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   Table of Contents - Current issue
January-June 2021
Volume 29 | Issue 1
Page Nos. 1-64

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Nigerian Journal of Ophthalmology Editorial Comments, January – June 2021 Edition p. 1
Bolutife A Olusanya
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Diabetic Retinopathy in Sub-Saharan Africa: A Review of Magnitude and Risk Factors p. 3
E. O. Achigbu, C. T. Agweye, K. I. Achigbu, A. I. Mbatuegwu
Aim: The aim of the study was to provide an updated review on the prevalence and correlates of diabetic retinopathy (DR) in sub-Saharan Africa (SSA). Materials and Methods: A systematic literature search of Medline, Embase, African Journal Online, Africa-Wide Information databases, and Google Scholar for relevant articles was done using a search strategy with key concepts. Studies published between 2010 and 2020 on the prevalence and correlates of DR in SSA were selected. Data on the main study outcomes were extracted into a table based on the study designs. Results: Twenty-seven studies from 12 countries were included. Studies varied in terms of patients’ selection, method of assessing the eye, and retinopathy classification. The reported prevalence range for any DR was 13% to 82.6% and sight-threatening retinopathy 2.1% to 51.4% respectively. Duration of diabetes mellitus and systolic blood pressure were the most common factors associated with an increased risk of DR. Conclusion: There is no recent population-based prevalence of DR in SSA. The available results are however comparable with recent values reported in Europe, America, Middle East, and North Africa. Urgent structured population-based studies on the prevalence of DR are needed for effective public health interventions.
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Surgically Induced Astigmatism After Phacoemulsification with Clear Corneal 2.75 mm Incision Using Superior Approach Highly accessed article p. 13
Angela S.D Amita, Laura A Djunaedi, Angelo Doniho, Andrew Adiguna Halim
Context: Optimal postoperative vision can be achieved through a low surgically induced astigmatism (SIA), which is closely related to the site of incisions. Studies showed that temporal incision gives low SIA. However, a temporal incision is not convenient for some surgeons and in a small operating room with a limited number of assistants. These limitations can be overcome by using a superior approach. Aims: The aim of the study was to evaluate SIA after phacoemulsification with clear corneal incision using superior approach in different kinds of astigmatism as an alternative site of incision. Settings and Design: Medical records of patients who underwent cataract surgery were collected retrospectively between April and August 2017. Appropriate statistical analyses using Kruskal–Wallis, analysis of variance (ANOVA), Games-Howell test were done to assess the effect of superior approach on corneal curvature and whether it varies between different kinds of astigmatism. Results: Kruskal-Wallis test shows that there was no significant postoperative power change across different astigmatism groups (χ2 (2) = 0.805, P = 0.669). ANOVA and Games-Howell test show that oblique astigmatism had higher changes to its curvature compared with against the rule or with the rule astigmatism. Conclusions: The average SIA from the study was 0.34 diopter. Our study concludes that there is no statistically significant difference to SIA between three groups of astigmatism when they were operated using superior approach.
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Exploring the Relationship Between Central Corneal Thickness and Intraocular Pressure Among Nonglaucoma Patients in a General Ophthalmology Clinic, South East Nigeria p. 17
Adaku I Mbatuegwu, Ebere O Achigbu, Chidi U Mbatuegwu, Florence U Nkwogu, Afekhide E Omoti
Context: Glaucoma is an important cause of irreversible blindness and visual impairment in Nigeria. Studies have shown that intraocular pressure (IOP) is the only modifiable risk factor for glaucoma. The true IOP of an individual, in turn, is determined by the central corneal thickness (CCT). Aim: The aim of the study is to describe the relationship between IOP and CCT among nonglaucoma patients in Owerri, Imo State, Nigeria. Methods: This was a hospital-based, cross-sectional, analytical study done on nonglaucomatous patients aged 18 years and above. A comprehensive ocular examination was carried out for all participants and IOP was measured between 8 am and 12 noon to reduce the effect of diurnal variations. Results: Four hundred and twenty-two subjects with a mean age of 40.34 ± 14.468 years and a female to male ratio of 1.7:1 participated. The mean measured IOP was 16.77 ± 4.37 mmHg, and the mean CCT was 533.05 ± 33.92 μm. The mean corrected IOP was 17.61 ± 4.57 mmHg indicating a pattern of falsely low IOP. There was a positive, statistically significant correlation between IOP and CCT (P = 0.045). Conclusion: There was a positive correlation between IOP and CCT with the resultant effect that thin corneas presented with falsely low IOP and thick corneas with falsely high IOP. Routine CCT measurement in addition to IOP measurement should be done on every patient.
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Glaucoma follow-up care in the face of COVID-19 pandemic in Enugu, Nigeria p. 22
Nkiru Kizor-Akaraiwe, Nkechi Uche, Jude Shiweobi, Edak Ezeanosike, Chinyelu Ezisi
Purpose: This study sought to find out the effect of the COVID-19 partial lockdown on adherence to glaucoma follow-up appointments and associated factors in a multispecialist eye care facility in Enugu, Nigeria. Methods: A retrospective cross-sectional survey of glaucoma patients who were booked for follow-up appointment and those who attended follow-up clinic at The Eye Specialists Hospital (TESH), Enugu, Nigeria before and during the COVID-19 lockdown. The hospital records of glaucoma appointments and visits in April 2019 and April 2020, corresponding to “before” and “during” COVID-19 lockdown, respectively, were used to collect information on visits to glaucoma clinic (with/without appointments). The primary outcome measure of this study was difference in adherence to follow-up appointments while the secondary outcome measure was the total glaucoma visits before and during the pandemic lockdown. Data entry and analysis was done using SPSS version 22. Results: Follow-up rate was not significantly different before (34.6%) and during (35.7%) the COVID-19 lockdown (P = 0.85). A total of 156 and 121 glaucoma visits were recorded before and during COVID-19 lockdown, respectively (P = 0.049). Patients within age group 60 to 80 years, males and persons with advanced glaucoma visited clinic more before and during the COVID-19 lockdown. Severity of glaucoma was significantly associated with more visits during the COVID-19 lockdown (P = 0.023). Conclusion: In TESH, Enugu, Nigeria, the COVID-19 partial lockdown affected total number of glaucoma visits but not adherence to follow-up appointments. Understanding the need for glaucoma follow-up checks and fear of blindness likely helps adherence to appointments.
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Prevalence of Ocular Surface Disease in Glaucoma Patients on Long-Term Antiglaucoma Medications p. 28
Emem G Abraham, Inyene E Udofia
Objective: Long term use of preservative-containing medications has been associated with the development or worsening of ocular surface disease (OSD). This study aimed to determine the prevalence of OSD in glaucoma patients on long-term antiglaucoma medications. Methods: A cross-sectional hospital-based study was carried out on 208 respondents using Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), and Schirmer 1 test. Data analysis was done using Statistical Package for Social Science version 22.0 (SPSS Inc, Chicago, Illinois, USA). Results: The prevalence of OSD was higher in those on antiglaucoma medication using all modalities of assessment. Prevalence of OSD in glaucoma patients on antiglaucoma drugs was highest using TBUT- 69.2% (P = 0.031), with OSDI questionnaire it was 62.5% (P = 0.005), and it was lowest for Schirmer 1 test - 59.6%. For those nonglaucoma cases/not on any antiglaucoma medication, the prevalence using TBUT was 42.3%, using OSDI it was 16.3%, and with Schirmer 1 test it was 25.9%. Prevalence also increased with the increase in the number of eye drops from 1 to 2 drops/day using all modalities of assessment (P = 0.004). Using multivariate analysis, adjusting for sex and age, subjects who instilled 2 drops/day had four to five times the odds of having OSD. Conclusion: The prevalence of OSD is higher in patients with glaucoma on topical antiglaucoma medication than the nonglaucoma population studied and this increased with the increase in number of drops per day.
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Ophthalmic Patients’ Perceptive on Corona Virus Disease (Covid-19) Pandemic in Onitsha, Nigeria p. 34
Sebastian N.N Nwosu, Adanma C Ezenwa, Chizoba U Uba-Obiano
Objectives To determine patients’ perception of COVID-19 and their practice of disease prevention measures. Materials and Methods: Consenting, consecutive new adult patients at the Guinness Eye Centre Onitsha were interviewed using a pretested questionnaire. Information sought included patients’ COVID-19 knowledge, its symptoms, transmission, preventive measures, compliance, and worries. Results: Of 81 participants, the mean age was 47.9 ± 17.6 years; 31 (38.3%) were males; 61 (75.3%) attained secondary or higher education. All participants knew about COVID-19; radio/television was the most common information source (88.9%). Although 85.2% participants knew that COVID-19 is a communicable disease, 86.4% knew of its viral etiology and 86.4% knew that it could be transmitted by close contact with persons/fomites. Common symptoms known to the participants were cough (82.7%), fever (61.7%), and breathlessness (55.6 %); the most common known preventive measures were wearing face mask in public (90.1%) and handwashing (82.7%). Although 44.4% knew that physical distancing was a preventive strategy, only 11.1% knew that the distance of separation should be at least one meter; 49.4% always wore face mask in public, 61.7% washed hands frequently, whereas only 4.9% maintained physical distancing; 44.4% worried that pandemic restrictions negatively affected their access to eye care and 29.6% feared contracting the disease in eye clinics. Conclusions: All study participants knew of the COVID-19 pandemic. However, knowledge of the disease, its transmission, and preventive measures was suboptimal; many patients do not adhere to the recommended preventive measures. Repetitive public health education is required to improve compliance with disease control measures and allay fears.
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Utilization of Vision Corridor for Self-evaluation of Vision Among Secondary School Students in Igbo-Ora, Southwest Nigeria p. 39
Mary O Ugalahi, Charles O Bekibele, Ayobade O Ogundipe
Introduction: Uncorrected refractive errors have been identified as a major cause of visual impairment with a high magnitude in developing countries, due to the paucity of eye care workers. To overcome this, different approaches like screening by non-eye care workers and self-assessment have been explored. This study aims to determine the utilization, reliability, and factors affecting the utilization of vision corridors among secondary school students. Material and Methods: An observational cross-sectional study conducted among students of Lasogba High School, Igbo-Ora, Southwest Nigeria. All the students received training on visual acuity assessment with the 6-meter Snellen’s chart. Thereafter, the chart with graphic instruction “Vision Corridor” was provided with a 4-week exposure period. All students who utilized the vision corridor recorded visual acuity in a register maintained by a community health extension worker. The utilization and factors that may have affected utilization were assessed after the exposure. Data were analyzed with the Statistical Package for Social Science version 15. Results: A total of 373 students completed the study; males accounted for 48.8% and females 51.2%. The mean age of the students was 15.2 (±2.2) years. A total of 151 (40.5%) students utilized the vision corridor and factors associated with utilization included being female, age ≤15 years, and being in a junior class, all of which were statistically significant. Conclusion: A moderate proportion of the students utilized the vision corridor. This approach to refractive error screening appears promising, as self-evaluation may reduce the need for skilled manpower in refractive error screening in secondary school students. Therefore, this may effectively utilize skilled eye care manpower for other eye care services in developing countries where there is a paucity of eye care workers.
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Clinical Features and Associated Risk Factors for Thyroid Eye Disease Among Goiter Patients Who Attended Jimma University Medical Center Surgical Referral Clinic, Jimma Town, Ethiopia p. 45
Dagmawit Kifle, Aemero Abateneh, Sisay Bekele, Tsedeke Asaminewu, Melese Sinaga
Introduction Eye involvement is the most common extrathyroidal manifestation of Graves disease. Regarding our study area, there is no previous study done on the prevalence of thyroid eye disease among goiter patients. Methods: Institution-based cross-sectional study was carried out among 211 patients seen in Jimma University Medical Center surgical referral clinic from April to July 2018. The collected data were coded and entered into Epi data version 3.1 and analyzed using SPSS version 20. Variables having a P-value of less than 0.25 in the bivariate analyses were entered into a multivariable regression analysis to control the confounding variables. Results: Two hundred eleven goiter patients presented for care at JUMC surgical referral clinic over the 3 months study period; 57 (27%) of them were found to have thyroid eye disease. Lid retraction (40; 19%) was the most frequently observed sign of thyroid eye disease, whereas proptosis was found only in one case and no exposure to keratopathy or dysthyroid optic neuropathy was found. The factors that had statistically significant association with the prevalence of thyroid eye disease were thyroid dysfunction [adjusted odds ratio (AOR) = 2.781, (95% CI, 1.362–5.678) P = 0.005], smoking [AOR = 6.391, (95% CI, 1.868–21.860) P = 0.003], high blood pressure [AOR = 2.062, (95% CI, 1.001–4.251] P = 0.050] and high pulse rate [AOR=2.277 (95% CI, 1.003–5.167) P = 0.049]. Conclusion: Thyroid eye disease among goiter patients is common and many patients are followed up for goiter.
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Marshall syndrome in a Nigerian teenager presenting with refractive error p. 52
Olufunmilola Abimbola Ogun, Olusegun Adetomiwa Adediran, Adeyinka Olusola Ashaye, Onyekwere George Benjamin Nwaorgu
A 14-year-old girl, presented to our eye clinic, with poor distance vision since childhood. High myopia with degenerative retina was found. However, craniofacial disproportion and skeletal dysmorphism, as well as hearing impairment, drew clinical suspicion for a single multisystemic disorder prompting a literature review, which supported a clinical diagnosis of Marshall syndrome (MS). This case report and review of literature describes MS, worthy of note for its rarity, genetic basis and distinctive phenotypic features, but yet easily overlooked in routine clinical practice. This is the second case of MS reported in West Africa and the first in a Nigerian female. This extremely rare, systemic disorder may present unexpectedly, as a seemingly common condition as a refractive error and can be easily overlooked, without a high index of suspicion. Accurate diagnosis, however, is important because MS requires collaborative management by a multidisciplinary team and not the ophthalmologist alone, to ensure a good quality of life.
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Choroidal Tuberculoma Presenting with Exudative Retinal Detachment in a Young Male: A Case Report p. 58
Yewande O Babalola, Soumyava Basu
An 18-year-old male student presented with a 1 month history of poor vision in the right eye. Ocular examination revealed visual acuity of hand movement and 20/20 in the right and left eyes, respectively. Inflammatory cells were present in the anterior chamber of the right eye. Fundus examination revealed a right exudative retinal detachment with a tuberculoma in the superotemporal quadrant, whereas the left eye was normal. There was a positive history of contact with a relative with pulmonary tuberculosis. The patient was treated with a combination of antituberculous therapy and oral corticosteroids for 6 months following which the lesion resolved completely with full recovery of vision to 20/20 in the right eye.
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Alveolar Soft Part Sarcoma of the Orbit: A Clinicopathological Report of a Rare Case and Review of the Literature p. 62
ZY Musa, BH Askira, AB Zarami, UH Pindiga
Background: Alveolar soft part sarcoma (ASPS) of the orbit is a very rare neoplasm with an uncertain histogenesis. The tumor has an indolent clinical course that requires close and long-term follow-up due to late recurrence and metastasis. Surgery is the primary treatment option with adjunct radiotherapy. Case Report: We present the case of a 25-year-old male who presented with a 5-year history of progressive left eye swelling and loss of vision. He underwent left eye exenteration and histology diagnosed ASPS of the orbit. Conclusion: Orbital ASPS is an uncommon soft tissue tumor. Its prognosis is determined by patient’s age, tumor size, and presence of metastasis at the time of diagnosis. Close and long-term monitoring of the patient is required as recurrence is known to occur up to 10 years after treatment.
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