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   Table of Contents - Current issue
January-April 2023
Volume 31 | Issue 1
Page Nos. 1-48

Online since Saturday, April 29, 2023

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Editorial Comments: Nigerian Journal of Ophthalmology, January–April 2023 p. 1
Feyi Grace Adepoju
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Determinants of Eye Disorders in Patients with Rheumatoid Arthritis and Systemic Lupus Erythematosus in a Tertiary Hospital in Northern Nigeria p. 3
Rilwan C Muhammad, Maryam H Abdullahi, Kehinde K Oladigbolu, Abdul Aziz Umar
Objectives: To investigate the determinants of eye disorders in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) in a Tertiary Hospital in Northern Nigeria. Methods: This hospital-based study was conducted among patients with RA and SLE. Information was obtained on patients’ socio-demographics, type of rheumatic disease, disease duration, activity, and prescribed medications. RAPID 3 was used among both RA and SLE patients to measure and classify disease activity as: >12 = high; 6.1–12 = moderate; 3.1–6 = low; <3= remission. Each patient had detailed ocular examination. Statistical significance was set at P < 0.05. Results: The female:male ratio was 4.3:1 for RA and all SLE patients were females. Eye disorders were present in 42% of all patients, the most common being dry eyes (38%), refractive errors (18%), and cataracts (16%). The least findings were corneal opacities (2%) and lateral rectus palsy (2%). Mean duration of disease in years was significantly higher among RA patient that had eye disorders (7.23 ± 3.44) than those without (2.23 ± 1.23) (P < 0.001). It was also higher among SLE patients with eye disorders (6.73 ± 3.93) than those without (2.13 ± 1.06) (P < 0.001). Most RA patients with eye disorders had moderate [21 (28%)] to severe [8 (11%)] disease activity whereas majority of patients without eye disorders had low activity [16 (22%)] and near remission [26 (35%)] (P < 0.001). Most SLE patients with eye disorders had moderate [9 (35%)] to severe [1 (4%)] disease activity whereas majority of patients without eye disorders had low activity [3 (12%)] and near remission [12 (46%)]. Conclusion: Eye disorders are common among RA and SLE patients, and are influenced by longer disease duration, higher disease activity, and older age. Gender and drug therapy were not found to influence the presence of eye disorders. Eye examination should be done on all RA and SLE patients at regular intervals.
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Estimated Number of Cataract Surgeries Performed in Government Hospitals in Nigeria and Factors Affecting Cataract Surgical Activity p. 11
Dilichukwu Isioma Aniemeka, John Buchan, Azuka Stephen Adeke, Abubakar Dange, Nanaishat Momoh
Aim: To estimate the number of cataract surgeries performed from 1 January 2017 to 31 December 2019 in government hospitals in Nigeria and explore factors affecting their cataract surgical activity. Methods: This was a retrospective study conducted between 1 August 2020 and 4 October 2020 through online survey emailed to respondents working in 55 government-owned hospitals in the 36 Nigerian states and federal capital territory. Information obtained included a number of cataract surgeries performed yearly and correlation analysed between variables obtained using IBM Statistical Package for Social Sciences software for Windows version 22 (SPSS Inc., Chicago, Illinois, USA). Results: A total of 40 institutions were included in the study, 26 (65%) federal government and 16 (35%) state government institutions. About 70,792 cataract surgeries were performed during the study period with the North-West geopolitical zone performing 47.7% of the surgeries. The average price for cataract surgical service in government hospital was USD($)77.45(±7.08) (surgical fee) and USD ($) 128.23(±11.96) (total treatment cost) with a wide variation from zone-to-zone. Lower fees were associated with increased surgical volumes, and GNI per capita of each state did not influence the price set for surgery or the number of surgeries performed. Provision of outreach services, free surgeries, and having an eye manager correlated to increased cataract surgical numbers (P < 0.05). Conclusion: There is need to improve existing strategies to increase cataract surgical numbers in government institutions such as increased advocacy for funding for eye care services, conducting frequent outreaches, establishing and redistribution of satellite centres to underserved communities and fostering surgical relationships between institutions to improve surgeon’s competency and cataract surgical outcome.
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Prevalence of low vision and barriers to uptake of low vision services in an adult population of Southwest Nigeria p. 19
Izuka A Okwudishu, Mary O Ugalahi, Bolutife A Olusanya, Charles O Bekibele
Aim: To determine the prevalence of functional low vision and barriers to uptake of low vision services in Oluyole Local Government Area, Oyo State with a view to obtaining data for proper planning of low vision services. Methods: A population-based cross-sectional study. Multistage random sampling technique with probability proportion to size was used to select respondents from the L.G.A. The study involved the administration of questionnaires to elicit basic demographic data, ocular history, and barriers to uptake of low vision services as well as ocular examination to determine the causes of low vision. Results: A total of 419 respondents participated in the study, 303 were females with male-to-female ratio of 1:2.6 and a mean age of 49.38 (± 13.17) years. Fourteen (3.3%) respondents were found to have functional low vision. The main causes of functional low vision were glaucoma (32%) and age-related macular degeneration (ARMD) (16%). Functional low vision was strongly associated with older age (p = 0.019) and the main barriers to utilization of low vision services were lack of awareness of the services and financial constraints. Conclusion: A significant burden of functional low vision was found in Oluyole Local Government Area of Oyo State. There is need for regular community-based surveys in other parts of the country to aid proper planning of low vision services in the host communities and the country as a whole. Also, more awareness needs to be created about common ocular diseases and facilities for appropriate treatment of these diseases.
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Economic burden of glaucoma in Nigeria: Estimating the direct health care cost in a tertiary eye clinic p. 25
Shahir Umar Bello, Ugochukwu A Eze, Murtala M Umar, Mohammed Abdull, OE Babalola
Aim: To estimate the direct health care cost of glaucoma in patients attending glaucoma clinic at National Eye Centre, Kaduna. Methods: The study was a hospital-based observational, cross-sectional study of 150 consecutive glaucoma patients on follow-up visits to the glaucoma clinic from November, 2017 to January, 2018. The study was conducted using a structured interviewer-administered questionnaire. The study investigated the patients’ monthly income, the method of funding glaucoma treatment, and cost of treatment of glaucoma. Data obtained were entered and analyzed using SPSS version 24 with level of significance set at 95% confidence interval. Results: There were a total of 150 patients who participated in the study, with a male-to-female ratio of M:F ratio is 1.2:1. Majority of respondents (65%) in the study were below the age of 60 years with a mean age of 55.36 (SD+/−13.7). The average monthly income of respondents was NGN 4,600 for unskilled workers, NGN 28,812 for skilled workers, and NGN 97,111 for professionals. The mean monthly direct health cost was NGN 9,954 and majority (91.7%) of the patients fund their treatment out of pocket. Only 14 (9.3%) patients were subscribers of the National Health Insurance Scheme. None among the unskilled and unemployed respondents had monthly direct costs below their average monthly income. The insured patients spent an average of 1.5% and 4.5%, respectively of their total monthly income on antiglaucoma medication and glaucoma surgery unlike the uninsured group who have spent 10.1% and 10.5%, respectively on medications and surgery. Conclusion: Data from this study have shown that up to one-tenth of the monthly income can be spent on glaucoma care alone. Health policy makers should consider making glaucoma a priority disease to ensure that patients on treatment have affordable, equitable, and of good quality in order to prevent consequent glaucoma-related blindness.
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A Report of Three Cases of Ocular Surface Squamous Neoplasia Treated with 5-Fluorouracil Drops p. 32
Josephine Nonye Ubah, Olufunmi Adebimpe Ijeoma Otuka
Objective To raise the awareness of the use of topical 5-fluorouracil in management of recurrent ocular surface squamous neoplasia. Methods A case series study carried out at an Ophthalmic clinic, in Western Nigeria. The subjects were managed for ocular surface squamous neoplasm. Results Three patients aged 31–52 years were seen in the period of study. They were operated upon and early recurrence was noted in them. 5-Flourouracil eye drop was used in the management of recurrent tumor with good results. Conclusion There was good response with the use of topical 5-fluorouracil for the management of recurrent ocular surface squamous neoplasia.
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Retinal Degenerative Disease (Retinitis Pigmentosa) Associated with Nonocular Abnormalities: A Case Series in Niger p. 36
Hadjia Yakoura Abba Kaka
Retinitis pigmentosa (RP) is a genetic abnormality affecting the retina cells and is responsible for a progressive visual impairment which at the end results in an irreversible blindness. In some rare cases, this inherited disease can be associated with other systemic abnormalities. In this report, three different families were presented with familial syndromic RP: Usher syndrome (RP and congenital deafness) reported in three members of the same family: RP associated with Marfan syndrome and RP associated with macular dystrophy in two siblings. All our patients are children from first-degree consanguineous marriages with no previous history of blindness or eye disease in each family. This case series demonstrates the variability of systemic associations with RP and its occurrence in consanguineous marriages.
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Ocular Hypotony Causing Choroidal Detachment Following Scleral Fixation of Intraocular Lens − A Case Report p. 41
Idris Saka, Modupe Balogun, Gafar Folohunso Yusuf
This article reports a case of choroidal detachment (CD) probably from reduced volume of the globe and ocular hypotony following scleral fixation of intraocular lens (SFIOL) in a diabetic. Ocular hypotony is a complication of intraocular surgeries such as glaucoma filtering procedures, penetrating keratoplasty, and vitreous surgery. Urgent identification and management of CD is important to ensure a favorable visual outcome. We report a case of CD from prolonged ocular hypotony (OH) following SFIOL in a Nigerian male. Our patient was a 59-year-old diabetic male who presented with poor vision in left eye following cataract surgery. Left eye examination revealed quiet anterior segment with aphakia and a normal posterior segment. A +10 Dioptre sphere lens over the index eye improved visual acuity to 6/12. He was scheduled for SFIOL which was uneventful. He developed sudden decline in vision 1 week postoperative, examination revealed a serous choroidal detachment that resolved completely with high dose oral and topical steroids, systemic vitamin C, and doxycycline to a final unaided visual acuity of 6/24 at 2 weeks, and 6/9 at 3 months.
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Glaucomatocyclitic Crisis in a Nigerian Child: A Case Report p. 45
Tarela F Sarimiye, Steve Adebusoye
Background: Glaucomatocyclitic crisis is a condition that elicits significant elevated intraocular pressure (IOP) with minimal non-granulomatous anterior uveitis. It is usually unilateral, occasionally recurrent, and easily treatable in most cases. It is seen mainly in young adults but is rarely reported in children. This is to report an uncommon case of glaucomatous cyclitic crisis (Posner-Schlossman syndrome) in a Nigerian child. Case report: A 15-year-old boy presented with pain, haloes around light, photophobia, and decreased vision in the left eye over the course of the day. He has a similar history from 5 years ago, with a brief resolution on steroid eye drops. Ocular examination in the left eye revealed minimal non-granulomatous anterior uveitis with significantly elevated intraocular pressure. He was treated with topical steroid and ocular hypotensive and his IOP was 14 mmHg at 14 hours, down from 44 mmHg at the start. The anterior chamber was quiet by the fourth day of treatment. The clinical picture in this child was consistent with Posner-Schlossman syndrome. Following resolution of the inflammation and discontinuation of all medications, the patient is being followed up as a glaucoma suspect because of the subtle disc finding and the slight risk of glaucoma development later. Conclusion: Although glaucomatocyclitic crisis is uncommon in children, it should be considered in the differential diagnosis of uveitis and glaucoma in paediatric patients.
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