Tuberculosis (TB) is an infectious disease responsible for significant morbidity and mortality worldwide. It is a resurgent disease in the developed world. The World Health Organization estimates that one third of the world's population is currently infected, with 9 million new cases occurring annually, leading to 3 million deaths per year (WHO Report, 2007). The disease affects the ocular anterior segment, the posterior segment, and adnexa. The purpose of this review is to describe the ocular manifestations, diagnosis and treatment of tuberculosis and to emphasize the fact that ocular tuberculosis may occur in the absence of systemic clinical activity and may mimic several clinical entities. Various studies have shown a clinical significance of purified protein derivative test results and computerized tomography of the chest while, molecular diagnostic procedures have provided a new approach to establishing the diagnosis of ocular tuberculosis. The current review focuses on the diagnostic modalities, various clinical features, and treatments for management of intraocular tuberculosis recommended in recent publications. It is an update on the manifestations and management of ocular tuberculosis.

Background: Inflammation of the optic nerve is a common cause of visual loss due to optic nerve pathology.Objective: To report the clinical features, demographic pattern and response to pulse steroid therapy in patients with idiopathic optic neuritis in eastern Nepal. Materials and methods:The hospital data of patients with idiopathic optic neuritis admitted to the department of ophthalmology in a tertiary level center in eastern Nepal between Jan 2000 to Dec 2006 were retrospectively analyzed. The parameters studied were demographic pattern, clinical features, visual acuity and field defects.Results: Thirty-six patients (52 eyes) were found to have optic neuritis (papillits in 36 and retrobulbar optic neuritis in16 eyes). The male to female ratio was1.25:1. The mean age of the patients was 33.56±17.88 years (95 % CI=24.66 -42.45). The most common modes of presentation were loss of visual acuity and color vision defect. One patient had features suggestive of multiple sclerosis. Vision improved in 42 eyes at discharge from the hospital. Response to pulse methylprednisolone therapy was good in most (42 eyes) of the cases except for the patients having initial visual acuity of no light perception. Conclusion:Response to pulse methylprednisolone therapy is good in patients with initial visual acuity of at least perception of light. Demographic and clinical features of our patients were different from those reported from the western world. Some similarity was observed between studies reported from the oriental countries.

Background: Corneal ulcer is one of the major causes of monocular blindness in developing countries. Objective:To determine demographic pattern, risk factors, microbiological pattern and treatment outcome of infective keratitis. Materials and methods:A retrospective analysis of hospital records of 44 patients with clinically-diagnosed infective keratitis presenting to B.P. Koirala Institute of Health Sciences in the eastern region of Nepal was carried out. Outcome measures:The parameters studied were risk factors and organisms responsible for keratitis. Results:The infective keratitis was mostly prevalent among the males between 21-40 years of age (50%). 79.5 % of them were engaged in agricultural work. A history of corneal injury was found in 30 eyes (68.1%). Vegetative matter was the most common agent of trauma in 17 (56.6%). Culture positivity for microorganisms was observed in 20 (45.5%) samples. Of these, 8 (40%) patients had purely bacterial corneal ulcer. Purely fungal growth was seen in 4 (20%) and mixed in 8 (40%). Staphylococcus aureus was the most commonly isolated bacteria (70%). The other bacteria included Pseudomonas species, E. coli and Acinetobactor. Aspergillus species was the most common fungal organism isolated in 8 (40%) samples. 65.9 % of the patients improved with medical treatment alone. Perforation, endophthalmitis and panophthalmitis were the common complications encountered in 11.3%, 4.5% and 4.5% respectively. Conclusion:Corneal ulcer is prevalent in males, predominantly amongst the farmers. Ocular trauma with vegetative matter is the commonest predisposing factor. Staphylococcus aureus and Aspergillus species are the most commonly isolated organisms in corneal ulcers.

Background: Sturge-Weber syndrome (SWS) is a rare congenital neuro-oculocutaneous disorder. Glaucoma is one of the ocular abnormalities associated with it. Management of glaucoma in SWS is challenging. Objective: To report surgical and visual outcome of trabeculectomy in bilateral glaucoma in Sturge-Weber syndrome and the challenges encountered in its management. Case description: A six-year-old girl presented with gradually progressive increase in size of both the eyes associated with watering, photophobia and diminution of vision since birth. On examination she was diagnosed to have bilateral SWS with glaucoma, refractive to antiglaucoma medications. She underwent trabeculectomy with intraoperative use of 5-FU. The post operative period was complicated with choroidal effusion in both the eyes with shallow anterior chamber. In the second post operative day, the right eye anterior chamber reformation was done with ringer lactate solution. There was spontaneous resolution of choroidal effusion with normalization of intraocular pressure with no adverse effect on visual acuity within one week. Conclusion: Treatment of glaucoma associated with Sturge-Weber syndrome is challenging. When planning surgical intervention an increased risk of choroidal effusion associated with it, should be kept in mind.

We tried to explore the demographic profile and complications of the out patients suffering with Diabetes Mellitus (DM). It was hospital based descriptive study conducted among the 100 diabetic out-patients of B.P.Koirala Institute of Health Sciences, Dharan, Nepal during the period of 1-1-2010 to 29-2-2010.Patients above 14 years diagnosed as per ADA guidelines 2009 giving written informed consent were taken. The number of common diabetes related complications were searched and diagnosed clinically with the use of relevant investigations which included macro-vascular complications like ischemic heart disease, peripheral vascular disease, and micro-vascular complications like diabetic retinopathy, diabetic neuropathy, and diabetic nephropathy. Among 100 confirmed cases of diabetes mellitus (51male and 49 female).Of all diabetes, 99% were type 2, 1% were type1. About 42% subjects were of age group between 40-60 yr. When BMI >23 kg/m 2 (as recommended for Asians) is taken as the determining factor for overweight, 29% of patients were overweight ,56% obese and 6% morbid obese. About 83% of subjects were on OHA, 9% on Insulin and 8% on OHA and insulin both. The most common and frequent chronic complications were neuropathy (44.4%) followed by cardiovascular and retinopathy (27.7%),nephropathy(16.6%) and others (11.3%).About 25 % of subjects had hypertension (stage 1 hypertension-17%, and stage 2 hypertension 8%).As most of the patients are overweight with more neurological and cardiovascular complications so the lifestyle changes are required with regular antidiabetics and dietary restriction.