Purpose: Persons with disabilities face additional barriers in accessing primary healthcare services, especially in developing countries. Consequently the prevalence of secondary health conditions is higher among this population. This study aims to explore the perceived barriers to access primary healthcare services by persons with disabilities in the Western region of Nepal.Methods: 10 primary healthcare providers and 11 persons with disabilities (physically or visually impaired) were selected by non-governmental organisations from the hilly and lower areas. Based on the International Classification of Functioning and the health accessibility model of Institute of Medicine, semi-structured interviews were conducted and analysed using analytical induction. Results:In general, healthcare providers and persons with disabilities reported similar barriers. Transportation and the attitude of family members and the community were the main environmental barriers. Even with assistive devices, people still depend on their families. Financial barriers were lack of funds for health expenses, problems in generating an income by persons with disabilities themselves, and the low socio-economic status of their families. Personal barriers, which affect help-seeking behaviour in a major way, were most often mentioned in relation to financial and socio-environmental barriers. Low self-esteem of the person with disability determines the family's attitude and the motivation to seek out healthcare. Lastly, poor public awareness about the needs of persons with disabilities was reported. Conclusions:Besides the known physical environmental barriers, this study found several environmental, financial and personal barriers that also affect access to primary healthcare. In particular, the attitudes of families and poor financial conditions seem to be interrelated and greatly influence help-seeking behaviour.Implications: There is a definite need to educate primary healthcare providers who work at the community level about disability-related health conditions, and train them to diminish barriers to access health services. In addition, the government support system for persons with disabilities should be revised and implemented accordingly. Lastly, further research is needed to understand the interaction between the reported barriers that influence the inclusion of persons with disabilities in healthcare.

The results of 300 consecutive glaucoma filtering procedures, which were performed in our clinic between January 1982 and September 1985, are described. The overall combined success rate (complete + qualified) was 66.5% (Heuer's classification). This is in good agreement with other glaucoma referral centers. The peak of the age distribution curve at the time of operation was between 70 and 75 years. Nevertheless, 30% of operations was performed on patients under 50 years of age. Relatively poor success rates were obtained in operations following prior unsuccessful filtering surgery (50.5%) or other surgery (47%), in patients under 50 years of age (61%) and in some types of secondary glaucoma. In aphakia/pseudophakia the success rate was 33%. The posterior capsule was intact only 13% of this category at the time of surgery, in 56% previously unsuccessful filtering surgery had been performed, and the age at operation was relatively young (53 yr). These factors have an unfavorable influence on the results of filtering surgery. The success rate in phakic primary open angle glaucoma was 85% and in phakic primary angle closure glaucoma 73%. The combination with a cataract extraction (in 28%) and a peripheral iridectomy, if this had not been performed previously, (in 31%) may have contributed to the relatively favorable surgical results in phakic primary angle closure glaucoma. Relatively high intraocular pressures were found in the early postoperative period; the peak of the pressure-curve was between 20 and 25 mm Hg, 10 mm Hg higher than at the end of follow-up. Postoperative progression of glaucomatous visual field defects was noted in 7%. The most disturbing complication was flat anterior chamber, causing or enhancing cataract formation (in 4 out of 8 phakic patients) and corneal dystrophy (in 2 out of 12 patients). A review of literature is given concerning methods of improving filtration, when the surgical prognosis is poor.

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A 30-year-old man with bilateral neuroretinitis and uveitis associated with secondary syphilis is described. Characteristic lesions on the palms of the hands and the soles of the feet gave us the clue to the diagnosis. Treatment with penicillin resulted in a rapid cure. Syphilic neuroretinitis is often associated with secondary meningitis. Early diagnosis and adequate therapy are important in this serious but treatable condition.

Purpose Treatment of HIV with highly active antiretroviral therapy (HAART) has extended life expectancy with many years. There are signs that the better prognosis of this formerly deadly disease has a negative spin‐off, which is a frequent occurrence of the coexistence of HIV and ocular syphilis. Methods We collected the cases of ocular syphilis in the last 7 years in a general hospital ( Medisch Spectrum Twente, the Netherlands). Furthermore, a literature search was performed to identify papers on the clinical manifestation of this disease, especially in relation to HIV‐infection. Results We analysed the characteristics of 3 patients with ocular syphilis, 2 of these patients had co‐infection with HIV. Several different disease manifestations of Treponema Pallidum infection in the eye were observed, especially with regard to the optic nerve, the macular area and the retinal periphery. Treatment with intravenous Penicillin was successful in all patients, though some eyes developed irreversible loss of function. Conclusion Especially in immune compromised patients ocular syphilis is an acute sight threatening disease, with specific diagnostic challenges, requiring immediate intravenous treatment.