Background: The present study is ¿ rst of its kind to evaluate causes of visual impairment of blind students in Nepal and assess their need for low vision rehabilitation services. Aim: To evaluate causes of vision impairment of students enrolled in blind schools in Nepal and assess the need for low vision rehabilitation services in these students. Materials and methods: A survey was conducted in 12 blind schools in Nepal, which were registered with Nepal Association for Welfare of Blindness (NAWB).It was conducted by a team of an ophthalmologist and an optometrist, by using standard eye examination protocols of the World Health Organization Prevention of Blindness Program (WHO/ PBL). Results: Of the 345 students enrolled in 12 schools, 285 students were examined (response rate of 82.61%). The students were in the 5 -29 years age group. Nearly three-fourth of the children had become blind within one year of age and 52.3% visually impaired at birth and 20.7% developed vision impairment within one year of age. After refraction, 26 students (9.12%) had mild visual impairment, 21 students (7.37%) had severe visual impairment and 238 students (83.51%) were blind. The main cause of vision impairment was found to be corneal 35.79% and retina diseases, mainly dystrophy, 20.35% followed by problems with the whole globe, lens and optic nerve, accounting for 13.33%, 12.63% and 12.98% respectively. The major etiological factors were those of childhood such as Vitamin A de¿ ciency, measles and similar causes (42.11%) followed by hereditary causes (25.26%). Of the total students examined, 48.07% were visually impaired due to preventable causes and 16.14% treatable aggregating to 64.21% of avoidable blindness. Fifty seven (28.22%) students could read smaller than 2 M print size after low vision assessment for near and 33(15.78%) students bene¿ ted with telescopic trial for distance low vision. Conclusion: In Nepal, renewed focus on providing best possible quality of life for visually impaired children by proper low vision assessment and eye health education focusing on, general public and community health workers, with governmental and institutional support is required to achieve Vision 2020 objectives to decrease childhood blindness.

Background: Post-operative endophthalmitis remains one of the most visually devastating complications of cataract surgery. Cluster endophthalmitis is defi ned as fi ve or more cases of endophthalmitis occurring on a particular day in a single operating room in one centre. Excessive infl ammation, particularly in the early post-operative phase, should be regarded as infective endophthalmitis. Early diagnosis and immediate intervention in such case, lead to salvage of eye as well as better visual outcome. Objective: To fi nd out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis in high volume cataract surgical centre. Materials and methods: Retrospective, interventional case series of 19 patients with acute post-operative endophthalmitis after manual small incision cataract surgery in a single day, underwent vitreous tap and received intravitreal Vancomycin, amikacin and Dexamethasone. Subconjunctival vancomycin was given at the end of the procedure. Vitreous samples were stained using Grams stain, Giemsa stain and KOH mount. Samples were sent to the hospital's microbiology laboratory for culture and sensitivity testing. All patients received intravenous ciprofl oxacin for 3 days and oral ciprofl oxacin for 7 days. Topical Prednisolone acetate, Ofl oxacin, Gentamycin and atropine were given to all patients. Patients were followed up till 6 weeks. Results: 10 eyes had vitreous tap culture negative (52.6%) where as 9 eyes (47.4%) had bacterial culture growth. The culture reports showed 4 cases (21%) of Staphylococcus epidermidis, 3 cases (15.8%) of Staphylococcus aureus and 2 cases (10.5%) of mixed growth. 48 hours after the intervention, 15 patients improved clinically. On sixth week follow up, 7 eyes (37%) had visual acuity better than 6/18, 7 eyes had 6/18 to 6/60 and 5 eyes had visual acuity between 1/60 to 5/60. Conclusion: Intravitreal antibiotics and steroid, along with systemic ciprofl oxacin and subconjunctival vancomycin has good visual outcome for post operative cluster endophthalmitis.

Purpose: To find out the epidemiologic features in 686 consecutive cases of fungal keratitis presenting in a tertiary eye hospital in the western region of Nepal. Materials and methods:A prospective hospital -based study was carried out on 1880 consecutive patients presenting with corneal ulcer in the outpatient department and cornea clinic of Lumbini Eye Institute, Bhairawa, Nepal. The socio-demographic data, predisposing risk factors, prior treatment modalities, laboratory results and the distribution pattern of fungus species were analyzed.Results: Diagnosis of fungus keratitis was established in 686 (36 %) out of the total study group of 1880 cases. The spectrum of fungi isolated were Fusarium species (Fusarium spp.) in 219 (31.9 %), followed by unidentified dematiaceous 151 (22 %), curvularia 122 (17.7 %) and unidentified hyaline in 111 cases (16.1 %). Men (59.3 %) were more commonly affected than women (40.6 %). The young adults age group of 31-40 years was most commonly involved (26.6 %). Corneal trauma (58 %) and topical steroids (12 %) were the most common predisposing risk factors noted. Conclusion:In contrast to the other studies done in Nepal, we found Fusarium to be the most common fungal isolate causing corneal ulcer followed by unidentified dematiaceous, unidentified hyaline and curvularia. Corneal trauma was the commonest predisposing risk factor in causing fungal keratitis.

Back ground: Trans-pars plana vitrectomy (TPPV) is an effective surgical procedure to retain the useful vision in vitreoretinal diseases. Objective: To evaluate the surgical outcome of pars plana vitreoretinal surgery. Study design: Retrospective non-comparative interventional case series. Materials and methods: A hospital-based retrospective interventional study of series of cases was carried out in retina clinic of Lumbini Eye Institute, Nepal, over a period of one-and-a-half years. Records of 64 patients who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. Outcome measurement: The parameters studied were post-operative visual acuity and complications. Results: Of 64 patients, 61 % presented 2 months after the onset of symptoms. Preoperatively, 65.5 % had visual acuity of hand motions to 3/60 followed by perception of light only in 26.6 %.The main indication for TPPV was vitreous haemorrhage (VH), in 53 %. The visual acuity improved to better than 6/60 in patients with VH (68 %), whereas, overall, in 72 % of the subjects, it improved by 2 lines postoperatively. The commonest intra-operative complications were iatrogenic retinal break (5, 7.8%) at the sclerostomy site. Conclusion: The main indication for TPPV is vitreous haemorrhage. Useful vision can be restored by pars plana vitrectomy in the majority of the patients. Retinal break is the commonest complication of TPPV. Keywords: Trans-pars plana vitrectomy; vitreous haemorrhage; visual outcome; retinal break. DOI: 10.3126/nepjoph.v2i1.3703 Nep J Oph 2010;2(1) 39-44