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   Table of Contents - Current issue
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September-December 2022
Volume 30 | Issue 3
Page Nos. 83-136

Online since Monday, December 26, 2022

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EDITORIAL  

Editorial Comments: Nigerian Journal of Ophthalmology, September–December 2022 p. 83
Bolutife A Olusanya, Mary O Ugalahi
DOI:10.4103/njo.njo_31_22  
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ORIGINAL ARTICLES Top

Prevalence of Visual Impairment Among Primary School Pupils in the Ga West Municipality, Ghana p. 85
Winston Ceesay, Benjamin Abaidoo, Imoro Zeba Braimah
DOI:10.4103/njo.njo_47_21  
Abstract Objective: To determine the prevalence and pattern of visual impairment (VI) among primary school pupils in the Ga West Municipality of Ghana. Methods: A descriptive cross-sectional survey among primary school pupils at the Ga West Municipality. A cluster sampling technique was used to select 765 pupils from 12 primary schools (six public and six private schools). All pupils had presenting visual acuity (VA) testing and pupils with VI (presenting VA <6/18 in the better eye) had detailed ocular examination to determine the cause of VI. Binary logistic regression was used to determine the association between independent variables and prevalence of VI. Results: Four hundred and forty-eight (58.6%) of the pupils were males and their mean age was 10 ± 2.4 years. The prevalence of VI was 4.3%. Refractive error, 17 (51.5%), was the most common cause of moderate VI. Other morbidities associated with moderate VI were ocular surface abnormalities secondary to vernal keratoconjunctivitis, five (15.2%), amblyopia, four (12.1%), cataract, two (6.1%), and albinism, two (6.1%). The causes of severe VI were corneal opacity, chorioretinal scars, and glaucoma, each accounting for 3.0% of VI. Increasing age of pupils (P = 0.04) and private school attendance (P = 0.01) were found to be significantly associated with a higher prevalence of VI. Conclusion: Refractive error was the most common cause of VI in the primary school pupils. Annual eye examination and provision of affordable spectacles to school pupils with refractive error is recommended to reduce the impact of VI on their educational achievement.
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Barriers to Free Cataract Surgery during a Surgical Outreach Camp in New Karu LGA, Nasarawa State, Nigeria p. 92
Adaora C Okudo, Oluwatoyin O Akanbi
DOI:10.4103/njo.njo_21_21  
Aim: To determine the proportion of screened cataract patients with vision ≤6/60 that will utilize the free cataract surgical services and to identify the barriers to uptake of the free cataract surgical services. Settings and design: A cross-sectional descriptive study. Materials and methods: A cross-sectional descriptive study was carried out among 53 cataract patients with vision acuity (VA) ≤6/60 who presented at a cataract surgical outreach camp in New Karu LGA, Nasarawa State from September 10 to 14, 2013, using both quantitative and qualitative measures. Statistical analysis used: Data were analyzed using SPSS Version 20 using the descriptive analysis. Results: Six hundred and sixty-six people registered for the outreach, 552 were examined, 125 had cataract of which 53 had cataract with VA ≤6/60, and were offered the free cataract surgical service. The age range of the participants was 36 to 77 with a mean age of 54 years. Twenty-seven were males and 26 were females. Initially, 64.2% were willing to have surgery, eventually 75.5% took up the free cataract surgical services. Females, residents of New Karu LGA, the uneducated and housewives were less likely to take up the free cataract surgical services and this was statistically significant. The most common barriers identified include 41% were afraid of surgery and 26.1% had heard of a bad outcome previously following cataract surgery. Conclusion: There was a high utilization of the free cataract surgical service. Fear of surgery and prior knowledge on poor outcome were major barriers. Community participation played an immense role to increase uptake.
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Posterior Iris-Claw Lens – A Boon to Budding Cataract Surgeons p. 100
C Vidhya, N Shreeshruthi
DOI:10.4103/njo.njo_2_22  
Abstract Aim: The aim was a retrospective comparative study on visual outcomes and complications of retro-pupillary fixated iris-claw lens (RPICL) with respect to the experience level of the operating surgeons. Methods and Materials: A retrospective study in which records of 126 patients who had RPICL implanted following cataract surgery between January and December 2020 at our hospital were analyzed. Patients were categorized into two groups: (a) RPICL done by a consultant (with experience of a minimum of 25 RPICL done) and (b) RPICL done by a resident (less than two RPICL done, with assistance). Visual outcome (best-corrected visual acuity in logMAR) and postoperative complications (on the first postoperative day and one month) were analyzed in the two groups. Results: There was a total of 126 eyes in 126 patients, of which primary RPICL was implanted in 45 eyes by the consultants (group A) and 81 eyes by the residents (group B). Overall ocular risk factors warranting a difficult surgery were significantly higher in the consultant group when compared with the resident group (P = 0.001). Mean preoperative vision was 0.899 and 1.137 in group A and group B, respectively. The final postoperative vision (postoperative period 1 month) was 0.246 and 0.332 in group A and group B, respectively. There was no statistically significant difference in preoperative and postoperative vision between both groups. Postoperative complications on day 1 were more in group B (71.6%) than in group A (55.6%) (P = 0.054). However, most of them resolved within 1 month postoperative period. Conclusion: Primary RPICL implantation is an effective modality of visual rehabilitation in complicated cataract surgery with deficient capsular support and is a boon for young budding cataract surgeons.
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A Study of Ocular Side Effects of Blood Transfusions and Iron Chelators in Thalassemia Patients p. 105
Reshma Ramakrishnan, Ayushi Choudhary, Priyanka Gandhi, Mamta Agrawal, Aesha Hastak, Ankita Choudhary
DOI:10.4103/njo.njo_32_21  
Aim: To determine the ocular changes and importance of ophthalmic consults in thalassemia patients on iron chelating agents and regular blood transfusions. Settings and Design: A cross-sectional study was conducted among thalassemia patients who were on regular blood transfusion and iron chelators. Materials and Methods: A detailed history was obtained from 50 thalassemia patients included in the study including birth history, family history, and treatment history which was taken from the parents. Ophthalmic examination performed included visual acuity test for distant and near vision with Snellen chart, color vision obtained with Ishihara plates, contrast sensitivity performed with Pelli–Robson charts, Schirmer test conducted with Whatman strip, intraocular pressure obtained with Perkins tonometer, detailed anterior segment performed with Appasamy Slit Lamp biomicroscope and posterior segment examination with the aid of 90D lenses, and indirect ophthalmoscopy with 20D lenses performed after dilatation. Fundus photograph was taken for all the patients with ZEISS fundus camera. The findings were recorded and documented. Statistical Package AQ6 for the Social Sciences software was used to analyze data obtained. Results: Study group included 26 males (52%) and 24 females (48%) of varying age from 4 years up to 18 years of age. Presence of thalassemia disorder was noted in the family of 10 patients (20%). Five (10%) patients had mild visual impairment for distant vision. While, 18 patients (36%) had mild dry eye disease. Fundus abnormalities were seen in 14 patients as arteriovenous tortuosity, tessellated fundus, and desferrioxamine retinopathy. Decreased visual acuity, dry eye, and fundus abnormalities were seen in patients with serum ferritin levels >1000 ng/mL. Fundus abnormalities were seen in patients with higher serum ferritin levels (>1000 ng/mL) and longer duration of treatment. In total, ocular changes were seen in 31 patients (62%). Conclusion: Regular ophthalmic consult is necessary for all thalassemia patients on regular blood transfusion and chelation therapy to unmask ocular changes at an early stage and provide optimum visual care.
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Perception of Hand Hygiene Practice among Eye Care Workers in Onitsha, Nigeria p. 110
Chizoba U Uba-Obiano, Adaora A Onyiaorah, Cyriacus U Akudinobi, Nonso E Okpala, Adanma C Ezenwa, Sebastian N.N Nwosu
DOI:10.4103/njo.njo_13_22  
Objectives: To determine the perception of hand hygiene practice by eye care workers of a tertiary hospital in Nigeria. Methods: This was a cross-sectional study of eye health workers at a tertiary hospital in Nigeria using the WHO Hand Hygiene Perception questionnaire to obtain information on different aspects of hand hygiene perception. Responses were graded as good (≥75%); moderate (50–74%); poor (<50%). Information obtained was analyzed. Results: Fifty-three eye care workers comprising 11 (20.8%) males and 42 (79.2%) females with age range 28 to 68 years; mean of 43.8 ± 9.0 years. Average work experience was 18.5 ± 9.6 years. Nurses and doctors constituted 47 (88.7%) participants. Mean overall perception score was 36.2 ± 9.0 (or 61.4%). Hand hygiene practice perception was good in 11 (20.7%), moderate in 32 (60.4%), and poor in 10 (18.9%) participants. Doctors had significantly higher mean score (39.7 ± 8.0) than nurses (33.5 ± 8.0) (P = 0.04). Fifty-one (96.2%) had soap and water at the service point but these were not always available all the time to 40 (75.5%) participants. Alcohol-based hand sanitizer was unavailable to 41 (77.4%); 13 (24.5%) participants had posters of hand washing at their service points. Fifty (94.3%) participants would want hospital management to lend greater support to hand hygiene practice. Conclusions: Hand hygiene practice perception was only moderate among the participants. Institutional support via frequent training and reminders on hand hygiene, and steady water and soap supply at service points would help to improve hand hygiene perception and practice among eye care workers.
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CASE REPORTS Top

Pars Plana Vitrectomy in a Patient with Severe Chronic Titubation Highly accessed article p. 116
Emmanuel Olu Megbelayin, Yewande Olubunmi Babalola, Asiwome Seneadza, Sunday Nnamdi Okonkwo
DOI:10.4103/njo.njo_11_22  
Surgeries on head and neck structures can be very challenging in individuals with titubation from any cause. Head tremor or titubation is a classic feature of Parkinson’s disease (PD) and Parkinsonism due to depletion of dopaminergic neurons in the substantia nigra pars compacta. A literature search using keywords such as head tremor, titubation, PD, eye surgery was carried out in English in major databases archiving medical literature like Google Scholar, Hinari, Scopus, and PubMed. Pars plana vitrectomy (PPV) was successfully carried out in a patient with titubation. A simple head support could ameliorate head tremors to enable performance of eye surgeries.
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Enterococcal Ulcerative Keratitis in a 32-Year-Old Nigerian: A Rare Case p. 119
Ernest I Ezeh, Sunday N Okonkwo, Bassey O Bassey, Roseline N Ezeh, Nkama Etiowo, Ekama Egbe
DOI:10.4103/njo.njo_4_22  
Globally, most cases of microbial ulcerative keratitis are bacterial in origin. The most common causative organisms in bacterial keratitis are Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, and Pseudomonas aeruginosa. Ocular infections by enterococci are rare. Only a few cases of keratitis and endophthalmitis caused by enterococci have been reported worldwide. To the best of the authors’ knowledge, no case has been reported in Nigeria. We present a case of ulcerative keratitis due to Enterococci specie, to highlight the occurrence of this unusual ocular pathogen. A case of a 32-year-old male trader is presented with a 4-week history of severe painful red left eye, associated whitish discharge, sticky eyelids, tearing, profound visual loss, and whitish patch on the eye. Examination revealed paracentrally located 4.0 × 3.0 mm epithelial defect with an iris plugged 2 mm corneal perforation and an underlying dense, well-defined, white stromal infiltrate. Cultures yielded growth of E. specie, verified by biochemical tests (the Analytical Profile Index system Approach). He was managed on intensive antibiotics and made remarkable improvement. This highlights the need for Eye care practitioners to be mindful of the potential risk of unusual pathogen such as E. specie, causing cornea infection in our environment.
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Retinal Artery Macroaneurysm − An Uncommon Manifestation of Radiation Retinopathy p. 123
Divyansh Mishra, Mahesh Shanmugam, Sonali Lomte, Rajesh Ramanjulu, Surendra Pal
DOI:10.4103/njo.njo_38_21  
To describe two cases of radiation retinopathy (RR) presenting with clinical and imaging characteristics of retinal artery macroaneurysm (RAM). The first case had radiotherapy to the right side of the brain 17 years prior to ocular manifestation, developed vitreous hemorrhage secondary to RAM in the right eye (RE) was managed with intravitreal anti-vascular endothelial growth factor. Second case had radiotherapy to right side of neck 6 years back, developed multiple tributary vein occlusions in RE, and was treated with sectoral laser. One year later, developed premacular and subretinal hemorrhage with RAM and managed with pars planavitrectomy and anti-VEGF. on subsequent follow up second patient had persistent cystoid macular edema which was managed with intravitreal triamcinolone acetonide and focal laser to RAM.
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Unusual Exaggerated Inflammatory Response in Fuchs Uveitis: A Case Report Highly accessed article p. 128
Samendra Karkhur, Deepak Soni, Smita Patel, Ria Sharma, Richa Nyodu, Bhavana Sharma
DOI:10.4103/njo.njo_3_21  
Objective: To report a case of Fuchs uveitis with an unusual exaggerated inflammatory response in the form of multifocal fibrin deposition. Case Report: Fuchs uveitis syndrome (FUS) has a characteristic clinical appearance but is frequently overlooked when heterochromia is subtle or absent. Specific atrophic changes in the iris, keratic precipitates, minimal cells and flare, the lack of posterior synechia, and the frequent presence of cataract and secondary glaucoma represent the clinical spectrum observed during the usual natural course of FUS. The occurrence of multifocal fibrin deposition on the entire iris surface in a young Indian male patient who presented with the clinical picture of Fuchs uveitis is reported. The finding of multifocal fibrin was unusual and thought to be an exaggerated inflammatory response in FUS. The patient was managed with topical corticosteroid therapy which resulted in complete resolution of fibrin. Regular follow-up was advised in view of the chronic nature of the disease and predisposition to complicated cataract and secondary glaucoma.
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Ocular Disorders Complicating Systemic Lupus Erythematosus in a Nigerian p. 131
Chizoba U Uba-Obiano, Sebastian N.N Nwosu, Emeka A Chianakwalam, Henry Mmadu Nwankwo
DOI:10.4103/njo.njo_23_21  
Systemic lupus erythematosus (SLE) is a connective tissue disorder involving a myriad of organs and structures in the body. We present a 45-year-old woman diagnosed with SLE at the rheumatology clinic and complained of gradual decrease in vision in the course of treatment. Analysis of case history, clinical features, and results of investigation was carried out. Ocular features reported were keratoconjunctivitis, mild visual impairment, nystagmus, and optic neuropathy. This is to report a case of ocular involvement in a Nigerian patient with SLE. SLE may be complicated by ocular disorders leading to visual impairment. Early ophthalmic assessment is therefore recommended for patients with SLE.
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LETTER TO THE EDITOR Top

Ophthalmologists’ Brain Drain: A Health Catastrophe in Nigeria p. 135
Kehinde Fasasi Monsudi, Tajudeen Mustapha, Joshua F.A Owoeye
DOI:10.4103/njo.njo_19_22  
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