Pattern visual evoked potential and foveal sensitivity in amblyopia

PURPOSE

Amblyopic eyes show impaired visual functions such as poor visual acuity and reduced foveal sensitivity. The purpose of this study was to determine the association between foveal threshold and visual evoked potentials (VEP) in strabismic and anisometropic amblyopia.

METHODS

Forty-five subjects (age range: 7-28 years, 43.3% female) including 15 strabismic and 15 anisometropic amblyopes, and 15 age-similar control subjects participated in this study. Each subject had pattern visual evoked potentials and foveal threshold recorded in each eye using RetiScan (Roland Consult, Germany) and Humphrey Visual Field Analyzer II (HFA II; Carl Zeiss Meditec Inc., Dublin, CA), respectively. These outcomes were compared among the amblyopic eyes, their fellow eyes, and the control eyes.

RESULTS

Compared to the amblyopic eyes (Mean ± SD: 33.4 ± 3.48 dB), the foveal threshold was higher in fellow eyes (37.0 ± 2.04 dB, p = 0.0002) and in control eyes (38.7 ± 0.96 dB, p < 0.0001). Strabismic amblyopes had a lower foveal threshold than anisometropic amblyopes (31.8 ± 3.86 vs. 35.0 ± 2.17 dB, p = 0.005). Relative to the P100 peak time in fellow eyes (1° checks:116.1 ± 9.00 ms; 0.25° checks:118.8 ± 5.67 ms), amblyopic eyes had delayed P100 peak times for both 1° (122.7 ± 11.4 ms, p < 0.0001) and 0.25° (130.4 ± 11.2 ms, p < 0.0001) check sizes. There were also significant differences in P100 peak time between amblyopic and control eyes (1°:122.7 ± 11.4 vs.112.4 ± 5.01 ms, p = 0.15; 0.25°:130.4 ± 11.2 vs.113.9 ± 5.71 ms, p < 0.0001) and between fellow and control eyes (0.25°:118.8 ± 5.67 vs.113.9 ± 5.71 ms, p = 0.009). Amblyopic eyes exhibited lower N75-P100 amplitudes than fellow eyes (1°:12.6 ± 7.96 vs.15.9 ± 8.82 µV, p = 0.01; 0.25°:10.6 ± 6.11 vs. 15.8 ± 10.6 µV, p = 0.001) and control eyes (0.25°: p = 0.0008). Foveal threshold correlated negatively with P100 peak time (1°: r = -0.45, p = 0.002 and 0.25°: r = -0.58, p < 0.0001) and positively with N75-P100 amplitude responses (1°: r = 0.42, p = 0.004 and 0.25°: r = 0.52, p = 0.002).

CONCLUSIONS

Amblyopic eyes showed reduced pattern VEP amplitudes and delayed peak times with significant associations with the foveal sensitivity. However, the VEP measures overlapped extensively between amblyopic and control eyes with no apparent criterion value for optimal discrimination, suggesting that foveal sensitivity might be a better discriminator of amblyopia than pattern VEP.

Evaluation of Peripapillary and Macular Nerve Fiber Layer Thickness in Paediatric Glaucoma Suspects

Introduction: Glaucoma patients are known to have optic disc cupping, leading to loss of retinal ganglion cell axons. This peripapillary nerve thinness is known to be associated with glaucoma in adult patients. Hence, we intended to evaluate the peripapillary and macular nerve fiber thickness in eyes of pediatric glaucoma suspects using spectral domain optical coherence tomography (OCT). Methods: This cross-sectional analytical study included 44 eyes of 22 paediatric glaucoma suspects, who were compared with 40 eyes of 20 normal paediatric eyes. Pearson correlation coefficients were calculated to assess the relations between the peripapillary retinal nerve fiber layer (RNFL) thickness and ganglion cell complex (GCC). Receiver Operating Characteristics (ROC) curve was plotted for OCT parameters in both the groups along with area under the curve (AUC) calculation. P values < 0.05 were considered as statistically significant. Results: We found the RNFL to be thickest in the superior, inferior, nasal and temporal quadrants in both glaucoma suspects and normal group. When compared among quadrants in RNFL, all the values in different quadrants were statistically significant from each other and in between groups with p < 0.01. The RNFL thickness was statistically different in glaucoma when compared with normal in superior, temporal, and nasal quadrants however, no statistically significant difference was found in inferior quadrant RNFL. The largest AUC for discrimination of glaucoma suspect eyes from normal in peripapillary RNFL in was nasal quadrant in right eye, followed by temporal quadrant whereas it was largest in superior followed by nasal quadrants then average in left eye. However, AUC for discrimination of glaucoma suspects from normal in GCC was poor. Conclusions: Glaucoma suspect paediatric eyes showed significant thinning in peripapillary nerve fiber layer thickness compared to normal subjects.

Refractive and Binocular Vision Status and Associated Asthenopia among Clinical Microscopists

Background Clinical microscopists are at a greater risk of developing binocular vision anomalies and asthenopia. Objective To assess the refractive and binocular vision status and to explore the association between the presence of asthenopic symptoms and microscopy work among clinical microscopists working at medical laboratory department. Method This cross-sectional study involved 37 clinical microscopists working at medical laboratory department of Dhulikhel Hospital, Nepal. The study was conducted from January to December 2013. Only those participants who had been using microscope for at least a year were enrolled in this study. Each participant underwent distance visual acuity (VA) assessment, refractions, and orthoptic evaluation, including measurement of distance and near phoria, near point of convergence (NPC), near point of accommodation (NPA), positive fusional vergence (PFV), adduction, and calculation of accommodation convergence/accommodation (AC/A) ratio. The tear test was also carried out in each subject. Information about use of glasses, microscopy work (duration, and time spent per day in microscope), and visual symptoms associated with the use of microscope such as eye strain, headache, double vision, and near vision were collected. Result The mean age of the clinical microscopists was 29 ± 5.7 years. The prevalence of refractive error was 56.76% and the mean spherical equivalent (SE) refractive error was -0.77 ± 0.86 D. Refractive error had neither correlation with microscopy work and asthenopic symptoms associated with it, and nor with binocular vision parametersNPC, AA and AC/A ratio. However, there was a positive association between asthenopic symptoms and microscopy work. There was statistically significant difference between symptomatic and asymptomatic subjects for binocular vision parameters, including NPC, AA and positive fusional vergence (PFV) for near. Conclusion Microscopy work has an impact on near binocular vision. Asthenopic symptoms bear a positive association with microscopy work. Refractive error has no significant correlation with either microscopy works or associated asthenopic symptoms.

Causes of Blindness and Visual Impairment Among Children Studying in Schools for the Blind in Central Development Region of Nepal

Introduction: This study was done to find out the causes of visual impairment in students studying in schools for the blind in the central development region of Nepal. Materials and Methods: The study was done in six schools for the blind in the central development region of Nepal. It was conducted by a team of Eye care professionals using standard eye examination protocols of the World Health Organization Prevention of Blindness Program in the year 2009. Results: A total of 133 students (5 - 21 years age group) enrolled in six schools for the blind were examined. 52.6% of children were visually impaired at birth and 12% developed vision impairment within one year of age. Twenty-one students (15.8%) had mild visual impairment, 5 students (3.8%) had severe visual impairment and 101 students (76%) were blind. The main cause of vision impairment was found to be lens-related anomaly 23.3% and retinal diseases, 18% followed by corneal lesions, 16.5%, and problems with the whole globe, optic nerve, and glaucoma accounting for 12.03%, 11.3%, and 7.5% respectively. The etiology could not be identified in 48.1% followed by hereditary causes (31.6%) and childhood factors (12%). Of the total students examined, 37.6% were visually impaired due to avoidable causes; preventable in 22.6% and treatable in 15% of cases. Conclusions: A high proportion of childhood blindness in schools for the blind in the central development region of Nepal is avoidable.

Perinatal Risk Factors for Retinopathy of Prematurity in Preterm and Low Birth Weight Neonates

BACKGROUND

Retinopathy of prematurity (ROP) is emerging as a leading cause of childhood blindness. The incidence of ROP is likely to increase after improvement in neonatal care unit in premature neonates. This study is conducted to determine the perinatal risk factors for ROP in preterm and low birth weight neonates.

METHODS

This is a prospective, descriptive and clinical; hospital based study. A total of 92 preterm neonates with gestational age of 36 weeks or less and birth weight of 2000 grams or less admitted in Neonatal Intensive Care Unit (NICU) were screened. Detailed antenatal, perinatal and neonatal history; birth asphyxia and subsequent oxygen support records were noted. All the neonates underwent detailed anterior and posterior segment eye examination with indirect binocular ophthalmoscope after pupil dilatation within 4 weeks of life. Retinal vascular changes were classified according to the International Classification of Retinopathy of Prematurity. The Chi-square test with odds ratio was performed to derive the association between ROP and antenatal, perinatal and neonatal factors. A p-value was considered significant at 0.05.

RESULT

Out of 92 neonates, 21(22.8%) developed ROP. Twelve neonates (13%) had stage-1 ROP, 6(6.5%) had stage-2 and 3(3.3%) had stage-3 ROP. Birth weight (OR=2.9; p=0.04; 95% CI=1.0-8.3), gestational age (OR=3.9; p=0.01; 95% CI=1.3-11.8) and time span of oxygen exposure (OR=2.9; p=0.05; 95% CI=1.0-8.4) had a strong association with ROP.

CONCLUSION

The incidence of ROP is significantly high among preterm low birth weight neonates. The risk of developing ROP becomes even greater with lower gestational age and more duration of oxygen exposure.

Flash VEP in clinically stable pre-term and full-term infants

PURPOSE

Pre-term infants are at risk of abnormal visual development that can range from subtle to severe. The aim of this study was to compare flash VEPs in clinically stable pre-term and full-term infants at 6 months of age.

METHODS

Twenty-five pre-term and 25 full-term infants underwent flash VEP testing at the age of 6 months. Monocular VEPs were recorded using flash goggles on a RETIscan system under normal sleeping conditions. Amplitude and peak time responses of the P2 component in the two eyes were averaged and compared between the two groups. Multiple regression analyses were performed to assess the relationship of the P2 responses with birth weight (BW) and gestational age (GA).

RESULTS

At 6 months corrected age, pre-term infants had significantly delayed P2 peak times than full-term infants (mean difference: 10.88 [95% CI 4.00-17.76] ms, p = 0.005). Pre-term infants also showed significantly reduced P2 amplitudes as compared to full-term infants (mean difference: 2.36 [0.83-3.89] µV, p = 0.003). Although the regression model with GA and BW as fixed factors explained 20% of the variance in the P2 peak time (F_2,47 = 5.98, p = .0045), only GA showed a significant negative relationship (β = -2.66, p = .003). Neither GA (β = 0.21, p = .28) nor BW (β = 0.001, p = .32) showed any relationship with P2 amplitude.

CONCLUSIONS

Our results demonstrate that, compared with full-term infants, clinically stable pre-term infants exhibit abnormal flash VEPs, with a delay in P2 peak time and a reduction in P2 amplitude. These findings support a potential dysfunction of the visual pathway in clinically stable pre-term infants as compared to full-term infants.

Orbital Teratoma: A rare congenital tumour

BACKGROUND

Orbital teratomas are congenital, unilateral germ cell tumors, which are present at birth with moderate to massive proptosis. The rare tumour has to be managed individually and is at times difficult.

CASE

A female child in her 2nd day of life was brought to our department with complains of forward bulging of the left eye which was noticed since the time of her birth.

OBSERVATION

Examination and investigations revealed a mass with scattered foci of calcification. The mass was causing expansion of left orbit with thinning and scalloping of bony boundaries of left orbit with no intracranial component. The scan suggests the diagnosis of orbital teratoma which was further confirmed by histopathological examination.

CONCLUSION

The rare tumour presents a challenge in management. The aim of management depends upon the extent of tumour, preservation of vision whenever possible, promotion of normal orbital growth and cosmesis.

Awareness of Eye Health and Diseases among the Population of the Hilly Region of Nepal

Purpose:

To collect information regarding awareness and knowledge of eye health and diseases among the population of the hilly region of Nepal.

Methods:

In a population-based survey, 1834 participants were enrolled in to the study. Field procedures included the development of a survey questionnaire, field orientation, pretesting, and household data collection. Association between knowledge of eye diseases was derived using the Chi-square test and odds ratios with a 95% confidence interval. A P value of ≤0.05 was considered significant.

Results:

Most participants were 31–40 years old (33.4%), female (51.1%), of upper caste (43.4%), Hindus (83.3%), received secondary level of education (34.4%), and involved in agriculture (48.6%). Awareness of cataract, night blindness, glaucoma, strabismus, and systemic diseases was 74.6%, 53.4%, 17.4%, 70.8%, and 46.5%, respectively. Knowledge regarding these diseases among those aware was 39.1%, 72.2%, 50.9%, and 92.3%, respectively. Awareness of cataract was significantly higher (88.4%) among higher caste groups (P < 0.001; OR, 4.29; 95% CI, 3.34–5.54), followed by business as an occupation (88.2%; P = 0.001; OR, 2.65; 95% CI, 1.44–4.9). Awareness of night blindness was significantly higher among students (72.6%; P < 0.001; OR, 2.46; 95% CI, 1.65–3.67).

Conclusion:

There was a general lack of awareness and knowledge of common eye diseases. Improved awareness and knowledge are required for the prevention, early treatment, and access to eye care.

A case of transorbital intracranial injury presenting with subtle neurological deficit

Background: Ocular trauma is a major cause of visual morbidity. Objective: To present a rare case of transorbital intracranial injury extending up to the left internal carotid artery (ICA) with no other systemic neural deficit except for the ocular manifestations. Case: A 14-year-old female presented to our out-patient department (OPD) with the history of trauma to her left eye with stumps of bamboo shoots secondary to a fall injury. Examination and investigations revealed a foreign body extending from left inferior conjunctival fornix into the intracranial cavity, occluding the various segments of left ICA. The patient subsquently underwent craniotomy and foreign body removal by a combined team of neurosurgeons and ophthalmologists. On discharge, the patient had slight improvement in extraocular motility of her left eye. However the trauma rendered the affected eye, non-seeing. Conclusion: The intracranial extent of a foreign body entering the cranium via the transorbital route cannot be judged merely by the clinical findings of the nervous system and ocular examination. These patients need timely management by the combined effort of ophthalmologists, neurosurgeons and radiologists.

Macular thickness and macular volume measurements using spectral domain optical coherence tomography in normal Nepalese eyes

PURPOSE

To record the normative values for macular thickness and macular volume in normal Nepalese eyes.

METHODS

In all, 126 eyes of 63 emmetropic subjects (mean age: 21.17±6.76 years; range: 10-37 years) were assessed for macular thickness and macular volume, using spectral domain-optical coherence tomography over 6×6 mm(2) in the posterior pole. A fast macular thickness protocol was employed. Statistics such as the mean, median, standard deviation, percentiles, and range were used, while a P-value was set at 0.05 to test significance.

RESULTS

Average macular thickness and total macular volume were larger in males compared to females. With each year of increasing age, these variables decreased by 0.556 μm and 0.0156 mm(3) for average macular thickness and total macular volume, respectively. The macular thickness was greatest in the inner superior section and lowest at the center of the fovea. The volume was greatest in the outer nasal section and thinnest in the fovea. The central subfield thickness (r=-0.243, P=0.055) and foveal volume (r=0.216, P=0.09) did not correlate with age.

CONCLUSION

Males and females differ significantly with regard to macular thickness and macular volume measurements. Reports by other studies that the increase in axial length reduced thickness and volume, were negated by this study which found a positive correlation among axial length, thickness, and volume.

Burden of ocular and visual disorders among pupils in special schools in Nepal

OBJECTIVES

To determine detailed oculo-visual characteristics of children with intellectual disability studying in special schools and explore the burden of visual impairment.

DESIGN OF THE STUDY

Detailed ophthalmic examination was carried out in all pupils studying at the seven special needs schools of Kathmandu valley, Nepal. Ophthalmic examination included case history, presenting distance visual acuity, cycloplegic refraction, binocular vision examination, contrast sensitivity and anterior and posterior segment evaluation.

MAIN OUTCOME MEASURES

Ocular and visual status of children.

RESULTS

Refractive errors (40%) and strabismus (17%) were the commonest visual disorders in our study children. Ninety-five per cent of the children who had clinically significant refractive errors presented without any correction. Visual impairment was present in 25% of the children. Severe visual impairment or worse was present in 3% of the children. Other common ocular findings were conjunctivitis, blepharitis, chalazion and ectropion.

CONCLUSIONS

High prevalence of preventable visual impairment in this population requires immediate attention. It is hoped that the formulation of proper vision care guidelines at a national level may help in early detection and management of visual disorders in this special population and enhance their quality of life.

Marfan's syndrome: a refractive challenge for optometrists

We present an interesting case of a child with Marfan's syndrome with ectopia lentis, who was followed for five years. The changes in refractive and visual findings of this child during this period are discussed. The importance of careful oculo-visual examination and possible management options in such children are highlighted.

Phacoemulsification surgery by a nationally-trained cataract surgeon of Nepal

INTRODUCTION

A one month phacoemulsification training course had been implemented by the Nepal Netra Jyoti Sangh (NNJS) in collaboration with Association for Ophthalmic Cooperation to Asia, Japan (AOCA).

OBJECTIVE

To evaluate the visual outcomes of phacoemulsification surgery by a nationally trained surgeon in Nepal.

MATERIALS AND METHODS

A retrospective study of patients that underwent phacoemulsification with foldable intraocular lens implantation during a period of 18 months was carried out. Cases that had a six-week follow-up period were included. Effective phaco time (EPT), intra-operative and postoperative complications were noted. Uncorrected visual acuity (UCVA) at day 1 and best corrected visual acuity (BCVA) at week 6 were noted. The data were analyzed using SPSS 11.5.

RESULTS

A total of172 patients that had completed a 6 week follow-up evaluation were included in the study. The mean age of patients was 57.12±10.19 years. The mean effective phaco time (EPT) was 9.74±7.41 seconds. Posterior capsule rupture (PCR) with vitreous loss occurred in 2 eyes (1.2%), Descemet's membrane detachment in 1 eye (0.6%), capsulorhexis extension in 1 eye (0.6%) and wound site thermal injury (WSTI) occurred in 3 eyes (1.7%). Postoperative complications were mild to moderate striate keratopathy (9/ 172), corneal edema (1/172), corneal epithelial defect (1/172) and uveitis (1/172). At 6 weeks post-operatively, 165 eyes (95.9%) had a BCVA better than 6/18 and 7 eyes (4.1%) had a BCVA of 6/18 to 6/60.

CONCLUSION

Patients undergoing phacoemulsification had a good visual outcome as a result of the procedure performed by cataract surgeon trained from AOCA/NNJS national phacoemulsification training program of Nepal.

Incidence of retinopathy of prematurity in a neonatal intensive care unit in Nepal

PURPOSE

To determine the incidence of retinopathy of prematurity (ROP) in low birth weight premature infants admitted to the neonatal intensive care unit of a children's hospital in Kathmandu.

METHODS

A hospital-based prospective study was performed in neonates with a gestational age of less than 36 weeks or birth weight of less than 2,000 g during 1 year. Ophthalmologic examination was performed 2 to 4 weeks after birth and patients were observed until the retinal vascularization was complete. ROP was classified using the revised International Classification of Retinopathy of Prematurity.

RESULTS

A total of 78 infants fulfilled the screening criteria. ROP was detected in 29.5% (n = 23) of neonates. Thirteen infants (16.7%) had stage 1 disease and 5 each (6.4%) were found to have stage 2 and stage 3 ROP. Threshold disease was present in 3.8% (n = 3) of infants with a gestational age of less than 32 weeks and birth weight less than 1,500 g who required laser treatment per Early Treatment of ROP criteria. Low birth weight (P < .01) and low gestational age (P < .01) were significantly associated with the incidence of ROP.

CONCLUSION

Prematurity and low birth weight were found to be major risk factors for ROP. ROP screening should be performed in such infants for early detection because its incidence is likely to increase as more premature infants survive with improved neonatal care.

Outcome of probing under topical anesthesia in children below 18 months of age with congenital nasolacrimal duct obstruction

Congenital Nasolacrimal Duct Obstruction (CNLDO) is one of the commonest causes of Childhood epiphora. This study was carried outat Sagarmatha Chaudhary Eye Hospital (SCEH), Lahan to determine the success rate of probing and syringing in children below 18 months of age with CNLDO. A hospital based prospective interventional study of 106 children with age 4 to 18 months (Mean 7.67, SD 4.37) who underwent probing and syringing under topical anesthesia in minor procedure room of OPD. The children were divided into 3 age groups, Group A (age d" 6 months), Group B (age = 7-12 months) and Group C (age = 13-18 months). Success of probing was defined as complete relief of signs and symptoms on follow up at 3-6 weeks. Out of 106 children with CNLDO below 18 months of age, 97 (91.5%) children had better outcome with first attempt of probing. First attempt of probing resulted in resolution in 92.3% (108 out of 117) eyes; 95.6%, 92.7%, 87.1% in the age group less than 6 months, 7-12 and 13-18 months respectively. 9 eyes underwent a repeat procedure of which 6 eyes were cured. Probing and syringing below 6 months of life has shown to be very effective with almost 100% success. The overall success of probing and syringing among children less than 18 months was 97.4%.

Spontaneous extrusion of subconjunctival cysticercous cyst: a case report

Ocular cystericosis is the common occurrence among the people of lower socioeconomic status and poor personal hygiene in developing countries. However, spontaneous extrusion of subconjuctival cysticercous cyst is a rare incidence. The present case report describes a spontaneous extrusion of subconjunctival cyst in a 12 year old boy in our clinical set-up. The histopathological examination revealed subconjunctival cysticercous cyst. The extrusion was associated with improvement in clinical sign and symptoms. Cysticercosis should be considered in any case of inflammatory swelling of subconjunctival space especially in people of lower socioeconomic status and poor personal hygiene.

Hookworms, malaria and vitamin A deficiency contribute to anemia and iron deficiency among pregnant women in the plains of Nepal

Anemia and iron deficiency during pregnancy are prevalent in developing countries, but their causes are not always known. We assessed the prevalence and severity of anemia and iron deficiency and their association with helminths, malaria and vitamin A deficiency in a community-based sample of 336 pregnant women in the plains of Nepal. Hemoglobin, erythrocyte protoporphyrin (EP) and serum ferritin were assessed in venous blood samples. Overall, 72.6% of women were anemic (hemoglobin < 110 g/L), 19.9% had moderate to severe anemia (hemoglobin < 90 g/L) and 80.6% had iron deficiency (EP > 70 micromol/mol heme or serum ferritin < 10 microg/L). Eighty-eight percent of cases of anemia were associated with iron deficiency. More than half of the women (54.2%) had a low serum retinol concentration (<1.05 micromol/L), 74.2% were infected with hookworms and 19.8% had Plasmodium vivax malaria parasitemia. Hemoglobin, EP and serum ferritin concentrations were significantly worse and the prevalence of anemia, elevated EP and low serum ferritin was increased with increasing intensity of hookworm infection. Hookworm infection intensity was the strongest predictor of iron status, especially of depleted iron stores. Low serum retinol was most strongly associated with mild anemia, whereas P. vivax malaria and hookworm infection intensity were stronger predictors of moderate to severe anemia. These findings reinforce the need for programs to consider reducing the prevalence of hookworm, malaria infection and vitamin A deficiency where indicated, in addition to providing iron supplements to effectively control anemia.

Hospital-based community cataract surgery: comparison of visual outcomes between conventional extra-capsular cataract extraction and small incision cataract surgery

Introduction: The small-incision cataract surgery is gaining popularity among the ophthalmic surgeons. Objective: To compare the visual outcome of conventional extra-capsular cataract extraction (ECCE) and small-incision cataract surgery (SICS) in a hospital based community cataract program. Materials and methods: A prospective interventional study without randomization was carried out including the patients undergoing cataract surgery by either conventional ECCE or manual SICS. They were followed up for 6 weeks postoperatively. The visual outcomes were compared between the two groups. Statistics: The statistical program Epi-Info version 2000 was used to analyze the data. Mean values with standard deviations, 95% CI and p value were calculated. The p value of <0.05 was considered significant. Results: Of 85 patients, 44 (M: F=10:34) underwent ECCE and 41 (M: F=15:26) SICS (RR= 0.71, 95% CI=0.42-1.2, p value=0.16). Unaided visual acuity on the 1st postoperative day in the ECCE group was e"6/ 18 in 22.7%,<6/18-6/60 in 63.6 %,< 6/60 in 13.7%, whereas in the SICS group, the same was e"6/18 in 70.7%,<6/18-6/60 in 22 %,< 6/60 in 7.3% (95% CI = 0.23 - 0.48, p=0.001). Best corrected visual acuity on the 6th week follow-up in the ECCE group was e"6/18 in 79.5%,<6/18-6/60 in 18.2 %,< 6/60 in 2.3% and in the SICS group the same was 6/18 in 90.5% and <6/18-6/60 in 4.9% (95% CI=0.44 - 0.73; p=0.0012). Conclusion: Both ECCE and SICS are good procedures for hospital based community cataract surgery but within the 6 weeks postoperative period SICS gives better visual outcome. Remarkably higher number of female patients can be provided service in a hospital based community cataract programme as compared to males. Keywords: cataract; small incision; extra-capsular DOI: 10.3126/nepjoph.v1i2.3686 Nep J Oph 2009;1(2):118-122

Congenital isolated bilateral upper lid coloboma

A case of congenital isolated coloboma of both the upper lids from just lateral to the lacrimal punctum up to the medial half, with symblepharon in the region of lower eyelid, was studied in a 7-year-old female child. She did not have any other associated anomalies. The birth and family histories were normal. The puncta were normal in position and well apposed to the globe. The closure of the lid coloboma was done by release of symblepharon along with direct closure of the defect, for the right eye first, and one month later, for the left eye. DOI: http://dx.doi.org/10.3126/nepjoph.v4i1.5877 NEPJOPH 2012; 4(1): 194-196