|Year : 2020 | Volume
| Issue : 1 | Page : 1-2
Nigerian Journal of Ophthalmology Editorial Comments, January − June 2020 Edition
Charles O Bekibele1, Chinyere Pedro-Egbe2, Oluyemi Fasina1, Festus O Oshoba3, T. S Oluleye1
1 Department of Ophthalmology, University College Hospital, Ibadan, Nigeria
2 Department of Ophthalmology, University of Port-Harcourt Teaching Hospital, Port Harcourt, Nigeria
3 LadkemEye Hospital, Lagos, Nigeria
|Date of Submission||24-Jul-2020|
|Date of Acceptance||24-Jul-2020|
|Date of Web Publication||07-Sep-2020|
Prof. Charles O Bekibele
Department of Ophthalmology, University College Hospital, Ibadan
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bekibele CO, Pedro-Egbe C, Fasina O, Oshoba FO, Oluleye TS. Nigerian Journal of Ophthalmology Editorial Comments, January − June 2020 Edition. Niger J Ophthalmol 2020;28:1-2
The article by Murthy and Sudhakar on the aetiology and clinical and neurologic findings in patients with Cortical visual impairment (CVI) in India (a third world country) brings to the fore the inadequacies in the Nigerian health system with respect to proper diagnosis of cortical visual impairment (CVI).
What is cortical visual impairment? According to Good et al., “Cortical Visual Impairment is defined as “bilateral loss of vision, with normal pupillary response and an eye examination which shows no other abnormalities.”1 This definition takes into account recent advances in neuroimaging and the fact that there some visual recovery following CVI. In recent years, there has been a rise in cases of CVI due mainly to a rise in the survival of infants with previously fatal conditions. To make an accurate or definitive diagnosis of CVI, the patient has to have a brain MRI or CT. In the literature, standard assessments for CVI involved neuro-imaging studies. Unfortunately, in Nigeria, CT/MRI are available in very few centers and because of its exorbitant cost (N55,000 ∼ USD 150), the poor can hardly afford the test thereby making it extremely difficult to properly assess a child or adult with visual impairment and confidently label it as CVI. MRI or CT will help evaluate the extent of injury and aid in prognosis for improvement in vision following visual stimulation therapy. Visual stimulation programs have been proven to be effective. Do we have provisions or facilities for visual rehabilitation programs in Nigeria and other middle- and low-income countries? Granted that visual recovery may be incomplete, any amount of recovered vision is worth it, considering the implications of diminished vision on one’s quality of life.
The article on eye cancers at Guinness eye centre Onitsha Nigeria, reviewed cases of ocular and adnexal cancers in the practice of the authors and alluded to the geographical variability in the pattern of these tumours. Majority of the tumours were primary malignancies and the commonest tumours were retinoblastoma and conjunctival squamous cell carcinoma. Late presentation with advanced tumour was noted in children with retinoblastoma by the authors. They re-emphasized educating the public on the early presenting feature of leukocoria to promote early detection. A strong association between conjunctival squamous cell carcinoma and HIV/AIDS was also noted hence, continuous training of health care workers on the early features of ocular and adnexal tumours to enhance early detection could reduce the morbidity and mortality associated with late presentation of the patients.
The authors from the University College Hospital Ibadan, Nigeria presented their 4 year review article on Pterygium surgeries at a tertiary Hospital, South West Nigeria. It was a surgical audit of 324 pterygium cases managed over a period of four years. They reported that pterygium excision combined with 5FU and conjunctival autograft with a recurrence rate of 9.6% was the treatment least associated with recurrence when compared with other surgical methods for pterygium treatment. A useful article which further adds value to the management of pterygium, a very common conjunctival growth with cosmetic and disturbing ocular surface effects.
The case report of intraocular lens opacification (IOL) following intracameral air injection from authors in New Delhi India, documented that IOL opacification may result from a direct contact between the IOL surface and exogenous air. The authors urge clinicians to bear in mind this rare but significant complication. They advised that It is important not to jump into additional surgery of IOL exchange, rather patients who develop this condition should be followed up and any increase in the size of the opacification and/or drop in visual acuity documented. If such a situation arises, an IOL exchange becomes necessary with the consent of the patient. It is therefore imperative that surgeons take precautions to prevent IOL opacification and do the needful to ensure the best interest of the patient is uppermost in decision making.
Megbelayin from the southern part of Nigeria describes a novel method of needle −assisted pterygium excision. The series consists of ten patients. The period and time lapse between when the first and last patient were done was not clearly stated. The advantages and disadvantages of this methodology when compared to other established methods would require further research. The golden rule before using any new procedure is to consider the overall benefit to the patient and the skill and competence of the Surgeon. There is need for comparative studies to be able to determine the advantage that will accrue to the care giver and receiver in adopting this novel approach of using a 21 gauge needle to excise pterygium.
The bacteriology profile and sensitivity pattern in a select group of patients with nasolacrimal duct obstruction was reported by the authors from Benghazi Libya. The challenge associated with patients having nasolacrimal obstruction and who require intraocular procedures makes it imperative to have a clear understanding on possible choice of antibiotics to use in them. The authors established that nasolacrimal drainage system harbour microorganisms when obstructed and re-emphasized that chronic dacryocystitis is a contraindication to intraocular procedures. Gram-positive bacteria were the most common isolates with Staphylococcus being the most cultured organism reported. These were found to be highly susceptible to Ciprofloxacin while the Gram-negative organisms were sensitive to Gentamycin, hence, prophylactic treatment of patients with nasolacrimal duct obstruction with this combination of antibiotics is recommended.
From south western Nigeria was the case report of retinochoroidal coloboma in a female Nigerian. The authors noted that Retinochoroidal coloboma is a rare ocular malformation of development. Failure of complete fusion of optic fissure results in coloboma. it may extend from the iris all the way to the optic disc. Complications include amblyopia and retinal detachment which may or not be related to the coloboma.
Early detection and laser photocoagulation before retinal detachment sets in may prevent irreversible visual loss.
Retinal detachment from coloboma is difficult to treat and may require multiple vitrectomy surgeries.
These and other interesting articles await your perusal in the current edition of the Nigerian Journal of Ophthalmology.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Good WV, Jan JE, Burden SK, Skoczenski A, Candy R. Recent advances in cortical visual impairment. Developmental Medicine and Child Neurology, 2001;43:56-60.
Hoyt CS. Visual function in the brain-damaged child. Eye 2002;17:369-384. Huo R, Burden SK, Hoyt CS, Good WV. Chronic cortical visual impairment in children: Aetiology, prognosis, and associated neurological deficits.
Malkowicz DE, Myers G, Leisman G. Rehabilitaion of cortical visual impairment in children. International Journal of Neuroscience 2006;116:1015-33