Summary Childhood cataracts have become a leading cause of preventable childhood blindness in many areas of the world. Here we summarize regional focus group discussions from the 4th Annual International Congenital Cataract Symposium on the current situation, challenges, and recommendations for the management of congenital cataracts in sub-Saharan Africa, the Middle East and North Africa, South Asia, Central America, South America, and developed nations. Strategies for managing congenital cataracts must be adapted and developed according to regional conditions. A basic framework for acceptable outcomes must focus on developing systems to address the critical components of education, access, quality care, and good follow-up.

Background: Paediatric blindness presents as an enormous problem to developing countries in terms of human morbidity, economic loss and social burden.Aims and Objective: The objective of this study was to observe the visual outcome of congenital and developmental cataract surgery.Materials and Methods: This study was prospective, longitudinal and interventional. The patients aged ≤15 years, diagnosed either congenital or developmental cataract and planned for cataract surgery were enrolled during March 2014 to February 2015 at Lumbini Eye Institute, Nepal. The patients underwent either: a) Lens aspiration + PPC+ Anterior Vitrectomy; b) Lens aspiration + PPC+ Anterior Vitrectomy + PCIOL; c) Lens Aspiration + PCIOL depending upon age of patient. The patients were examined after surgery day 1, day 2, after 2 weeks and after 6 weeks. Glasses were prescribed at 6 weeks from the date of surgery. Occlusion therapy was initiated in cases wherever necessary.Results: A total of 54 eyes of 43 children were included in the study. The sex ratio was 1.26 female per male with mean age of 3 years (SD ± 2.16). In the verbal group, 61.1% (33 eyes) had final visual acuity (6/6-6/18). In the non verbal group, 16.7% (9 eyes) had final visual acuity of good fixation and follow. There was a statistically highly significant improvement in post surgical Best corrected visual acuity (p< 0.001).Conclusion: Good visual outcome after pediatric cataract surgery can be obtained if surgery is performed by skilled surgeon. The awareness of pediatric cataract, early diagnosis and timely intervention to surgical treatment, and postoperative management of residual uncorrected refractive error and amblyopia are important factors for the prevention of childhood blindness from cataract.Asian Journal of Medical Sciences Vol.9(2) 2018 36-39

Introduction: Penetrating eye injury is an important cause of visual impairment in pediatric population.Aims and Objectives: To study the epidemiology and visual outcome of penetrating eye injuries in pediatric population presented to Lumbini Eye Institute, the tertiary eye hospital of western Nepal.Materials and Methods: This retrospective study was conducted at the Department of Pediatric Ophthalmology and Strabismus, Lumbini Eye Institute over a period of one year from June 2014 to May 2015. All patients of penetrating eye injuries up to the age of 15 years were included in the study. The demographics of the patient, cause and duration of injury were recorded. The presenting and final best corrected visual acuity, anterior and posterior segment findings were recorded in specially designed proforma.Results: A total number of 127 children (127 eyes) presented with penetrating eye injuries during a year. The incidence of penetrating eye injury in one year was 127 out of 12927 new patients. Minimum age was 11 months, while the maximum age was 15 years with mean of 7.29 years (SD= ±3.49). Male and female patients were 99 (78%) and 28 (22%) respectively. Involvement of right eye was seen in 69 cases (54.33%) and left eye 58 (45.67%). The most common cause of injury was wooden stick in 55 cases (43.31%) followed by iron wire 12 (9.45%) and the stone 11 (8.66%). Corneal laceration was found in 102 cases (80.31%), scleral laceration in 10 (7.87%) and corneo-scleral laceration in 15 (11.81%). Seventy three percent patients were blind at the time of presentation whereas at discharge 37.63% were blind and 11.43% of patients had visual acuity better than 6/18 at presentation whereas 35.48% had visual acuity better than 6/18 after treatment.Conclusion: Penetrating eye injury is one of the common causes attending Pediatric Ophthalmology Department. Penetrating eye injury is common in male and majority of trauma is caused by wooden stick. The awareness of ocular trauma and its consequences should be increased to reduce incidence of childhood blindness.Asian Journal of Medical Sciences Vol.7(4) 2016 84-87

Background: Influencing factors of conventional horizontal surgery for surgical outcome has not been assessed in Nepal. Aims and Objective: To assess the pre-operative factors that influences the surgical outcome of horizontal strabismus surgery. Materials and Methods: The medical records of 68 patients who underwent their first horizontal strabismus surgery at Lumbini Eye Institute from 1 st January to 30 th December 2015 were retrospectively reviewed. The collected clinical data included diagnosis, age group, visual acuity, binocular function, extraocular motility and pre and postoperative deviation. The success of surgery was defined by eye deviation less than 10 prism diopters (PD) at 6 weeks after operation. The influencing factors for surgical success (diagnosis, age group, visual acuity, binocular function, and angle deviations) were analyzed using chi square test and Mann-Whitney -U test, where ever appropriate. Results: Out of 113 patients who underwent strabismus surgery during the year, 68 patients were enrolled in the study. Majority of the patients (27, 39.7%) were >9 years of age and 52.9% were female. Thirty seven patients (54.4%) were esotropic whereas, 31 were exotropic. Preoperatively, angle of deviation ranged from 20 to 90 PD with binocular vision present in 57.4% cases. Overall, success was seen in 26 patients (38.2%). Pre-operative angle of deviation and binocular vision had statistical significance with surgical success (p = 0.012 and 0.026 respectively). Conclusion: Larger angle of deviation and poor binocular vision at presentation has higher failure rate for horizontal strabismus surgery.

Introduction: Surgical removal is the treatment of choice for pterygium; however, prevention of recurrence is a challenge. Several techniques have been tried to reduce the fibro-vascular activity aiming to reduce rate of recurrence such as B-irradiation, conjunctival and limbal auto-grafting, anti-mitotic drugs, and amniotic membrane transplantation. This study reports the magnitude of the disease in a hilly region of western Nepal and outcome of excision and conjunctival autografting for pterygium surgery. Methods: A prospective study was done from 1st July 2015 to 31st December 2016 in which all patients with primary pterygium presented to Palpa Lions Lacoul Eye Hospital from 1st July 2015 to 30th June 2016 were treated and followed up for next six months. Patients were treated medically or surgically as indicated. Data on age, sex, visual acuity, extent of disease, treatment modality, complications, and outcome were collected and analyzed by descriptive statistics, Chi-square test, t-test, and Anova tests. P value less than 0.05 was considered significant. Results: There were 18,960 patients in total attending hospital for various conditions among which 290 (1.5%) had pterygium. There were 186 (64.1%) female and 104 (35.9%) male and this difference was significant (p<0.001). The mean age was 47.42 yrs (SD=14.23) with age ranging from 20 to 80 years. Right eye was affected more (43.1%) than left eye (33.1%); remaining 23.8% had bilateral disease. Grade-1 disease occurred in younger age compared to Grade-2 and Grade-3 disease. All grade-1 patients were managed medically; grade-2 and grade-3 patients were equally likely to be managed medically or surgically. There were no major intra or post-operative complications. Minor post-operative complications noted were subconjunctival hemorrhage, corneal scarring, suture gaping, and conjunctival cyst among others. Conclusion: Despite much advanced techniques in pterygium surgery, pterygium excision combined with conjunctival autograft is found to be a safe and effective method for treating pterygium in developing world.