Background We conducted this study to report on the indications and types of retinal laser therapy (RLT) performed in Bhutan, knowing which is critical for proper planning and successful delivery of the services. Methods We reviewed the laser registers maintained in the laser rooms and vitreoretinal (VR) operating theatres (including paediatric cases managed under anaesthesia) over three years at the national and the two regional referral hospitals (RRHs). Intraoperative laser treatments (endolaser) were excluded. Patient demography, indications and types of RLT were recorded and quantified. Comparisons of the expected and observed frequencies used Chi-squared tests. Results A total of 685 patients, including 8 cases of bilateral retinopathy of prematurity (ROP) received RLT. The majority of patients (411 cases, 60.0%, p < 0.0001) were males. The mean age was 54.1 ± 14.1 years, median 56 years. The most common indications for RLT were diabetic retinopathy (DR) and diabetic macular oedema (DMO) (542 cases, 66.0%), followed by retinal vein occlusion (RVO) (91 cases, 13.3%). Pan-retinal photocoagulation was the most common type of RLT performed (337 cases, 49.2%), followed by modified grid laser (207 cases, 30.2%), sectoral laser (41 cases, 6.0%), and prophylactic laser photocoagulation (33 cases, 4.8%). Conclusions The majority of patients were within working-age. Common indications for RLT were preventable such as DR, DMO and RVO, indicating need to control systemic diseases such as diabetes, hypertension, and dyslipidaemia. Currently, regular RLT is provided only at the national referral hospital in Thimphu, and periodically in the eastern and central RRHs when the retinal specialist visits. There is need to extend the retinal services to the eastern and central RRHs to improve accessibility and patient coverage in these regions challenged with difficult terrain and poor public transport system.

Purpose: To describe the pattern of vitreoretinal surgeries performed in Bhutan. This first national study informs policy making and resource development. Methods:We reviewed the surgical registers of the three hospitals in Bhutan providing VR operations or interventional procedures for VR diseases over three years. Patient demography, indications and types of vitreoretinal surgeries were logged and quantified. Comparisons of the expected and observed frequency used Chisquared tests.Results: A total of 214 patients received vitreoretinal surgeries, 36 paediatric cases received examination under anaesthesia for diagnostic confirmation followed by vitreoretinal surgery or retinal laser. Additionally, 381 cases received intravitreal anti-vascular endothelial growth factor injections in the operating theatres as mandated in Bhutan. The mean age was 56.2 ± 22.3 years. The majority, 375 cases (59.4%) were males (p<0.001). The common indications for VR surgery were retinal detachment (45.1%), vitreous haemorrhage (13.6%), and macular hole (7.7%). Retinal detachment surgery was the most common surgery performed, followed by silicon oil removal with cataract surgery. The common indications for anti-vascular endothelial growth factor injection were neovascular age-related macular degeneration (168 cases, 44.12%), retinal vein occlusion (132 cases, 34.6%), and diabetic macular oedema and retinopathy (50 cases, 13.1%). Conclusion:Performing high-tech vitreoretinal surgeries in a resource-limited setting is challenging. With an ever-increasing load of vitreoretinal diseases such as retinal detachment, age-related macular degeneration and macular hole, and the complications of systemic diseases such as retinal vein occlusion, vitreous haemorrhage, and diabetic macular oedema and retinopathy, there is a need to improve vitreoretinal services in Bhutan.

A 60 year old farmer presented on 4th Sept, 2015with progressive diminution of vision in the right eye following trauma while hammering about a month previously. His vision was Hand Movement only in the right eye and 6/6 in left eye. The anterior segment showed normal findings, except mild anterior chamber reaction and an early cataract in the right eye. The left eye was normal except for an early age-related cataract. Fundoscopy revealed retained intra-ocular foreign body (ROOFB, subtotal RD with macula off in right eye. Interestingly, no entry wound was found. A B-scan and CT scan of the brain and orbit confirmed RIOFB and RD. On 9th September 23G PPV was done and RIOFB was removed. Fluid-air exchange, endolaser and silicon oil injection were done to attach the RD. On 6th February 2016 a cataract extraction with intraocular lens implantation and silicon oil removal was performed which improved the patient’s vision to 6/18p.

Conversion of Solid waste into energy is the most resourceful process to combat landfill saturation and environmental impression. Bhutan, with an exponential rise in the waste production, Waste to Energy (WTE) conversion is an alternative solution for municipal solid waste management (MSW). The study for MSW composition and its energy potential analysis for Memelakha (Thimphu) and Pekarshing (Phuntsholing) landfills was done to resolve the waste management challenges in the country. The standard number of samples from two dumpsites were used to analyze for the waste characterization (waste composition, proximate analysis, chemical analysis) and high heating value (HHV) of MSW. MSW of two landfills showed that the main elemental constituents were Carbon and Oxygen with 17.26% and 9.97% by mass respectively for Pekarshing and 16.52% (Carbon) and 11.07% (Oxygen) by mass for Memelakha landfill. Based on the physio-chemical analysis of MSW, the average calorific HHV of MSW obtained were 10.028 MJ/kg (26.04% of coal energy) for Pekarshing dumpsite and 9.6 MJ/kg (24.94% of coal energy) for Memelakha. The analysis showed that by the year 2050 Memelakha landfill has the potential to generate the power of 8.85 Megawatt (MW) and 1.44 Megawatt (MW) for Pekarshing. For (WTE) conversion, incineration, pyrolysis, and gasification technologies are found suitable based on the current composition MSW of Bhutan. Furthermore, in terms of energy efficiency and percentage of wastage, the gasification process was the most feasible method for WTE conversion at two locations with a waste volume reduction of 80 to 90 percent at the landfill.