Papers by Purushottam Joshi
Nepalese Journal of Ophthalmology, May 23, 2022
Introduction: This study aims to evaluate outcomes and complications of temporary suture tarsorrh... more Introduction: This study aims to evaluate outcomes and complications of temporary suture tarsorrhaphy (TST) in cases of impending corneal ulcer perforation. Case records of patients who underwent temporary suture tarsorrhaphy at Mechi Eye Hospital during a period of 18 months were retrospectively evaluated. All the smear positive fungal keratitis with more than 5mm infiltration involving central and/or paracentral cornea with impending corneal perforation were included. Demographic and clinical profile including -visual acuity, indication for temporary suture tarsorrhaphy, duration of signs and symptoms were noted. The outcomes were evaluated after 1 month and 3 months post tarsorrhaphy, in relation with time to epithelial healing, anatomical success rate, best corrected visual acuity, complications associated with non-healing corneal ulcer, number of temporary suture tarsorrhaphy needed and complications of TST. The study included 119 cases of smear positive fungal keratitis with mean age of 51.34 + 15.56 years. In this study, 56.30% of the patients developed epithelial healing at 2 -4 weeks with mean duration of 23.24 + 12.09 days of temporary suture tarsorrhaphy. Out of 119 patients, the corneal ulcer healed in 84 patients (70.6%), whereas 35 (29.4%) did not heal. Among those with non-healing ulcers, 15 patients (12.6%) had to undergo evisceration. The anatomical success rate was 87.39% which was statistically significant (P = 0.001). Regarding visual outcome, in 62 patients (52.10%) BCVA improved by 2 or more lines, which was statistically significant (P<0.05) resulting in a functional success of 26.89%. This study concludes that temporary suture tarsorrhaphy could be a useful option for management of corneal ulcers with impending perforation in eye centers with limited resources settings and high disease burden with good anatomical and functional outcome.
Therapeutic advances in ophthalmology, 2022
Background: Spontaneous vitreous hemorrhage is one of the common causes of ocular emergency. Ther... more Background: Spontaneous vitreous hemorrhage is one of the common causes of ocular emergency. There are very few prospective studies on the clinical profile and surgical outcomes for patients with dense vitreous hemorrhage caused by non-diabetic and non-traumatic till date to our knowledge. Objectives: This study was conducted to better understand the etiologies, clinical profile, surgical outcome, and visual prognosis following pars plana vitrectomy for dense vitreous hemorrhage in adults with non-traumatic and non-diabetic retinopathy. Design: This was a prospective interventional study. Methods: This study was conducted in Mechi Eye Hospital (Birtamod, Nepal) from October 2018 to September 2019. All consecutive cases, 46 eyes of 46 patients, with vitreous hemorrhage that underwent vitrectomy were included in our study. There were 14 (30.4%) female and 32 (69.6%) male patients, and the average age at presentation was 43.74 ± 16.19 (17–84) years. The success rate of surgery in terms of visual outcome was evaluated. Results: The most common cause of vitreous hemorrhage was retinal vasculitis with fibrovascular changes and vascular sheathing 19 (41%). The indication of vitrectomy on patient demand was 20 (43.5%). Success rate of surgery in terms of visual outcome (functional outcome) was defined as final visual acuity of &gt;6/60 which was 86.9%. Conclusion: The most common cause of spontaneous vitreous hemorrhage in our study was retinal vasculitis with fibrovascular changes and vascular sheathing. Vitrectomy has a good surgical outcome for spontaneous vitreous hemorrhage in terms of visual outcome (functional outcome) unless guarded by other factors like chorioretinal atrophy followed by optic atrophy and epiretinal membrane.
Nepalese Journal of Ophthalmology, Jun 26, 2021
The routine technique of tarso-frontalis suspension surgery for simple congenital blepharoptosis ... more The routine technique of tarso-frontalis suspension surgery for simple congenital blepharoptosis with poor levator action is cosmetically less rewarding due to either an absence or asymmetry of the postoperative eyelid crease. The objective of this study was to assess the eyelid crease quality after a modified open method of tarso-frontalis suspension surgery compared to the closed method. This was a retrospective comparative study reviewing the case sheets of all the patients undergoing unilateral tarso-frontalis suspension surgery with silicon rod employing Fox pentagon design from September 2017 to February 2019 at Mechi Eye Hospital, Jhapa, Nepal. A review of 40 case sheets of congenital lid ptosis with poor levator function(<4mm) aged 9 years or more was done. Tarsofrontalis suspension surgery, modified with a mini blepharoplasty incision, direct attachment of silicon rod to tarsus, completion of pentagon design with supra-brow incisions, and skin-orbicularis-tarsusorbicularis-skin suture (open method) was done in 20 cases whereas other 20 cases underwent surgery with supraciliary stab incisions (closed method). The mean age of the patients was 21.1+5.9 years (range 9-30 years). The ptosis amount ranged from 3-10mm. At the 6th postoperative month, most of the cases had good ptosis correction (90% open group, 85% closed group, p=0.74). However, cosmetic outcomes were better in the open group compared to the closed group: 100% symmetrical eyelid crease compared to 40% (p<0.001) and 90% acceptance rate for eyelid contour compared to 70% (p=0.23). Predictable, targeted, and symmetrical lid crease can be obtained using the modified open method of tarso-frontalis suspension surgery.
नेपाल मेडिकल जर्नल, Aug 1, 2019
Birat Journal of Health Sciences
Microphthalmos with orbital cyst is a rare congenital abnormality of fetal fissure closure leadin... more Microphthalmos with orbital cyst is a rare congenital abnormality of fetal fissure closure leading to a small eyeball associated with an orbital cyst. In this case series, we describe six such cases and discuss the clinical features, differential diagnosis, diagnostic modalities, and management in accordance with the existing literature. Out of the six cases, four were male and two were females. All the cases presented with a swelling in the lower eyelid of the involved eye, which was the right eye in all the male patients and the left eye in all the female cases. Other eye showed uveal coloboma in 50% of the cases. Microphthalmos with orbital cyst was diagnosed based on the clinical features and radiological findings (ultrasonography B-scan and/or Computed Tomography scan). Two patients from our case series underwent surgery (cyst excision with enucleation of microphthalmic eye with orbital implant and conformer) and, histopathology confirmed the diagnosis of microphthalmos with or...
Therapeutic Advances in Ophthalmology
Background: Spontaneous vitreous hemorrhage is one of the common causes of ocular emergency. Ther... more Background: Spontaneous vitreous hemorrhage is one of the common causes of ocular emergency. There are very few prospective studies on the clinical profile and surgical outcomes for patients with dense vitreous hemorrhage caused by non-diabetic and non-traumatic till date to our knowledge. Objectives: This study was conducted to better understand the etiologies, clinical profile, surgical outcome, and visual prognosis following pars plana vitrectomy for dense vitreous hemorrhage in adults with non-traumatic and non-diabetic retinopathy. Design: This was a prospective interventional study. Methods: This study was conducted in Mechi Eye Hospital (Birtamod, Nepal) from October 2018 to September 2019. All consecutive cases, 46 eyes of 46 patients, with vitreous hemorrhage that underwent vitrectomy were included in our study. There were 14 (30.4%) female and 32 (69.6%) male patients, and the average age at presentation was 43.74 ± 16.19 (17–84) years. The success rate of surgery in terms...
Nepalese Journal of Ophthalmology, 2021
Introduction: Optic atrophy results from the disease process that cause irreversible damage to th... more Introduction: Optic atrophy results from the disease process that cause irreversible damage to the ganglion cells and the anterior visual pathway, but may also result from posterior visual pathway involvement. The etiology causing this condition is vast and regardless of underlying cause it carries bad visual prognosis and at times may be life threatening. The study aims to assess patients with optic nerve atrophy presenting to B.P. Koirala lions centre for ophthalmic studies and identify the underlying etiology. Materials and methods: This is a descriptive study conducted at B.P. Koirala Lions Centre for Ophthalmic studies. All cases of optic atrophy who presented to our outpatient department from March 2016 to March 2017 were included in the study. In addition to detailed evaluation, assessment of visual acuity, color vision, contrast sensitivity and visual field were done if feasible. Other relevant investigations were conducted to establish the underlying etiological cause. Res...
EC Ophthalmology, Nov 29, 2021
International Journal of Clinical Medicine, 2012
Background: HIV has the capability to affect every organ system in the body. Ocular manifestation... more Background: HIV has the capability to affect every organ system in the body. Ocular manifestations have been reported in up to 70% of individuals infected with HIV and the ocular manifestations reflect systemic disease and may be the first sign of disseminated infection. Aim: To identify different types of ocular involvement in the cases known to be infected with HIV. Methods: A cross sectional, descriptive study was undertaken during the period between January 2005 and July 2006. All the diagnosed cases of HIV infected individuals either coming to the hospital or collected from rehabilitation centres were included in the study. Results: 103 HIV infected cases were examined; of which 45 cases (43.6%) were AIDS cases. The mean age of presentation was 29.6 ± 9.8 years. The commonest systemic disease was pulmonary tuberculosis (65.9%). In the study group, 38.8% of the cases had ocular involvement. In the ocular findings, posterior segment lesions (32%) were most common. Ocular involvement among asymptomatic patient was 22.7% while it was 91.6% among symptomatic patients. HIV retinopathy (23.3%) was the most common HIV-associated ophthalmic lesions. Ocular involvement was the most common in cases that contracted the disease through sexual contact. A negative correlation was observed between CD4 level and ocular involvement. Conclusion: There needs to be awareness of ocular involvement among HIV infected individuals and an increased emphasis on regular ophthalmic examination in all HIV patients. Routine referral system for ocular evaluation from other medical departments seems mandatory for timely diagnosis of the vision threatening conditions.
Case Reports in Ophthalmological Medicine
A congenital cystic eyeball is an extremely rare condition, with only 52 cases reported in the li... more A congenital cystic eyeball is an extremely rare condition, with only 52 cases reported in the literature to date. An orbital cyst replaces the eyeball which occurs due to the complete or partial failure in invagination of the primary optic vesicle during the fourth week of gestation. We discuss a case of a congenital cystic eyeball in a 14-year-old female who presented to us for a cosmetic blemish due to a large swelling in the right eyelid with the absence of a right eyeball since birth. She underwent removal of the cyst followed by an orbital implant and later prosthesis. Diagnosis of the congenital cystic eyeball was made based on the clinical and ultrasound B-scan features, intraoperative findings, and histopathology report. This article adds one more case to the existing literature on the congenital cystic eyeball. Orbital implant with prosthesis after excision of the cyst provided definitive diagnosis and a good cosmetic outcome in our case.
Quick Response Code Abstract: Purpose: Retinoblastoma is rare disease but potentially fatal if le... more Quick Response Code Abstract: Purpose: Retinoblastoma is rare disease but potentially fatal if left untreated. This study aimed to evaluate demographic profile, treatment and complications in survivors of retinoblastoma in tertiary care center in 2019. Method: This is multicentric hospital based cross sectional study conducted from January 2019 to December 2019 after ethical clearance from National Health Research Council. All post-treatment cases of retinoblastoma who had completed at least 1-year follow-up examination in any of our retinoblastoma (RB) center in 2019 were included whereas newly diagnosed and ongoing treatment cases and those failed to consent were excluded. Data based on demographic profile, ethnic and geographical distribution of RB survivors was collected and entered into Microsoft Excel 2016. Statistical analysis was performed using Statistical Package for Social Sciences version 20. Result: A total of 37 RB survivors that included 24(64.9%) female and 13(35.1%)...
Nepalese Journal of Ophthalmology, 2021
Introduction: The routine technique of tarso-frontalis suspension surgery for simple congenital b... more Introduction: The routine technique of tarso-frontalis suspension surgery for simple congenital blepharoptosis with poor levator action is cosmetically less rewarding due to either an absence or asymmetry of the postoperative eyelid crease. The objective of this study was to assess the eyelid crease quality after a modified open method of tarso-frontalis suspension surgery compared to the closed method. Materials and methods: This was a retrospective comparative study reviewing the case sheets of all the patients undergoing unilateral tarso-frontalis suspension surgery with silicon rod employing Fox pentagon design from September 2017 to February 2019 at Mechi Eye Hospital, Jhapa, Nepal. A review of 40 case sheets of congenital lid ptosis with poor levator function(<4mm) aged 9 years or more was done. Tarso-frontalis suspension surgery, modified with a mini blepharoplasty incision, direct attachment of silicon rod to tarsus, completion of pentagon design with supra-brow incision...
Nepalese Journal of Ophthalmology, 2021
Introduction: Eye examination and different procedures performed in close contact with eye and fa... more Introduction: Eye examination and different procedures performed in close contact with eye and face, put medical and non medical staff of an eye hospital at higher risk for COVID-19. This causes increased psychological burden. The objective of this study was to find out depression, anxiety, stress and insomnia among Mechi Eye Hospital staff. Materials and methods: A web based cross-sectional study among Mechi Eye Hospital staff was done from 1st to 20th July 2020. Insomnia Severity Scale and DASS-21 were used. Results: Out of 220, 190 (86.6%) participated, 63.2% were female and 61.05% were medical staff with an overall mean age of 31.1±8.4 years. Overall prevalence of anxiety, depression, insomnia and stress were 20.5%, 18.9%, 16.3% and 12.6% respectively and those were common in female with 63.9% (p value <0.02), 64.1% (p value 0.5), 58.4% (p value 0.2) and 100% (p value <0.01) respectively. Depression, anxiety and insomnia were common in the age group 30-39 years (50%, p va...
Nepalese Journal of Ophthalmology, 2021
Introduction: Glaucoma is one of the major causes of irreversible blindness. In Nepal, the most c... more Introduction: Glaucoma is one of the major causes of irreversible blindness. In Nepal, the most common type of Glaucoma seen is Primary Open Angle Glaucoma. There are many risk factors associated with Primary Open Angle Glaucoma. The main objective of the study was to compare ocular biometric parameters in patients diagnosed with Primary Open Angle Glaucoma and age matched controls. Material and methods: This is a hospital based cross sectional study done at Mechi Eye Hospital. The study included 137 cases of Primary Open Angle Glaucoma and 75 normal individuals as control. Axial length (AL), anterior chamber depth (ACD), Keratometry ‘K’ value and Central Corneal Thickness (CCT) were measured. Mann – Whitney U test was used for statistical analysis. Results: Mean age in Primary Open Angle Glaucoma group was (55.25 ± 10.16 years) and in the control group was (60.96 ± 10.91 years). Axial length in the Primary Open Angle Glaucoma group (23.16 ±1.19 mm) was deeper as compared to the c...
Nepalese Journal of Ophthalmology, 2020
OPD, IPD, Waiting area ,Operation theatre Cleaning staffs Cleaning with detergent and disinfectan... more OPD, IPD, Waiting area ,Operation theatre Cleaning staffs Cleaning with detergent and disinfectants Cap-Mask-Heavy duty gloves Cotton Gown-Eye protection Boots or closed work shoes Patho Biochemistry Laboratory Lab technicians Handles samples Blood, tissue samples and cornea and conjunctival swabs etc Mask-Gloves Cap-Apron or Cotton Gown Canteen area Canteen staff Prepare Food for patient and staffs Mask-Cap-Gloves Administrative area Academic/Training Research area Outreach area Admin staff including medical staff at admin Cleaning Staffs No patient care Mask Note-The staff working in Isolated OPD/Emergency room should not go to regular OPD at any time. In case, if further consultation is needed, the staff should communicate over telephone or virtual communication. Similarly ,if OPD staff needs to go to isolated OPD, full PPE must be worn .Bringing patients from Isolated OPD to regular OPD should be restricted.
Nepalese Journal of Ophthalmology, 2020
Introduction: Dacryocystorhinostomy (DCR) is the commonest surgery for nasolacrimal duct obstruct... more Introduction: Dacryocystorhinostomy (DCR) is the commonest surgery for nasolacrimal duct obstruction. Inhibition of the scarring process within the anastomosis and rhinostomy site which has been attributed to the failure of this procedure, might improve the success rate of DCR. The objective of this study was to evaluate the outcomes of DCR with Mitomycin-C (MMC) and to compare the results of DCR with and without MMC. Materials and methods: A hospital based, prospective study was conducted in patients with primary acquired nasolacrimal duct obstruction. Standard conventional DCR was performed upto the level of creation of flaps. Application of MMC 0.2 mg/ml in and around the ostium and underneath the created flaps for two minutes was effected with cotton pledgets. The area was thoroughly washed with normal saline after removal of the pledgets. Rest of the surgery was completed as usual. The patients were followed up on the first postoperative day, one month and three months post sur...
Nepalese Journal of Ophthalmology, 2020
Introduction: Diabetic macular edema (DME) is the leading cause of visual impairment in patients ... more Introduction: Diabetic macular edema (DME) is the leading cause of visual impairment in patients with diabetes mellitus. The objectives of the study was to figure out the effect of intravitreal injection bevacizumab on visual acuity and retinal thickness in people with DME. Materials and methods: We observed the case records of patients with DME requiring injection Avastin (Genentech Inc., San Francisco, CA, USA) intravitreal from January to July 2016 in Mechi Eye Hospital. The eighty seven eyes of 60 patients with DME were included in the study. Inclusion criteria were determined independently of the age, metabolic control, type of diabetes mellitus, visual acuity, leakage area size,retinal thickness as measured by optical coherence tomography. All the patients were treated with 0.05 ml injection containing 1.25 mg of Avastin (Genentech Inc., San Francisco, CA, USA) after written informed consent. Results: The mean age group was 55.86 ± 9.61 years with 47 males and 13 females. At b...
BMJ Open Ophthalmology, 2020
ObjectiveTo investigate the factors affecting the duration of subretinal fluid (SRF) resolution a... more ObjectiveTo investigate the factors affecting the duration of subretinal fluid (SRF) resolution and their correlation with the final anatomical and functional outcome in cases of treatment naïve acute central serous chorioretinopathy (CSCR).Methods and analysisWe retrospectively studied 93 eyes of 93 patients diagnosed with treatment naïve acute CSCR presenting within 30 days of onset of symptoms. The eyes were divided into two groups (1 and 2) based on the duration of SRF resolution; which was ≤3 months in group 1 and >3 months in group 2. Demographic and medical history, and spectral domain optical coherence tomography features were noted and their association with duration for SRF resolution, final central macular thickness (CMT) and final best-corrected visual acuity (BCVA) were studied. All the patients were prescribed topical non-steroidal anti-inflammatory drug for 1 month at the diagnosis of CSCR.ResultsLonger duration of symptoms, female gender and baseline OCT factors l...
The Pan-American Journal of Ophthalmology, 2020
Background: Phacoemulsification is the main stay of cataract extraction surgery in the developed ... more Background: Phacoemulsification is the main stay of cataract extraction surgery in the developed world as well as it is becoming increasingly popular in the developing nations as well. However, this technique is not widely incorporated in the residency training program in many developing nations. Objective: This study was conducted to evaluate the visual outcomes and complications of phacoemulsification surgery performed by a trainee surgeon. Methods: A prospective, cross-sectional study was performed in the tertiary eye hospital of eastern Nepal. All the consecutive cases of phacoemulsification surgery were included which was performed by a trainee surgeon with previous exposure of conventional extra-capsular cataract surgery and competency in sutureless manual small incision cataract surgery. The technique implied for nuclear division was stop and chop method. The visual outcomes and the complications of the surgery were evaluated. Results: A total of 200 eyes of 200 patients were included. The patients were followed up for 12 weeks. The mean age of the patients was 57.8 ± 9.8 years. The average effective phacoemulsification time (EPT) was 21.6 ± 15.8 seconds. The incidence of intra-operative complication of posterior capsular rupture with vitreous loss was 6/200 (3%). Striate keratopathy was present in (6.5%) of the cases in the first post-operative day. At the final examination, improvement in vision by 6/12 or better was observed in 183 (91.5%) eyes. Conclusion: Improvement in surgical teachings, good orientation to manual cataract extraction, careful selection of early cases and staffed supervision will lead to safe and easy transition to phacoemulsification surgery.
Case Reports in Ophthalmological Medicine, 2020
Background. Angle closure glaucoma (ACG) whether primary or secondary lens induced has rare occur... more Background. Angle closure glaucoma (ACG) whether primary or secondary lens induced has rare occurrence in cases with retinitis pigmentosa (RP). Method. Five patients with history of diminished vision, ocular pain, and nyctalopia were clinically evaluated. Four patients had unilateral presentations of circumciliary congestion, corneal edema, and high intraocular pressure (IOP), while one had bilateral presentation, respectively. Anterior chambers were shallow; fundoscopy revealed the features of RP and gonioscopy affirmed closed angles in all the cases. The management strategies were individualized based on the specific ocular condition. Result. The raised IOP were not well controlled with conventional medical treatment. Neodymium yttrium aluminium garnet laser peripheral iridotomy (LPI) was performed in two patients and in the fellow eye in other two patients as a prophylactic measure. Phacoemulsification surgery with implantation of intraocular lens (IOL) was performed in three pat...
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Papers by Purushottam Joshi