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   Table of Contents - Current issue
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May-August 2022
Volume 30 | Issue 2
Page Nos. 33-82

Online since Monday, August 29, 2022

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EDITORIAL  

Nigerian Journal of Ophthalmology Editorial Comments, May–August 2022 Edition p. 33
Charles O Bekibele
DOI:10.4103/njo.njo_15_22  
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ORIGINAL ARTICLES Top

Prevalence and Causes of Visual Impairment among Adults in Jos North Local Government Area of Plateau State p. 35
Umar Fatima Hudu, Ojo Perpetua Odugbo, Caleb Damilep Mpyet
DOI:10.4103/njo.njo_16_21  
The objective of the study was to determine the prevalence and causes of visual impairment among adults in Jos North Local Government Area (LGA) of Plateau State, Nigeria. This was a rapid assessment of avoidable blindness (RAAB) study in which a multistaged sampling technique was used to select a total of 22 clusters. Households were selected by the compact segment technique, which were visited door by door until 39 persons aged 50 years and above are identified and recruited for the study. Examination and diagnosis was made based on the RAAB protocol to determine the major cause of visual impairment. The prevalence of visual impairment and blindness was 18.8% [confidence interval (CI) = 16.2–21.4%] and 5.6% (CI = 4.2–7.0%), respectively. The wards with the highest prevalence of visual impairment are Rigiza (45%), Gangare (35%), and Ibrahim Katsina ward (35%). About 96.8% causes of visual impairments and 95% causes of blindness were avoidable with cataract [78 (48.8%)], glaucoma [26 (16.3%)], uncorrected refractive error [25 (15.6%)], cataract surgical complications [17 (10.6%)], and couching [5 (3.1%)] being the most common causes of visual impairment and cataract [18 (37.5%)], glaucoma [16 (33.3%)], and couching [5 (10.4%)] being the most common causes of blindness. The prevalence of visual impairment was found to be 18.8% in Jos North Local Government Council, and this varies among the wards with Rigiza, Gangare, and Ibrahim Katsina having the highest prevalence. Most of the causes were avoidable. There is a need to reorganize the existing eye-care program and also integrate eye-care services into the existing health-care services that are not rendering eye-care services in the LGA so as to reduce the burden of blindness and visual impairment.
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The Impact of the COVID-19 Pandemic on Postgraduate Ophthalmology Training Program in Nigeria p. 43
Tarela F Sarimiye, Henrietta Monye, Olusola Olawoye, Sowunmi Hughes
DOI:10.4103/njo.njo_8_21  
Background: The severe acute respiratory syndrome coronavirus 2 which causes coronavirus disease 2019 (COVID-19) has resulted in a challenging and an unprecedented pandemic in the 21st century. This pandemic affects almost all aspects of human life including the medical field. Methods: This was a cross-sectional, descriptive multicenter survey of resident doctors in ophthalmology training programs in Nigeria. An anonymous web survey was created on Google form and circulated to ophthalmology residents in Nigeria using electronic communication tools between April and July 2020. Results: Seventy-two ophthalmology residents in 25 residency training institutions across five geopolitical zones of the country participated in the online survey. There was a significant decrease in the number of patients attended to in the clinic per week by respondents, time spent in consulting per patient, number of unit admissions per week, frequency of eye camps and outreaches per month, and number of surgeries performed by the unit per month (P = 0.000) in the COVID era compare to the pre-COVID era. Two-thirds of respondents felt their posting schedules had been affected at least to a moderate extent, this in turn affected their eligibility for examinations. Three-quarters of the respondents also felt that the pandemic had negatively affected trainer–trainee and mentor–mentee relations in terms of knowledge transfer. Respondents recommended a greater focus on online learning. Conclusion: In this survey, the impact of the COVID-19 pandemic has been shown to negatively impact ophthalmology residency training. A need for a paradigm shift in training may be the way forward.
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A Comparison of Clinical Profile and Treatment Outcomes of Phacomorphic and Phacolytic Glaucoma in a Tertiary Eye Care Hospital of India p. 51
Sardar Khan, Avik Kumar Roy, Aparna Rao
DOI:10.4103/njo.njo_36_21  
Objective: To compare the clinical features, and treatment outcomes of phacomorphic glaucoma (PMG) versus phacolytic glaucoma (PLG) in a tertiary care eye hospital in India. Methods: A retrospective review of electronic medical record data of all patients operated for phacolytic and PMGs, between March 2013 and March 2020, was performed. Patients with a history of trauma pre-existing glaucoma or who were blind at presentation were excluded. Patients’ demographic data, clinical features, visual and surgical outcomes were analyzed. Results: There were 78 and 86 eyes with a mean age of 69.0 and 70.3 years for PMG and PLG, respectively. Time from onset of symptoms to presentation in the clinic was longer in PMG group of patients (30.7 ± 53.2 days) compared to the PLG group (15 ± 17.5 days). Visual acuities and/or intraocular pressures (IOPs) at presentation were comparable in the two groups. Corneal decompensation or scarring was 3.8% in PMG versus 2.8% in PLG. About 24.4% patients in PMG group were initially misdiagnosed and treated as either primary open angle or closed angle glaucoma, whereas there was no misdiagnosis in the PLG group. Small incisional cataract surgery (SICS) with posterior chamber intraocular lens implantation was performed in 65.4% of phacomorphic and 68.6% of phacolytic groups. Combined cataract and trabeculectomy were carried out in 8.9% of phacomorphic and 4.6% of phacolytic. Vitrectomy was required in 17.9% in phacomorphic and 12.8% in PLG, statistically significant improvement in overall mean logMAR visual acuity improved from 1.5 to 1.4, and IOP reduced by 53% by postoperative 1 week. Conclusion: Both PMG and PLG respond favorably to standard SICS, irrespective of their duration of symptoms. The final visual acuity gain and control of IOPs were comparable in the two groups.
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Retinoblastoma in a Referral Center in Nigeria: 7- year Review of Changing Pattern of Presentation and Lag Time p. 56
Dupe S Ademola-Popoola, Ibrahim A Yusuf, Tokunbo S Obajolowo, Sikirat O Akinremi, A.S. Gobeh
DOI:10.4103/njo.njo_40_21  
Background: Improvement in survival from retinoblastoma (RB) improved to about 98% in developed countries because of early presentation and prompt intervention at designated RB care center, whereas in low-resourced countries, late presentations and poor survival are not unusual. This study reviews the changing pattern of presentations over a 7-year period when various efforts were deployed to improve early presentation and intervention in a low-resourced setting. Materials and methods: Data were extracted from RB clerk sheets that were used for documentation of clinical records of patients with RB managed at a single tertiary referral center for RB in Nigeria between 2013 and 2019. The data were analyzed for changing trend of clinical presentation and lag time. Ethical approval was obtained from the institution. Results: Two hundred and twenty-two eyes of 148 children were reviewed. There were 79 males and 69 (46.6%) females, and male to female ratio was 1.14:1. There were 74 (50%) unilateral, 72 (48.6%) bilateral, and 2 (1.4%) trilateral cases. Discussion: Overall, 66 (44.6%) and 82 (55.4%), patients had shown symptoms by 6 months and 1 year, respectively, whereas only 39 (25.7%) had presented by 1 year. Early disease stage presenting as leukocoria increased from 22.2% to 85.7%, whereas late presentation as proptosis declined from 55.5% to 10.7% between 2013 and 2019. Some cases were identified during vision screening performed by community health workers during routine immunization at primary healthcare clinics. At presentation, 188 (84.7%) RB eyes were intraocular, 32 (14.4%) orbital, and 2 (0.9%) had systemic spread. The median of the lag-time (delay) between when symptom was noticed to presentation reduced gradually each year by 1 month, from a median of 9 months in 2013 to 4 months in 2018. Conclusions: In Nigeria, early presentation as leukocoria increased, whereas late presentation as proptosis and lag time in RB reduced significantly from year 2013 to 2019 which was supported by deliberate efforts to educate the public and institute training across all levels of health care. In low-resourced country like ours, achieving early presentation of RB cases would increase the survival of affected children.
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Assessment of Retinal Nerve Fiber Layer Thickness in Nigerian Adults Using Spectral-Domain Optical Coherence Tomography p. 63
Habibat Y Daromosu, Olufemi E Babalola, Regina E Morgan, Bolajoko A Adewara
DOI:10.4103/njo.njo_6_21  
Objective: To measure the circumpapillary retinal nerve fiber layer (RNFL) thickness in normal eyes of Nigerian adults using spectral-domain optical coherence tomography (SD-OCT). Materials and methods: This was a cross-sectional study of normal eyes of Nigerian adults between July and September 2016 at the eye clinic of a tertiary hospital in Nigeria. Sociodemographic data, clinical history, and examination findings were obtained. Dipstick urinalysis and blood pressure measurements were performed. Circumpapillary RNFL thickness was measured with the Topcon 3D OCT-1 Maestro version 8.30 (Topcon Medical Systems, Inc., Oakland, NJ, USA), using the 3D optic nerve head analysis. Data were analyzed using the International Business Machine (IBM) Statistical Package for the Social Sciences (SPSS) Statistics, version 25.0 (IBM Corp., Armonk, NY, USA) and the level of significance was set at P ≤ 0.05. Results: The study included 120 participants (240 eyes) with an age range of 18 to 53 years and a mean age of 34.06 ± 7.64 years. There were 59 (49.17%) males and 61 (50.83%) females. The average RNFL thickness in the right and left eyes was 112.26 ± 9.6 and 110.53 ± 9.14 μm, respectively. The average RNFL thickness for the Igbo ethnic group was 117.5 ± 7.69 and 115.04 ± 7.18 μm in the right and left eyes, respectively. The mean RNFL thickness for the inferior, superior, nasal, and temporal quadrants was 148.92 ± 15.77, 142.59 ± 16.48, 85.3 ± 15.39, and 71.89 ± 9.35 μm in the right eyes and 149.28 ± 16.03, 141.69 ± 13.33, 81.82 ± 13.59, and 68.8 ± 10.17 μm in the left eyes, respectively. Conclusion: This study showed the normal circumpapillary RNFL thickness values in Nigerian adults using SD-OCT. There were variations based on ethnicity that suggest it may be important to use ethnic-specific benchmarks when interpreting OCT results for the management of glaucoma.
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Serum Levels of Vitamin C among Patients with and Without Age-Related Cataract at The University of Abuja Teaching Hospital, Abuja, Nigeria p. 69
Aisha S Kalambe, Rilwan C Muhammad, Abdulkabir A Ayanniyi, Abubakar Imam
DOI:10.4103/njo.njo_45_21  
Objectives: To evaluate serum levels of vitamin C in patients aged between 45 and 60 years with and without age-related cataract. Methods: One hundred and eighty consenting adults were recruited for this hospital-based comparative cross-sectional study and distributed equally into the cataract and no-cataract groups. They were interviewed using a pretested questionnaire on their demographics, health, lifestyle, and nutritional habits followed by full ocular examination. All the subjects had blood drawn and serum vitamin C assayed using the Cell Biolabs’ Oxiselect Ascorbic Acid Assay kit. Data were analyzed using IBM SPSS version 21 statistical software. P-value of <0.05 was considered statistically significant. Results: One hundred and seventy-eight serum vitamin C assays were analyzed (response rate of 98.9%). One hundred and fifty-eight (88.8%) participants had low levels of vitamin C, whereas 20 (11.2%) had normal levels. Serum vitamin C levels were significantly higher among the no-cataract group than the cataract group with mean values of 0.121 to 0.567 mg/dL [mean ± 2 standard deviation (SD)] and 0.160 to 0.454 mg/dL (mean ± 2SD), respectively [P = 0.004 and 95% confidence interval of −0.64 to −0.013]. Serum vitamin C levels were significantly higher among the male participants in each group (P = 0.004). Serum vitamin C was found to have a weak positive correlation with the age of the participants (P = 0.577). Conclusion: In a vitamin C-depleted study population, serum vitamin C was found to have an inverse relationship with age-related cataract.
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CASE REPORTS Top

Ocular Manifestations of Rubella Virus Disease in a 32-Year-Old Female Patient Case Report p. 75
Ogbonna Grace, Anyika Fidelis, Ehigbor Rosemary
DOI:10.4103/njo.njo_22_21  
Rubella (German measles) is a viral disease that affects all age groups. It is spread through contact with airborne droplets of the virus found in the cough or sneeze of infected people. It can also be spread through sharing of cutleries and drinks with infected persons. Following rubella infection, symptoms may be nonspecific as with most viral infections, and may include: arthralgia, cough, runny nose, low grade fever, maculopapular rashes, and lymphadenopathy. Rubella infection cannot be clinically differentiated from other viral diseases based on symptoms. However, it is important for clinicians to know symptoms which may be suggestive of rubella for quick differentials and implementation of precautionary measures against its spread, hence this case report. In this study, we report a case of rare ocular involvement of the third cranial nerve in a 32-year-old black woman with rubella which resulted in pain on superior eye movement and partial eyelid ptosis. The patient also reported experiencing blurred vision, light sensitivity, and objects appearing washed out. All her symptoms appeared 17 days after she had embarked on an international travel (through Ethiopia) and sharing a can of drink with a child who she did not know his measles, mumps, and rubella vaccination status. She tested positive to rubella immunoglobulin M test. However, all of the patient’s ocular symptoms resolved 6 weeks after their onset following the resolution of the rubella symptoms.
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Eyelid Sarcoidosis Lesion in Abuja, Nigeria p. 79
Adaora C Okudo, Olufemi E Babalola, Emanso O Umobong, Hilda A Titiloye
DOI:10.4103/njo.njo_25_21  
We report a case of sarcoidosis involving the eyelid in a Nigerian setting. Lid masses are sometimes overlooked by patients and attending physicians. This report is on a 47-year-old Ghanaian male who presented to private eye clinic in Abuja, Nigeria. He had multiple eyelid lesions, skin lesions on his scalp, back of his ear and neck. He had a history of coughing and wheezing. Histopathology of skin biopsy confirmed that they were sarcoid lesion. Chest X-ray showed hilar lymphadenopathy. He was placed on tablets prednisolone 20 mg daily for 8 weeks. The symptoms abated and have not reoccurred 3 years posttreatment. In conclusion, atypical eyelid lesions with pulmonary involvement should be biopsied and sent for histopathology. Systemic steroids are effective in treating lid involvement of sarcoidosis. The management of sarcoidosis requires a multidisciplinary approach between the physician, dermatologist, and ophthalmologist.
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