No author has a financial or proprietary interest in any material or method mentioned.

PurposeTo evaluate the anterior segment biometry characteristics in congenital cataract patients before undergoing surgery in a tertiary eye care centre.MethodsWe retrospectively reviewed the charts of congenital cataract patients aged less than 15 years who had undergone the congenital cataract surgery from Jan-Dec, 2015. 451 eyes of 351 patients were reviewed. The eyes were examined using an autorefract-keratometer, applanation A-scan and parameters like keratometry, axial length, corneal astigmatism were noted.ResultsThe mean age at the surgery was 92.4 ± 4.13 months (range 6 months to 15 years). The ratio of boys to girls was 2.34:1. The mean axial length was 21.94 ± 1.94 mm. Girls had shorter axial length than boys (21.53 mm vs 22.11 mm, p = 0.01). The axial length in the cataractous eyes in bilateral cases was significantly smaller than that in the unilateral cases (21.46 mm vs 22.55 mm, p < 0.0001).The mean keratometry was 44.12 ± 2.6 D. Girls had larger mean keratometry value than boys (44.71 vs 43.88, p = 0.0032). Keratometry values were higher in cataractous eyes in bilateral cases than in the unilateral cases (44.61 D vs 43.51 D, p < 0.0001). The mean corneal astigmatism was 1.49 ± 1.13 D. The prevalence of the corneal astigmatism of 2.0 D or more was 25.5%. The with-the-rule astigmatism was the most frequent type (62.53%). Girls had higher mean astigmatism than boys (p = 0.0122). The mean corneal astigmatism was higher in the cataractous eyes in bilateral cases than in the unilateral cases (p = 0.0094).ConclusionsThe axial length, mean keratometry and corneal astigmatism in congenital cataract patients varied with age, gender, and laterality. The data on biometry characteristics of Nepalese pediatric patients provided in the present study are of clinical significance and hence greatly enhance the guidelines for treatment decisions, IOL power calculations and management of congenital cataract patients.

No abstract

Introduction: Eye lid and adnexal tumours are one of the major problems we see in the oculoplastic department. Malignant eye lid tumours are rare in comparison to benign and diversity in its clinical presentation makes it difficult to diagnose earlier.  Eyelid malignancies can mimic a host of benign neoplasms and other less aggressive neoplastic or non-neoplastic inflammatory conditions and need differentiation before definitive therapy is planned. Out of 90% of all skin cancer occurring in head and neck region 10% occurs in the eyelid. A histopathological study confirms the diagnosis that can be correlated with patient history and other clinical data. Objectives: To study the clinicopathological correlation and its outcome in patients with malignant eyelid and adnexal tumours presenting at Biratnagar eye hospital. Methodology:   Details of the cases of histopathologically proven malignant eyelid and adnexal tumours presenting to the department of oculoplasty from July 2016 to August 2019 were recorded.  The duration of disease, presenting symptoms, risk factors, demographic data, clinicopathological correlation with its accuracy and mode of treatment were analyzed using SPSS 17. Results: Out of total 28 patients, male were 53.6% and female were 46.4%.  The mean age of presentation was 60.5±11.8 years. 53.6% tumors were located in upper lid, 39.9% were located in lower lid and 7.1 % were located in medial canthus.  Basal cell carcinoma and sebaceous gland carcinoma were the most common type of malignancies (35.7% each) followed by 28.6% of squamous cell carcinoma of eyelid. The clinicopathological correlation revealed 75% of clinical accuracy. Different types of reconstructions were done according to the size and site of the defect. Modified Hughes procedure for lower eyelid defect was the most common procedure performed (32.1%), followed by  14.3%  Cutler beard,  28.6%  Cutler beard with post auricular cartilage graft,  10.7%  Glabellar flap rotation 7.1% had combined procedure and  4.3%   direct closure . Conclusion:  Sebaceous cell carcinoma and Basal cell carcinoma were the most common malignant tumors followed by squamous cell carcinoma. The upper lid was the most common site for such malignancy. Histopathological examination was useful for the establishment of complete and accurate diagnosis, which led to further management and follow up protocol for malignant eyelid tumours.

In this study, we present 2 patients, including 1 pediatric patient, with orbital tumors in the deep superonasal intraconal space, which were approached with upper fornix technique combined with a superior lateral cantholysis. The first patient was a 1-year-old girl who had presented with left upper eyelid retraction since the age of 2 months. Imaging studies revealed an orbital mass in the left postero-superonasal intraconal space. The second patient was a 71-year-old man who complained of decreased vision after cataract surgery in the left eye. Imaging studies revealed an orbital mass in the left superonasal intraconal space surrounding the optic nerve in the posterior orbit. In both the patients, incisional biopsy of the orbital mass with upper fornix approach was performed under general anesthesia. The diagnoses of congenital upper eyelid retraction caused by fibrosis in patient #1 and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue in patient #2 were made, after pathological examinations. No significant intra- or postoperative complications occurred during a follow-up period of 10 months and 2 months, respectively.

A detailed ocular examination and in vivo confocal microscopy (IVCM) using the Heidelberg retinal tomograph 3 with Rostock cornea module were performed in a patient with multiple endocrine neoplasia (MEN) 2b syndrome. Ocular findings included ptosis secondary to thickening of the lid margins, subconjunctival and perilimbal neuromas, and prominent corneal nerves extending up to the pupillary area. IVCM demonstrated structural alterations of both the main nerve trunks and the smaller branches. The main nerve trunks were grossly thickened while the smaller fibers were present in an intertwining manner in the anterior stroma. Some fibers showed prominent looping and nodular dilatations at irregular intervals along the length of the nerves. These nodular dilatations were in all probability ganglioneuromas of corneal nerves demonstrated by histopathology in earlier reports of MEN 2b. IVCM may be potentially useful in detecting the nerve alterations in MEN 2b even before other ocular or systemic features become apparent clinically.

Introduction: Firework-related ocular injuries are an important cause of preventable ocular injuries and are common during the festival season. Despite the strict legislation in Nepal, the use of a firework is still commonly used during Tihar and Chaath festivals. Objective: To evaluate demographic distribution, mode, causative firework, type of fireworks-related ocular injuries, and visual outcome at a tertiary eye hospital in Eastern Nepal. Methods: This is a hospital-based prospective interventional study. All the patients with firework-related injuries who attended the emergency and outpatient department of SCEH, Lahan, during or within 1 month of the festival season (Tihar and Chaath puja) were included in this study. Results: Total of 65 eyes were included. The left eye was involved in 49.1%, 82.5% were males. Mean age of the patients was 15.3±14.7 years (range 5yr – 75yr). Children less than 16 years were predominantly involved (77.2%). Firecrackers (56.1%) were the most common type of fireworks causing injury. The closed globe injuries were more (78.5%) compared to open globe injuries (21.5%). Surgical management was done in 50.9% of cases. Following management visual acuity of most patients improved. Only 8 eyes (12.3%) had visual acuity less than 3/60 after management compared to 28 eyes (43.1%) at the time of presentation.   Conclusion: Firework related ocular injuries are important causes of preventable blindness. A combined approach of public awareness about the possible dangers, preventive measures, early treatment by trained primary ophthalmic care, and implementation of strict legislations are essential to reduce blindness due to this preventable cause.  

BackgroundThe presence of intraocular eyelashes following penetrating eye injury or ocular surgery is relatively uncommon. The response of the eye to intraocular eyelashes is variable. The eyelash may be symptomatic or may remain asymptomatic for long periods.ObjectiveWe report a case with two intraocular eyelashes and an iris cyst after 2 years of asymptomatic period following penetrating eye injury.Case presentationA 24-year-old male presented with decreased vision in the left eye which he had noticed for the previous 2 weeks. His visual acuity was 6/6 in the right eye and 6/18 in the left eye, improving to 6/9 with -2.5 DC × 140° correction. The intraocular pressure was 12 mmHg in both eyes. On slit-lamp examination, the left eye showed 8 mm linear peripheral corneal opacity nasally, two eyelashes in the superior anterior chamber, and an iris cyst measuring 4 mm × 4 mm in the superior iris. The right eye was normal. Dilated fundus examination of both eyes was normal. The eyelashes and cyst were removed surgically. There were no complications during the 3-month follow-up period.ConclusionIntraocular implantation of eyelashes following penetrating eye injury can remain asymptomatic for long periods; however, late development of iris cyst may occur.