key Words essential blepharospasm syndrome, hemifacial spasm, jankovic spasm grading, meige’s syndromePublication Theraputic application if Poly-2-hydroxy ethyl mathacrylate contact lens in various ocular surface disorders among Nepalese population(Institute of Medicine, 2015) Joshi, SN; Chaudhary, M; Bhattarai, D; Gnyawali, S; Shrestha, G S; Adhikari, PAbstract Introduction: Therapeutic contact lens (TCL) is indicated to relieve pain, promote corneal wound healing, provide mechanical protection and support, maintain corneal hydration, improve vision and seal or splint cornea in various ocular surface disorders. Till date no study has been reported about use of contact lenses for these purposes in Nepalese population. is study thus aims to evaluate the outcome of TCL in ocular surface disorders in Nepalese population. Methods: A prospective analysis of patients fitted with TCL for various ocular surface disorders was done at B.P. Koirala Lions centre for Ophthalmic Studies. All the subjects were fitted with Poly-2-hydroxy ethyl methacrylate (70% water content); information on clinical conditions were evaluated and recorded at initial and final treatment visit. Results: Of 57 eyes fitted with TCL, corneal laceration caused by mechanical injury (22.8%) and vernal keratoconjunctivitis (21.1%) were the most common ocular surface disorders. The common indications for applying TCLs were to alleviate pain and discomfort (31.5%) and corneal thinning impending to perforation (26.3%). Subjects’ clinical conditions and symptoms were resolved partially to completely in 89.4%. Dry eye was a common cause of contact lens associated therapeutic failure. Conclusion: Poly-2-hydroxy ethyl methacrylate contact lenses are safe and effective in alleviating symptoms and healing of various ocular surface disorders in Nepalese population. Keywords: Cornea, Therapeutic contact lens, Ocular Surface DisordersPublication Visual outcome in Keratoconus with spherical rigid gas permeable contact lens(Institute of Medicine, 2017) Chaudhary, M; Kandel, H; Adhikari, PAbstract Introduction: Keratoconus is a bileteral asymetric progressive ecteria of cornea commonly associated with vernal keratoconjunctivitis and Atopic dermatitis. Rigid gas permeable (RGP) contact lens is the first choice for refractive correction in keratoconic eyes. The visual outcome in Keratoconus with spherical RGP contact lens along with the mean age of presentation, gender predominance, ethnicity, associated conditions, refractive error and corneal astigmatism was evaluated. Methods: The records of the Keratoconus patients attending cornea and contact lens clinic for last 6 years were reviewed and analyzed using SPSS-14 software. Data on laterality, race, age, gender, refractive error, visual acuity (VA), associated conditions and contact lens parameters were obtained. A total of 22 patients with 38 keratoconic eyes were included in the study. Results: The mean age of Keratoconus presentation was 18.11 ± 4.45 years. Sixteen cases (72.73 %) were bilateral; 6 (27.27 %) were unilateral. Mean uncorrected visual acuity (UCVA) was 0.86 ± 0.40 Log MAR. Mean spectacle visual acuity was 0.54 ± 0.38 Log MAR. Mean visual acuity with spherical RGP contact lenses was 0.08 ± 0.14 Log MAR. The difference between mean spectacle visual acuity and mean VA with spherical RGP contact lens was statistically significant (p < 0.001). Conclusion: In all stages of Keratoconus, improvement in visual acuity with spherical RGP contact lens was highly significant. Key words: Contact Lenses, Keratoconus, Visual AcuityPublication WAGR syndrome in a Nepalese male child(Institute of Medicine, 2016) Chaudhary, RP; Chaudhary, MAbstract WAGR syndrome which includes Wilms' tumor, aniridia, genitourinary anomalies and mental retardation is a rare, sporadic, genetic disorder characterized by de nova deletion in the distal band of 11p13chromosome. Here, we report first case of WAGR from Nepal of a 5 year old male child with hypospadias, right Wilms' tumor and bilateral aniridia treated successfully by surgery and chemotherapy. Keywords: WAGR syndrome, Wilms' tumor, Hypospadias, Aniridia, Chemotherapy