Browsing by Author "Sthapit, PR"
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Publication Bacterial Conjunctivitis and Use of Antibiotics in Dhulikhel Hospital - Kathmandu University Hospital(Kathmandu University, 2011) Sthapit, PR; Tuladhar, NR; Marasini, S; Khoju, U; Thapa, GABSTRACT Background Acute Infective Conjunctivitis may be due to viral or bacterial infection; though it is usually self limiting, topical antibiotics are often prescribed for rapid recovery. Objectives This study aims to find out prevalence of bacterial infection among cases of acute infective conjunctivitis and to determine their in-vitro antibacterial susceptibilities to commonly used antibacterial agents and to find out whether the rampant use of topical antibiotics are at all necessary or justified. Methods A prospective analytical study conducted over a period of two years on clinically diagnosed cases of Acute Infective Conjunctivitis. Isolation and identification of microorganisms by culture and antimicrobial susceptibility test were done on conjunctival swabs from 65 patients. Results A total of 65 patients were included where children (one month to 10 years old) accounted for the commonest age group (35.4%).On Gram’s Stain, 90.8% were negative for pus cells or micro organisms. Gram positive cocci were found in 6.2% of cases. On culture, bacterial growth was seen in 11 cases (18.9%) among which Streptococcus pneumonia was seen in seven cases (10.8%).The analysis on in-vitro susceptibility testing showed that Chloramphenicol and Gentamicin were the most sensitive (78.6% of samples) drugs for conjunctivitis. Conclusion Ophthalmic antibiotics should be prescribed judiciously in acute infective conjunctivitis even for suspected bacterial cases; since it is found to resolve spontaneously without any serious complications. Chloramphenicol and Gentamicin are drugs of choice if at all required. Key Words acute infective conjunctivitis, bacterial conjunctivitis, chloramphenicol, gentamicinPublication Ocular Morbidity among Earthquake Survivors in a Community Based Hospital in Nepal(Kathmandu University, 2017) Shrestha, P; Sthapit, PRABSTRACT Background Nepal suffered a massive loss of lives and property following devastating earthquake on Saturday 25 April, 2015 and 12 May, 2015. Though Nepal is prone to natural disasters and ocular trauma being important cause of visual morbidity, the impact of ocular trauma in disaster setting has rarely been studied. Objective The aim of this study was to report the spectrum of ocular morbidities among the earthquake survivors who presented to a tertiary care Hospital which lies close to major earthquake hit districts of Nepal. Method This is a hospital based retrospective study where details of all the cases with ocular injury or ocular diseases during first three weeks of earthquake were extracted from the record books of Ophthalmology and Emergency department. Detail ophthalmic examination findings and treatment received by the patients were also noted from the records, tabulated and analyzed. Result There were total 3679 earthquake survivors, majority from Kavrepalanchowk district, visiting our Hospital during first three weeks of earthquake among which 92 patients had ocular problems. Among the 117 affected eyes, 75% had unilateral involvement. Males and females were equally affected. Children and adolescents of age group 11-20 years was the most commonly affected age group. Spectrum of ocular injuries ranged from lid lacerations, conjunctival inflammation to sixth nerve palsy and traumatic optic neuropathy. Conclusion Ocular morbidity either in the form of ocular injuries or diseases were common in polytrauma cases among the earthquake survivors. Though most of them had eyelid injuries and conjunctival inflammations, vision threatening conditions were also observed which needed expert opinion and meticulous treatment. KEY WORDS Earthquake, ocular trauma, ocular morbidityPublication Ocular trauma in patients presenting to Dhulikhel Hospital(Kathmandu University, 2011) Sthapit, PR; Marasini, S; Khoju, U; Thapa, G; Nepal, BPABSTRACT Background Ocular trauma is an important cause of blindness and ocular morbidity throughout the world. Prevalence studies help to define the target group, plan strategies and thereby lessen trauma related blindness in the country. Objective To identify the risk factors for ocular trauma, those at risk, describe the visual acuity at time of clinical presentation, and assess the nature and severity of ocular trauma in patients presenting to Dhulikhel Hospital’s emergency department and eye OPD with ocular trauma. Methods It is a descriptive and prospective study of all the patients with ocular trauma presenting to Dhulikhel Hospital from December 2009 to December 2010. A complete history and detailed ophthalmologic evaluation was done and noted down. Results There were 112 subjects with ocular trauma. Mean age was 28.43±16.36 years with a range of one year to 74 years. Males predominated with 72.3% frequency (p<0.001). Incidence peaked in third decade of life (p<0.01). Ocular trauma peaked in months of September and October. Presenting visual acuity better than 6/12 was noted in 83.9% of cases whereas 2.7% of cases had visual acuity of <3/60. Household (56.3%, p<0.001) was the commonest place of injury with wooden objects (19.6%) being the commonest object of injury. Most of the injuries were mechanical (85.7%, p>0.001). Conclusion Blunt injuries were more common in young males. Household and workplace were common location of ocular injuries. Public awareness and strict legislation to use personal protective devices can help to reduce the occurrence of ocular injury. KEY WORDS blindness, corneal abrasion, mechanical injury, ocular traumaPublication Refractive Errors and Visual Anomalies in Schoolchildren in the Kavrepalanchowk District(Kathmandu University, 2010) Marasini, S; Sharma, R; Sthapit, PR; Sharma, D; Koju, U; Thapa, G; Nepal, BPABSTRACT Background Schoolchildren form an important target group for a nation, as any ocular morbidity in this age group has huge physical, psychological and socio-economical implications. Childhood eye disorders can contribute to the burden of blindness in any society. This study aims to highlight the prevalence of ocular morbidity in governmental schools in a sub-urbanised area of Nepal, in relation to ethnic variation. Methods A descriptive study, and the study population used were schoolchildren who were examined in their schools and afterwards referred to the hospital if required. Presenting and best corrected visual acuity, refraction, binocularity assessment, anterior and posterior segment evaluation was carried out. Data was analysed statistically using SPSS software, version 14. Results We examined 1,802 school children. The mean age was 10.78±3.61 years. Ocular abnormality was detected in 11.7%. Low vision and blindness was rare (0.11% and 0.05%). Ocular morbidities were more common in Newar communities (3.71%) followed by Brahamans (3.38%). Lid abnormalities were the most common (3.55%), and morbidities in each ethnicity were followed by refractive errors (3%), conjunctival abnormalities (1.10%), strabismus (0.88%) and amblyopia (0.33%). Refractive errors were most common among Newar communities (1.16%) at almost twice as many Brahamans (0.61%) followed by Mongolians (0.49%). Convergence insufficiency was detected in 2.49% (p<0.01). Conclusions Ocular morbidities are common in children in Kavhrepalanchowk District with lid abnormalities being the most common issue, probably due to a lack of hygienic practice. Ethnic variation of ocular morbidities is an important observation mostly for refractive error and strabismus. Key Words blepharitis, blindness, ethnicity, oculo-visual, visual acuityPublication Surgical Outcomes in Cases of Marcus-Gunn Jaw-Winking Phenomenon(Kathmandu University, 2015) Sthapit, PR; Saiju, RABSTRACT Background Markus-Gunn Jaw-winking Phenomenon (MGJW) is a congenital ptosis associated with synkinetic movement of upper lid on masticating movements of jaw. It results from aberrant connection between motor division of trigeminal nerve and oculomotor nerve. Objective To investigate the clinical characteristics of MGJW phenomenon and evaluate its surgical outcomes of unilateral levator excision and frontalis suspension. Method It is a retrospective analysis of nine cases of MGJW phenomenon seen from 2007 to 2013 AD. The clinical features were recorded and analysed. Unilateral levator excision and frontalis suspension for the correction of synkinesis and ptosis was done for all the patients. The result of surgery was analysed. Result MGJW phenomenon was seen more in males. All the cases had unilateral ptosis with jaw winking phenomenon. Ipsilateral hypotropia and refractive errors were seen in 44%. One week post operative margin reflex distance was good in 67% of cases. Persistent jaw-winking was seen in 3 cases, two underwent repeat surgery to abolish the synkinesis. At one year follow up, 33% had good margin reflex distance of more than 4mm and 22% had fairly good margin reflex distance of 3mm. Conclusion Patients with Marcus Gunn jaw winking synkinesis can present at a wide age range. There may be an associated vertical muscle imbalance, which should be managed before ptosis surgery to avoid ptosis under correction. Unilateral frontalis flap suspension combined levator excision can correct ptosis very well for patients with Marcus-Gunn syndrome. KEY WORDS Congenital ptosis, frontalis sling, levator excision, markus gunn jaw winking synkinesis.