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Background: Endodontic literature search revealed that no study has been conducted to evaluate the prevalence of apical periodontitis (AP) in root canal treated teeth from an adult Nepalese population of Madhesh Province. Consequently, little is known about the extent and risk factors associated with it. This study aimed to determine AP prevalence in root canal treated teeth from an adult Nepalese subpopulation and to analyze the related risk factors including age, sex, tooth type, type of coronal restoration and quality of root canal treatment and coronal restoration as predictors of AP., Methods: Digital panoramic radiographs were evaluated. Periapical status of 300 root canal-treated teeth was scored by using the periapical index. The quality of root canal treatment and coronal restorations were categorized as adequate or inadequate through radiographic and clinical evaluation. The data were analyzed using univariate and multivariate logistic regression models., Results: Prevalence of AP in the present study was 31.7%. In 45.7% of the treated teeth, quality of root canal treatment was adequate whereas 46% of the cases had adequate coronal restorations. Multivariate logistic regression analysis revealed statistically significant associations and remarkably increased risk for AP in teeth with inadequate root canal treatment (odds ratio [OR] = 7.92; 95% CI: 3.96-15.82; p < 0.001) whereas lower risk for AP was found in females (OR = 0.51; 95% CI: 0.28-0.90; p = 0.021) and in teeth restored with crown (OR = 0.22; 95% CI: 0.09-0.51; p < 0.001) and filling (OR = 0.18; 95% CI: 0.08-0.42; p < 0.001). Quality of coronal restoration, tooth type and age of the patient were not found to be the predictors of AP., Conclusions: Within the limits of this study, a high prevalence of AP and poor overall quality of root canal treatment and coronal restoration was found in the subpopulation studied. Quality of root canal treatment, type of coronal restoration and sex of the patient are significant predictors of possible AP development in root canal treated teeth. Substantial efforts are needed to improve the endodontic treatment standards., (© 2024. The Author(s).)

One of the most common causes of eye loss is ocular trauma that overtime results in shrunken, non-functional eye known as a pthisical eye. The prosthetic options for such case include either prefabricated prosthesis or custom-made prothesis. Various materials and techniques are used for the fabrication of the prosthesis. Semi-customized prosthesis uses stock iris while the scleral shell is customized. This prosthesis has the advantages of both stock and custom-made prosthesis providing functionally and esthetically satisfactory result. This case report demonstrates the case of a 32 years old male who reported to the Department of Prosthodontics and Crown-Bridge, College of Dental Surgery, BP Koirala Institute of Health Sciences, Dharan, Nepal for eye prosthesis to mask his pthisical eye. For this case, a semicustomized scleral shell prosthesis was planned and fabricated.

Purpose: To investigate if topical chlorhexidine 0.2%, which is low cost and easy to formulate, is noninferior to topical natamycin 5% for the treatment of filamentous fungal keratitis., Design: Randomized controlled, single-masked, noninferiority clinical trial., Participants: Adults attending a tertiary-level ophthalmic hospital in Nepal with filamentous fungal infection confirmed on smear or confocal microscopy., Methods: Participants were randomly allocated to receive topical chlorhexidine 0.2% or topical natamycin 5%. Primary analysis (intention-to-treat) was by linear regression, using baseline logarithm of the minimum angle of resolution (logMAR) best spectacle-corrected visual acuity (BSCVA) and treatment arm as prespecified covariates. Mixed fungal-bacterial infections were excluded from the primary analysis but included in secondary analyses and secondary safety-related outcomes. The noninferiority margin was 0.15 logMAR. This trial was registered with ISRCTN, number ISRCTN14332621., Main Outcome Measures: The primary outcome measure was BSCVA at 3 months. Secondary outcome measures included perforation or therapeutic penetrating keratoplasty by 90 days., Results: Between June 3, 2019, and November 9, 2020, 354 eligible participants were enrolled and randomly assigned: 178 to chlorhexidine and 176 to natamycin. Primary outcome data were available for 153 and 151 of the chlorhexidine and natamycin groups, respectively. Of these, mixed bacterial-fungal infections were found in 20 cases (12/153 chlorhexidine, 8/151 natamycin) and excluded from the primary analysis. Therefore, 284 patients were assessed for the primary outcome (141 chlorhexidine, 143 natamycin). We did not find evidence to suggest chlorhexidine was noninferior to natamycin and in fact found strong evidence to suggest that natamycin-treated participants had significantly better 3-month BSCVA than chlorhexidine-treated participants, after adjusting for baseline BSCVA (regression coefficient, -0.30; 95% confidence interval [CI], -0.42 to -0.18; P < 0.001). There were more perforations and emergency corneal grafts in the chlorhexidine arm (24/175, 13.7%) than in the natamycin arm (10/173, 5.8%; P = 0.018, mixed infections included), whereas natamycin-treated cases were less likely to perforate or require an emergency corneal graft, after adjusting for baseline ulcer depth (odds ratio, 0.34; 95% CI, 0.15-0.79; P = 0.013)., Conclusions: Treatment with natamycin is associated with significantly better visual acuity, with fewer adverse events, compared with treatment with chlorhexidine. Natamycin remains the preferred first-line monotherapy treatment for filamentous fungal keratitis., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Introduction: Awareness and knowledge about the common ocular conditions can help people to seek early eye care services. The understanding and acceptance of the importance of routine eye examinations can help in timely detection and treatment of the eye diseases and thus help to reduce the burden of avoidable ocular blindness from the general population., Objective: This study aims to assess and analyze the information related to knowledge and awareness of common ocular diseases and eye health among the rural and urban communities of the Siraha district, Nepal., Materials and Methods: A descriptive cross-sectional study was conducted between April and June 2018 in Lahan Municipality ward number 6 (urban) and Sakhuwa Nankarkatti Rural Municipality ward number 4 (rural) in Siraha district. The sample size of 975 was calculated from study population of 3247. A systematic random sampling technique was used to interview adults above 18 years of age, using a pre-tested structured questionnaire. The collected data was analyzed., Results: Out of total 975 participants, 514 (52.7%) were from rural community in Sakhuwa Rural Municipality and 461 (47.3%) were from urban community in Lahan Municipality. The mean age was 38.38 ± 15 years. Female participants were more (63.2%) compared to male (36.8%). Overall, 58.3% were literate and 41.7% were illiterate. Rural community had more uneducated participants (48%) compared to urban community (34%). In rural community, 69% were aware about cataract, 83% had knowledge about its treatment; while in urban community 81% were aware about cataract and 86% had knowledge about its treatment. The awareness of glaucoma among the participants was poor, more so in rural cohort (15%) than the urban cohort (25%). The knowledge of glaucoma was 14% in rural and 62% in urban cohort. Awareness that diabetes can affect the eye was found to be significantly lower (p = 0.01) in rural population (25%) compared to that in urban population (41%) in this study. The knowledge about diabetic retinopathy was lower in rural community (38%) compared to urban community (49%). Awareness about Night Blindness was lesser in rural (62%) compared to urban (70%) community (p = 0.17). Awareness about refractive errors were 37% in rural compared to 60% in urban community. The major sources of information were society and eye hospital in both community., Conclusion: The knowledge and awareness level regarding common ocular diseases was high among the community people of urban community (Lahan) in comparison to rural community (Sakhuwa Nankarkatti). Awareness and knowledge level mainly regarding glaucoma and diabetic retinopathy was very poor in both urban and rural community. There is need to conduct comprehensive awareness programs on common ocular diseases like cataract, glaucoma, diabetic retinopathy, night blindness, congenital eye disease, ocular trauma, eye donations and others in both rural and urban areas to raise the awareness level and improve attitudes and right practices reducing the burden of avoidable blindness., (© NEPjOPH.)

Introduction: Fungal infections of the cornea, fungal keratitis (FK), are challenging to treat. Current topical antifungals are not always effective and are often unavailable, particularly in low-income and middle-income countries where most cases occur. Topical natamycin 5% is usually first-line treatment, however, even when treated intensively, infections may progress to perforation of the eye in around a quarter of cases. Alternative antifungal medications are needed to treat this blinding disease.Chlorhexidine is an antiseptic agent with antibacterial and antifungal properties. Previous pilot studies suggest that topical chlorhexidine 0.2% compares favourably with topical natamycin. Full-scale randomised controlled trials (RCTs) of topical chlorhexidine 0.2% are warranted to answer this question definitively., Methods and Analysis: We will test the hypothesis that topical chlorhexidine 0.2% is non-inferior to topical natamycin 5% in a two-arm, single-masked RCT. Participants are adults with FK presenting to a tertiary ophthalmic hospital in Nepal. Baseline assessment includes history, examination, photography, in vivo confocal microscopy and cornea scrapes for microbiology. Participants will be randomised to alternative topical antifungal treatments (topical chlorhexidine 0.2% and topical natamycin 5%; 1:1 ratio, 2-6 random block size). Patients are reviewed at day 2, day 7 (with reculture), day 14, day 21, month 2 and month 3. The primary outcome is the best spectacle corrected visual acuity (BSCVA) at 3 months. Primary analysis (intention to treat) will be by linear regression, with treatment arm and baseline BSCVA prespecified covariates. Secondary outcomes include epithelial healing time, scar/infiltrate size, ulcer depth, hypopyon size, perforation and/or therapeutic penetrating keratoplasty (corneal transplant), positive reculture rate (day 7) and quality of life (EuroQol-5 dimensions, WHO/PBD-VF20, WHOQOL-BREF)., Ethics and Dissemination: The Nepal Health Research Council, the Nepal Department of Drug Administration and the London School of Hygiene and Tropical Medicine ethics committee have approved the trial. The results will be presented at local and international meetings and submitted to peer-reviewed journals for publication., Trial Registration Number: ISRCTN14332621; pre-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Purpose : Vision 2020 and the Global Action Plan 2013-2019 prioritise primary eye care (PEC) as an important component of reducing avoidable blindness. Studies in sub-Saharan Africa have demonstrated that current PEC provision is poor. There has been no evaluation of the current practice of PEC among primary health care workers (PHCWs) in Nepal. Methods : A mixed methods descriptive cross-sectional study with semi-structured interviews and focus group discussions (FGDs) was carried out in Eastern Nepal. Government employed PHCWs working at health posts in three districts were invited to take part in a PEC knowledge and skills assessment. Each health post was assessed for ophthalmic equipment and medications. Three focus group discussions and eight semi-structured interviews were carried out with community ophthalmic assistants, PHCWs and a district health manager. Results : 107 PHCWs in 35 health posts took part in the quantitative study. Only 8.4% had received eye care training. 27.1% PHCWs could diagnose a corneal ulcer, 83.2% conjunctivitis, 75.7% cataract and 54.2% ophthalmia neonatorum. Only 14.0% could measure visual acuity, and 5.7% of HPs had a vision chart. Ophthalmic assistants described their concern for the low level of PEC at health posts. PHCWs were keen to receive training and highlighted the need for greater government support in the provision of eye care services. Conclusion : PEC knowledge and skills among PHCWs in eastern Nepal is inadequate to provide quality PEC services. There is a pressing need for PEC training in the region, provision of ophthalmic equipment and greater government support for eye care.

Introduction: Agricultural workers are prone to corneal injuries due to vegetative trauma especially during the harvesting season. This study reports the number of new cases of corneal injuries and corneal ulcer presenting in a month of harvesting season., Methods: This is a cross-sectional, hospital based study of all new cases of corneal injury and corneal ulcer presenting to the cornea department from 1st November, 2016 to 30th November, 2016. Typical or suspected cases of corneal ulcer of viral, immunologic or metabolic causes were excluded. Detailed history and clinical examination was carried out. Corneal scrapes in cases with corneal ulcer were taken and subjected to direct microscopy. Details of the findings were recorded in a proforma designed for the study. Statistical analysis was done by SPSS 18., Results: 259 cases presented during that period. Females were more affected (54%). Fifty-one percent of the cases presented from Nepal. Forty-eight percent gave history of ocular trauma by vegetative material. 40% presented within a week of development of symptoms, and about 40% after 2 weeks. Fifty percent of the cases had not presented to an eye care professional. 9% were using topical steroids. Progressive status of the disease was noted in 80%. Sixty-five percent presented with corneal ulcer of less than 2 mm size. Direct smear examination was carried out in 105 cases and 73% of them showed fungal elements., Conclusion: Awareness of agriculture related corneal injuries due to trauma by vegetative materials and methods to prevent such injuries is very important., (© NEPjOPH.)

Pulmonary tuberculosis (PTB) is one of the major infectious diseases in developing countries. The objective of this study was to compare rapid diagnostics technique, GeneXpert MTB/RIF (GeneXpert) and Multiplex PCR assay (MPCR) targeting IS6110 segment and mpb64 gene for direct detection of Mycobacterium tuberculosis (MTB) in suspected PTB patients. A cross sectional study was carried among 105 sputum samples from suspected PTB patients to evaluate GeneXpert and Multiplex PCR who visited National Tuberculosis Center, Nepal. The patient's sputum samples were used directly for the GeneXpert whereas DNA extraction by CTAB method was followed to process the sample for MPCR. The sensitivity and specificity of GeneXpert and MPCR in smear positive cases was 78.6, 33.3, and 100.0%, 66.7%, respectively (P = 0.125). However, in smear negative cases sensitivity and specificity of both methods exhibited 90.9, 95.2, and 100.0%, 100.0% respectively (P = 0.625). Finally, the sensitivity and specificity of GeneXpert and MPCR were 82.9, 95.3 and 100.0%, 98.5% respectively, (P = 0.549) in pulmonary cases. Comparatively, we observed higher sensitivity and specificity for MPCR than GeneXpert for both smear positive and negative samples. Thus, we recommend MPCR alongside GeneXpert for the better diagnostic accuracy of PTB in a resource-limited country where tuberculosis is endemic.

Usher syndrome, also known as retinitis pigmentosa-dysacusis syndrome, is an extremely rare genetic disorder, characterized by retinitis pigmentosa (RP) and congenital sensorineural hearing loss. It has been estimated to account for 3-6% of the congenitally deaf population, upto 8-33% of individuals with RP and half of all cases with combined deafness and blindness (Vernon M,1969; Boughman JA et al,1983). The prevalence of Usher syndrome have been reported to range from 3.5 to 6.2 per 100,000 in different populations (Vernon M,1969; Boughman JA et al,1983; Yan D et al, 2010). We report a case of Usher syndrome type I in an adult Nepalese male with typical congenital profound hearing loss, and night blindness secondary to retinitis pigmentosa., (© NEPjOPH.)

Introduction: Low vision is an important public health problem., Objective: To study the profile of low vision patients in a hospital of Nepal., Materials and Methods: Information related to the patients' profile, visual status, ocular disease and, low vision devices prescribed were obtained retrospectively from the records of 1,860 visually- impaired patients, regardless of the cause, presenting to the low vision department of the Biratnagar Eye Hospital, Biratnagar, Nepal, over a period of four years. These patients, after a comprehensive ocular examination, underwent low vision examination by an ophthalmologist and a low vision specialist., Results: Of 1,860 patients, males comprised 1298 (70 %), while 562 (30 %) patients were female. Six hundred and one (32.3%) patients were of less than 20 years while 398(21.4%) were more than 60 years of age. Agriculture (500, 27 %), household work (341, 18 %) and students (308, 17 %) were the common occupations. Retinal diseases were the commonest cause of low vision. They were: macular disorders 408 (22 %), retinitis pigmentosa 226 (12.1 %) and other retinal causes 361 (19.4 %) (diabetic retinopathy, choroidal coloboma, post laser for retinal vasculitis and central retinal/branch retinal vein occlusion, healed macular chorioretinal scar secondary to retinochroiditis and choroiditis). Refractive error 215 (11.5 %), amblyopia 49 (2.6 %), optic atrophy 144 (7.8 %) and microphthalmos 105 (5.6 %) were the other causes. Uncorrected distance visual acuity was between 6/24 and 6/60 in 509 (27.4 %) and between 5/60 and PL in 1,327 (71.3 %) patients. Similarly, near visual acuity with vision better than 2.50 M (N 20) and worse than 2.50 M (N20) was present in 643(34.5%) and 1,217(65.5%) patients. About 67% and 54.5% of the patients had some improvement in their distance and near visual acuity with glasses and low vision aids. Distance spectacles 909 (49 %), near spectacles 106 (5.7 %), hand held magnifiers 78 (4 %) and telescopes 18 (1 %) were the optical devices prescribed., Conclusion: The prevalence of low vision is common among the people of the younger and older age groups. Retinal diseases are common among the causes for low vision. Adequate prescription and availability of low vision devices can improve the visual acuity., (© NEPjOPH.)

Objective: This study aimed to determine the epidemiological characteristics and risk factors predisposing to corneal ulceration in patients presenting to Biratnagar Eye Hospital (Nepal)., Methods: All patients presenting to Biratnagar Eye Hospital between January 1 and December 31, 2011 with corneal ulceration were retrospectively reviewed. Sociodemographic data and information pertaining to risk factors were recorded, all patients were examined and corneal scrapping and cultures were carried out., Results: Over one year period 1644 patients with corneal ulcer were evaluated, out of which 76.6% of patients were in the age range of 30 to 69 years and 65% of patients had presenting visual acuity less than 3/60. Ocular trauma was the most common cause of keratitis accounting for 60.3% of corneal ulcer and majority of the patients (40%) presented after 2 weeks of symptoms. Among corneal scraping positive cases 1150 (70%) showed fungus, 73 (4.4%) showed bacteria and 20 (1.2%) showed both bacterial and fungus., Conclusion: Corneal ulcer continues to be one of the leading causes of preventable blindness in this region. Lack of awareness about gravity of this disease, financial constraints and geographic barriers remain the major reasons for delay in seeking proper medical help., (© NEPjOPH.)

Population genetic structure of melon fly analysed with mitochondrial cytochrome oxidase I gene suggested that melon fly populations across the globe is homogeneous with non-significant variation of 0.000-0.003 base substitutions per site. Test isolates representing various geographic situations across the world were placed in 26 mitochondrial haplotypes based on variations associated with a maximum of three mutational steps and the predominant haplotype i.e. H1 was present in all melon fly populations except Hawaiian population. Evolution of mtCOI gene suggested that the fly could have originated some 0.4 million years ago. The present study also indicated that the B. cucurbitae population expansion is an event of post Pleistocene warm climatic conditions with small number of founder population. The invasion of B. cucurbitae in Hawaii was associated with the large population size and the global presence of the fly is associated with human mediated dispersal. The very low genetic variation suggested that the fly management might be possible by large scale sterile insect techniques programme.

Purpose: To report clinical characteristics and early postoperative outcomes of pediatric cataract surgery with intraocular lens (IOL) implantation from Lahan, Nepal., Methods: Demographics and surgical, preoperative, and postoperative clinical characteristics data were collected and analyzed., Results: Of 2,633 eyes with primary IOL implantation, 2,003 eyes were in the non-traumatic group, whereas 630 eyes were from trauma. Median age at surgery was 7 and 9 years in the non-traumatic and traumatic groups, respectively. Boys comprised 74.2% of the non-traumatic and 85.4% of the traumatic cataract patients. Unilateral cataracts accounted for only 7.7% (154 of 2,003) of the non-traumatic group. Average follow-up was 35 days with greater than 6 months follow-up in 134 of 2,633 (5.1%) eyes. Most (68.5% [1,804 of 2,633]) of the lens opacities were described as total cataract. Although early postoperative best-corrected visual acuity improved from the preoperative recording in 95.0% (2,495 of 2,626) of eyes, 78.1% (2,050 of 2,626) remained in the poor (20/100 or worse) category. Median preoperative and early postoperative best-corrected visual acuity was hand motions and 20/200, respectively., Conclusion: A high-volume cataract surgical center in Lahan, Nepal, is able to provide cost-effective and high-quality pediatric surgery. Most of the patients in this series were noted to have complete cataracts and were boys. Visual improvement was achieved, but excellent visual outcomes were rarely documented due to late referral and inadequate follow-up. Educating families and primary caregivers with regard to the importance of earlier referral and postoperative optical correction and tracking will improve outcomes., (Copyright 2011, SLACK Incorporated.)

Background: several studies have shown comparable visual outcomes of SICS and phacoemulsification (Gogate et al 2007, Ruit et al 2007)., Objective: to compare the safety and efficacy of different types of surgical procedures (phacoemulsification versus SICS) for cataract surgery in immature cataract., Material and Methods: a prospective randomized controlled trial was carried out involving 93 and 89 patients with immature senile cataract selected for phacoemulsification and SICS respectively., Statistics: mean values with standard deviations were calculated. P value of less than 0.05 was considered significant., Results: there was no difference between the groups in terms of gender, age and pre-operative visual acuity (p = 0.09). In phacoemulsification group (n=93) more than two thirds and in SICS group (n=89) more than three quarters of the patients had good visual outcome (6/6-6/18) on first postoperative day (p=0.065). Poor outcome (<6/60) was recorded in 6% (phacoemulsification group) and 1% (small incision cataract surgery group). Mean visual acuity was 0.43 +/- 0.27 in phacoemulsification group and 0.47 +/- 0.24 in SICS group. Mean surgery time was significantly shorter in SICS group (p=0.0003)., Statistics: data were computed and analyzed using the SPSS software program vs 10. The p value of < 0.05 was considered significant., Conclusion: there was no significant difference in visual outcome on first post operative day in between phacoemulsification and SICS technique. However, performing SICS was significantly faster. Small incision cataract surgery with implantation of rigid PMMA lens is a suitable surgical technique to treat immature cataract in developing countries.