Introduction: Diabetic retinopathy (DR) is the emerging cause of blindness in developing countries. This study aimed to assess the accuracy of grading retinal findings of patients with diabetes using fundus photographs by allied medical personnel (AMP) when compared to an ophthalmologist. Materials and Methods: Six AMPs were enrolled for grading fundus photographs of patients with diabetes after three and six months of training twice at two weeks interval. The total number of fundus photographs graded were 1,344. Grading by a retina specialist was used as the gold standard. Intra-rater and inter-rater agreement was assessed using the kappa coefficient (k). Results: The intra-rater agreement of half of the AMPs in both three months and six months was almost perfect for grading of any retinal abnormalities, and substantial for retinal hemorrhages. In three months, the overall inter-rater agreement at the second rating was moderate for any retinal abnormalities (k=0.60) and retinal hemorrhage (k=0.48) and was fair for macular exudates (k=0.35). The overall inter-rater agreement of AMPs in six months at the second rating was substantial for any retinal abnormalities (k=0.61), fair for retinal hemorrhage (k=0.30), and moderate for macular exudates (k=0.49). The overall inter-rater agreement at first rating was almost similar to the second rating in both three months and six months. Conclusion: Intra-rater agreement of AMPs was almost perfect for any retinal abnormalities and substantial for retinal hemorrhage. The inter-rater agreement of AMP was substantial for any retinal abnormalities and moderate for retinal hemorrhages and macular exudates. The agreement results were almost similar at three months and six months. AMPs could be utilized in screening of DR and other retinal pathologies for timely referral to reduce the blindness in low-resource settings.

Background. To review the pattern of retinal detachment (RD) in patients with choroidal coloboma and type of reattachment surgery performed and to study its outcome in terms of retinal reattachment, visual acuity, and postsurgical complications. Methods. Observational case series of a single tertiary eye institution of 13 eyes having choroidal coloboma with RD done from January 2015 to June 2017. Results. Mean age of presentation was 29.3 years (Range 14–60 years). Males were two times more affected than females (2.25 : 1). The overall rate of anatomic success achieved after RD repair and silicon oil removal at 6 months was 92.3% (12/13 eyes). Following surgery, visual acuity improved in 6 out of 11 eyes (54.54%), remained unchanged in 4 eyes (36.36%), and worsened in 1 eye (9.1%). The most common complication following surgery was secondary glaucoma in 30.7% (4/11 eyes). Conclusion. The overall anatomic success rate of retina reattachment surgery in colobomatous eye is good, and the visual outcome following surgery can improve in majority of the cases or may remain same in few cases. Hence, timely surgery is advocated. But careful follow-up is required as the risk of postoperative complications is also high.

Purpose: To evaluate clinical characteristics, visual outcomes and globe survival after intraocular foreign body removal from posterior segment via pars plana approach. Methods: A hospital based retrospective study. All the patients of penetrating eye injury with intraocular foreign body in posterior segment as detected by computed tomography were enrolled from 2012 to 2014.Results: Thirty patients of 30 eyes were included. The mean age was 27.7 years. (2-52). Twenty-four (80%) were male. Out of 30 eyes 19 (63.3%) eyes had injury at Zone 1 and 11 (36.7%) eyes had injury at Zone 2. The mean time spent between primary repair following surgery and intra ocular foreign body removal, was 15.47 days. Retinal detachment and endophthalmitis prior to intraocular foreign body removal was present in 9/30 of eyes. We looked for correlation between post operative Phthisis bulbi with zone of injury and pre operative endophthalmitis and preoperative retinal detachment. However, p value for the above correlation was more than 0.552 and 0.815 respectively, which was statistically not significant.Conclusions: The eyes with posterior segment intraocular foreign bodies showing clinical features of preoperative endophthalmitis, retinal detachment and the zone of injury also did not have any direct significance with globe survival.

Introduction: There are many reports of endophthalmitis following Anti- VEG F use in developed countries and from India, but there are none from Nepal yet. Therefore, the aim of this study was to report the prevalence and management of acute endophthalmitis after intravitreal injection of bevacizumab.Methods: This is a clinical, retrospective, non-comparative study, performed in Tilganga Institute of Ophthalmology, Kathmandu, Nepal from Jan 2015 till Dec 2016. All consecutive cases of intravitreal 1.25 mg of bevacizumab injections during the study period were collected from Bevacizumab registry of the operation theatre. A total number of endophthalmitis, following intravitreal bevacizumab injections were collected from Endophthalmitis registry. The statistical analysis was carried out by SPSS for percentage calculation and its 95% Confidence Interval (CI) calculation.Results: There were 4182 injections performed during the study period for various retinal conditions. Two eyes of two patients with acute postoperative endophthalmitis were identified in the first week following intravitreal injections of 1.25 mg bevacizumab among a total of 4128 injections with a prevalence of 0.048% (95% CI: 0.00 to 0.12.).Conclusions: The prevalence of acute endophthalmitis following intravitreal Bevacizumab in our retrospective series was 0.048% and was comparable with the other studies conducted elsewhere. Acute post-injection endophthalmitis following intravitreal bevacizumab can result in severe loss of vision. Therefore prompt recognition and treatment are important part of its management in such patients.

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