Background: Ocular involvement in pregnancy-induced hypertension (PIH) is common.Objective: To study the association between pregnancy-induced hypertensive fundus changes and fetal outcomes. Subjects and methods:A prospective cohort study was carried out including 153 subjects with the diagnosis of PIH. The subjects were evaluated for hypertensive fundus changes. Fetal outcomes were assessed in terms of gestational age, birth weight, 1 minute Apgar score, stillbirth and neonatal death. Statistics:The chi 2 test was used to evaluate the association between the various fundus changes and fetal outcomes using SPSS version 10 software program.Results: Fundus changes were found in 13.7 % of the subjects. The means of systolic and diastolic BP of the subjects with hypertensive fundus changes were 182.86 ± 33.64 and 125.24 ± 21.36 respectively, whereas those values without fundus changes were 150.72 ± 12.86 and 100.07 ± 9.51.Vitreous hemorrhage, serous retinal detachment and macular star were not found in this study. Fetal outcomes in PIH patients with vascular changes alone were similar to those with no fundus changes. Retinal and optic nerve head changes were found to be associated (p =0.016) with low birth weight (<2.5 kg). Choroidal changes and optic nerve head changes were associated with low Apgar score. Conclusion:Retinal and optic nerve head changes are associated with low birth weight. Choroidal changes and optic nerve head changes are associated with low Apgar score. Fundus evaluation in patients with PIH is an important procedure to predict adverse fetal outcomes.
The aim of our study was to evaluate the effectiveness of debridement, antibiotics, irrigation and retention (DAIR) in patients who developed a periprosthetic joint infection (PJI) after primary hip or knee arthroplasty in two community hospitals in the Netherlands. We retrospectively collected data in two hospitals in the Netherlands on all episodes of PJI after primary hip (THA) and knee arthroplasty (TKA) from 1998-2012. In 109 of 8234 THA (1.32%) and 65 of 5752 TKA (1.13%) a PJI developed. DAIR was used as treatment in 84 patients after THA (77.1%) and 56 patients after TKA (86.2%). 34 Patients only received antibiotics or were immediately revised. After 1 year follow-up, prosthesis retention was achieved in 81 THA patients (74.3%) and 48 TKA patients (73.8%). Acute infections showed a better survival compared to late infections (84.0% vs 46.6% respectively; p<0.01). Furthermore, a young age was associated with an increased revision risk (p<0.01). In conclusion, debridement, antibiotics and irrigation in acute PJI may lead to retention of the prosthesis in a majority of cases. Large patient cohort studies can provide data on PJI outcome, complementing National Registries which have limited detail.
Chronic dacryocystitis is more common in the subtropical plains of Nepal with a monsoon climate than in the high hills. It is predominantly found in pre-menopausal females. External DCR without bicanalicular silastic tube intubation is an effective method for treating chronic dacryocystitis due to NLDO in these patients.
Background: Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology.Objective: To report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in eastern Nepal. Materials and methods:The hospital data of patients with idiopathic optic neuritis admitted to the department of ophthalmology in a tertiary level center in eastern Nepal between Jan 2000 to Dec 2006 were retrospectively analyzed. The parameters studied were demographic pattern, clinical features, visual acuity and field defects.Results: Thirty-six patients (52 eyes) were found to have optic neuritis (papillits in 36 and retrobulbar optic neuritis in16 eyes). The male to female ratio was1.25:1. The mean age of the patients was 33.56±17.88 years (95 % CI=24.66 -42.45). The most common modes of presentation were loss of visual acuity and color vision defect. One patient had features suggestive of multiple sclerosis. Vision improved in 42 eyes at discharge from the hospital. Response to pulse methylprednisolone therapy was good in most (42 eyes) of the cases except for the patients having initial visual acuity of no light perception. Conclusion:Response to pulse methylprednisolone therapy is good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world. Some similarity was observed between studies reported from the oriental countries.
Background: Trabeculectomy is the standard surgical procedure for management of glaucoma. Objective: To compare the outcome of triangular and rectangular scleral flaps in trabeculectomy. Materials and methods: This study was carried out in the Department of Ophthalmology, BPKIHS, Dharan, over a period of one year. A total of 22 patients undergoing trabeculectomy were randomized to undergo either trabeculectomy with triangular scleral flap (Group A= 11 eyes) or trabeculectomy with rectangular flap (Group B =11 eyes). Outcome measurement: The parameters studied were intraocular pressure (IOP), anterior chamber depth (ACD), bleb characteristics and surgical complications. Statistics: P value of <0.05 was considered significant. All calculations were executed using SPSS 11.0 software program. Results: The age ranged between 40 to 76 years with the mean of 56.5±9.25 years. The most common preoperative diagnosis was angle closure glaucoma. The postoperative percentage of IOP reduction (Group A=68.9%; Group B=66.51%) was statically significant in both the groups (p=0.001). Trabeculectomy was almost equally effective with complete surgical success of 91% in group A, and 82% in group B (p=0.534). Final bleb scores were almost similar in both the groups with 3.27 ± 1.5 in group A and 3.36±1.21 in group B (p=0.877). Hypotony with the IOP less than 6 mmHg was found in the first post-operative day in 2 patients in Group A and in 1 in Group B. All of them improved spontaneously within a week. Conclusion: Both triangular and rectangular scleral flaps in trabeculectomy are equally effective in terms of post surgical IOP control, bleb characteristics and complications. Keywords: Trabeculectomy; glaucoma; intra ocular pressure; scleral flap DOI: 10.3126/nepjoph.v1i1.3669 Nep J Oph 2009;1(1):20-24
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