Aim: To describe wound construction in manual small incision cataract surgery (MSICS) in relation to anatomy, physiologic functioning and challenges of sclerocorneal tunnel. Methods: The author's method of wound construction during MSICS was explored in a lucid prose. Where relevant, information obtained from major scholarly databases (Scopus, Hinari, PubMed and Google Scholars) was cited. Results: Valvularly competent sclerocorneal tunnel largely contributes to the outcome of sutureless MSICS and takes practice to master. Conclusion: Core to a successful MSICS is the construction of a leak-proof sclerocorneal tunnel.

Aim: The aim was to determine the quality of cataract surgeries in Port Harcourt, and ascertain the difference in the outcome, if any, between small incision cataract surgery (SICS) and extra capsular cataract extraction (ECCE). Materials and Methods: This is a retrospective study carried out in a Private Eye Hospital in Port Harcourt between August 2006 and November 2012. Case notes of 83 consecutive patients (92 eyes) who had either SICS OR ECCE with posterior chamber intraocular lens (PCIOL) were included in the study. Demographic data and data concerning ocular and systemic co-morbidities were retrieved from patients' case notes. Best-corrected visual acuity was measured with Snellen's chart preoperatively, and 6 weeks following surgery. The visual outcome was categorized, using the World Health Organization (WHO) recommendation, as good (>6/18), borderline (6/24-6/60), or poor (<6/60). Statistical software package Epi-info version 6.04d was used to analyze our data. Result: A total of 92 eyes of 83 patients who had cataract surgeries was included in the study. Sixty-seven eyes (73%) had ECCE + intraocular lens (IOL) while 25 eyes (27%) had SICS + IOL. At 6 weeks postoperative, 66.3% of cases had good visual outcome while about 9.8% of cases had a poor outcome. Conclusion: Since only 66.3% of cases had good visual outcome and 9.8% had poor outcome, cataract surgical outcome in Port Harcourt is below the acceptable WHO standards of >85% and <5% for good and poor outcomes respectively. Steps to improve good outcome will include proper postoperative hygiene of patients, good preoperative evaluation of all cases, and improvement in surgeons' skills. Good visual outcome was associated more with ECCE (71.7% of 67 eyes) than SICS (52% of 25 eyes) probably due to inadequate experience of the surgeons in SICS. This difference was, however, not statistically significant.

Purpose: The aim of this study was to report the types and severity of glaucoma at presentation in patients attending the glaucoma clinic of the University College Hospital, Ibadan, Nigeria. This information will help in designing an awareness and management strategy that will help in reducing glaucoma blindness. Materials and Methods: Consecutive new glaucoma patients of all age groups who presented to the glaucoma clinic of the University College Hospital, Ibadan, over a 1-year period between January and December 2009 were evaluated. Each patient had a complete ophthalmic evaluation, including intraocular pressure (IOP), visual acuity, visual field, optic disc assessment and gonioscopy. Results: A total of 336 patients (669 eyes) presented with glaucoma (mean age was 56.5 ± 16.5, 56.3% male) during this period. The mean presenting IOP was 23 ± 11.6 mmHg and 48.5% of the 669 eyes evaluated had severe glaucoma (MD > −12dB, cup to disc ratio of ≥0.9). Primary open angle glaucoma (POAG) was the most common form (51.2%), glaucoma suspects were 55 (16.4%), 66 (19.6%) patients had normal tension glaucoma (NTG), 28 (8.3%) patients had primary angle closure glaucoma (PACG), and 15 (4.5%) patients had secondary glaucoma. Conclusion: POAG is the most common form of glaucoma seen in the glaucoma sub-specialty clinic in Nigeria. NTG and PACG were common in this case series. A large proportion of the patients had advanced disease at presentation.

Objective: To determine the causes and the intraocular pressure (IOP) outcome of neo-vascular glaucoma at the Guinness Eye Centre of the Lagos University Teaching Hospital, Lagos, Nigeria. Materials and Methods: The case records of all patients with the diagnosis of neo-vascular glaucoma who presented at Guinness Eye Centre from January 1 ^st , 2008 to December 31 ^st , 2012 were reviewed. Information extracted from their records included the bio-data, eye affected, best corrected visual acuity, intra-ocular pressure, etiology of neo-vascular glaucoma, ocular co-morbidity, systemic co-morbidity and forms of treatment received. Cases of retinoblastoma were excluded from the study. Data were analyzed using the SPSS V.17.1 Results: A total of 31 cases of neovsacular glaucoma were reviewed. The male to female ratio was 1.8:1 and the age range was from 26 to 83 years. Patients aged 51 years or older were 22 (70.4%). The presenting best corrected visual acuity in the affected eye or in the worse affected eye was counting fingers in 30 (96%) patients. The presenting IOP was 30 mmHg or higher in 26 (83.2%). Both eyes were affected in three (9.6%) patients. Patients with diabetes mellitus, hypertension or both constituted 57.8% of the total number of patients. Primary open angle glaucoma and retina vein occlusion were the etiologies of neo-vascular glaucoma in 14 (45.2%) patients. A total of 15 (48.4) patients failed to turn up for repeat appointments. Only 5 (16.0%) patients (who received ocular medications, intravitreal bevacizumab and pan-retina photocoagulation) showed a significant IOP reduction. Conclusion: Late presentation, loss to follow up and lack of full and complete treatment regime were important findings in this study. A significant IOP reduction occurred with only in the patients who had a combination therapy of IOP lowering medications, intravitreal bevacizumab and pan-retina photocoagulation. A routine eye examination for patients at risk is essential for early detection and treatment in order to minimize visual loss in neo-vascular glaucoma.

Purpose : To evaluate the role of prophylactic use of Timolol maleate (0.5%) eye drop in preventing rise of intraocular pressure (IOP) post Nd: YAG capsulotomy. Materials and Methods: A randomized, single-blinded, parallel group study conducted in 220 eyes, over a period of 18 months. Precapsulotomy baseline IOP, Slitlamp examination and grading of PCO was done. After instilling the test medication Nd: YAG laser capsulotomy performed. Post capsulotomy patients were assessed immediately, after 1 hour and 3 hours for IOP. Result: Precapsulotomy, mean IOP in Group I (use of placebo) was 15.30 ± 2.83 mm Hg as compared to 16.15 ± 2.48 mmHg in Group II (use of Timolol eyedrop), Group II mean IOP was significantly higher (P = 0.019). However, immediately after the procedure mean IOP in Group I was 14.55 ± 2.87 mmHg as compared to 13.16 ± 3.72 mmHg in Group II thus showing mean IOP in Group II to be significantly lower (P = 0.002). One hour and 3 hours after the procedure too, mean IOP in Group II was significantly lower as compared to that in Group I (P < 0.001). With increasing grade of PCO reduction in post-procedure IOP was lower and reduction in IOP was maximum in patients requiring <30 milliJoules of total energy. Conclusion: A judicious control over energy use and post laser IOP monitoring can influence the trend of IOP rise in a positive manner. Whenever anticipated that >60 mJ of laser energy is required as in higher grades and younger age, prophylactically Timolol maleate 0.5% eye drop should be instilled before Nd: YAG capsulotomy while all other patients in which Timolol is not used, should be kept under observation after laser capsulotomy.

Objective: To report the clinical profile and outcome of treatment in patients with serpiginous choroiditis. Materials and Methods: A retrospective non-comparative case series was conducted over a period of 1 month. Seventeen eyes of 11 patients that were diagnosed as serpiginous choroiditis were included in the study. Laterality, clinical presentation, presence of any systemic abnormality, best corrected visual acuity (BCVA), lens status, intraocular pressure, findings on funduscopic examination, type of serpiginous choroiditis and treatment modality offered were recorded. Information obtained was entered into SPSS 17.0 data base and analyzed. Results: There was a male preponderance (3:1). Age at presentation ranged from 14 to 51 years with a mean age of 30 years (±9.95 SD). Eight subjects (64.7%) had bilateral involvement at presentation. Mean visual acuity (VA) improved to 0.34 (±0.45 SD) after treatment from 0.49 at presentation. Vision improved or maintained in 15 eyes, whereas it deteriorated in two eyes due to foveal involvement and choroidal neovascular membrane, respectively. Conclusion: Patients with serpiginous choroidits can achieve a significant visual improvement following successful treatment with steroids and immunosuppressive treatment.

Background: The role of key informants (KIs) in identifying children with vision loss is expanding, yet there is a minimal understanding of KI perceptions of vision loss in children. The aim of the study was to understand the KI's perception of childhood vision loss in order to design more effective training programmes. Materials and Methods: A population-based study on the prevalence and causes of childhood blindness and severe visual impairment was conducted using the KI method. KIs were selected by their communities and trained in advocacy, identification and referral of children with visual impairment. Prior to the KI training, a pre-test was conducted, asking, "what is your perception of vision loss in children and how will you identify these children in your community?". Result: The 742 KI provided 1,650 responses. There were three main methods suggested to identify children; observation of a child, vision assessment of a child, and recognition of isolation of a child. Conclusion: KI have a good understanding of the impact of vision loss on children. Training programmes should use existing knowledge of KI. Furthermore, training programmes should include the social impact of severe vision loss to help identify children needing the assessment.

Purpose: To evaluate the effects of laser retinopexy in retinal breaks and the recurrence cases. Materials and Methods: 45 eyes of 25 patients who underwent laser retinopexy in retinal breaks between the period of July 2009 and January 2013 are included. All the breaks and suspicious areas for possible breaks are treated with laser photocoagulation. The breaks were surrounded with three rows of laser spots. After the routine controls, the patients are called every 6 months and advised to come immediately to our clinic if new flashing or floaters occur. Results: The patients were followed-up for an average period of 29.65 ± 10.45 months. New breaks were treated again and evaluated for the possible reasons. We found in three patients new breaks after an average period of 27.33 ± 2.03 months. No specifications are observed in these subjects. Conclusion: Retinal breaks can occur even a long time after. It is not known why this process is progressing and new tears develop. For this reason, patients who underwent a laser therapy because of retinal breaks should followed-up for a lifetime. We advise that, unsymptomatic patients who underwent laser retinopexy, should be examined every 6 months and every new complaint of flashing and big floaters should be carefully taken into consideration to prevent retinal detachments.

Objective: To review the indications and visual outcome of the fi rst one hundred pars plana vitrectomies performed at the newly established surgical retina unit of Makkah Specialist Eye Hospital, Kano, Kano State, Nigeria. Materials and Methods: A retrospective chart review was performed. Data recorded from the patient chart include demography, pre and postoperative visual acuity, indication for surgery and associated systemic or ocular co-morbidities of fi rst hundred consecutive patients, who underwent pars plana vitrectomy between March 2012 and January 2013. Result: One hundred eyes of 97 patients underwent pars plana vitrectomy including 75 (77%) males and 22 (23%) females with a mean age of 45.62 ± 16.1 years. Preoperatively, presenting visual acuity in the affected eye was <3/60 in 80 eyes (80%), while that in the contralateral eye was <3/60 in 24 eyes (24%). Postoperatively, 41 eyes (41%) had unaided visual acuity of <3/60. The most common indications for surgery were rhegmatogenous retinal detachment 49 eyes (51%) and vitreous hemorrhage 20 eyes (21%). Conclusion: Rhegmatogenous retinal detachment and vitreous hemorrhage are the major indications for pars plana vitrectomy in this environment. As vitreoretinal disorders have become more common in this part of the world, there would be a corresponding increase in demand for vitreoretinal services. There is therefore a need for more eye care providers with sub-specialty training in retinal diseases.

Background: Strabismus is the most common amblyogenic factor and approximately 40% of children with manifest strabismus have amblyopia. In Nigeria, it is generally believed that strabismus is not common. However, few studies have been done to determine the prevalence of strabismus in Benin City, Edo State. Objective: This study aims to determine the prevalence and pattern of tropias and phorias in primary school children in Benin City. Methods: This was a cross-sectional study carried out on primary school pupils in government schools located within Egor Local Government Council Area, Edo State. Results: Two thousand one hundred and thirty-nine students (2139) were examined. There were 1024 males (47.87%) and 1115 females (52.13%). The overall prevalence of tropias in this study was 0.89%. Esotropia was seen in 0.56% (12 pupils, SE 0.03%) and exotropia in 0.33% (7 pupils, SE 0.02%) of the pupils. Infantile esotropia was the most common form of esotropia while alternating exotropia was the most common pattern of exotropia. 57.04% of the pupils had heterophoria. Conclusion: The prevalence of manifest strabismus in Benin City was low however there should be training of non-ophthalmic staff such as teachers to detect and refer cases of strabismus.

Aim: To report an unusual presentation of retained safety pin in ocular adnexae of a 3 year old child. Methods: A case report. The patient presented within the hour of accident and surgical intervention followed immediately after preliminary investigations. Results: Under general anesthesia, entry site of foreign body was explored. The safety pin was surprisingly lodged subtarsally in the matrix of firmly anchoring tenons. This was at variance to preoperative appearance of actual globe penetration. Conclusion : X-ray of the orbit confirmed by wound exploration correctly localized the foreign body.

Congenital anophthalmos is a rare clinical condition. This is a report of two cases of clinical anophthalmos seen in Benin City, Nigeria. Two cases of unilateral anophthalmos have been previously reported. Bilateral clinical anophthalmos is a relatively rare condition hence the first reported case in Benin City is presented. The first patient presented with primary anophthalmos while the second case presented with degenerative or consecutive anophthalmos.

Orbital cellulitis is the inflammation of the tissues of the eye behind the orbital septum. The disease is mainly caused by either bacteria or fungal organisms. Orbital cellulitis is an emergency condition that requires prompt hospitalization and appropriate antibiotic cover without which there will be visual loss and even death! It affects all ages but more common with the younger age groups and males are more prone to the disease. It is a unilateral disease commonly but in rare situations both eyes are affected. We report a case of a bilateral disease in a healthy middle-aged man who presented with fevers, diminished vision, eye pains, lid swellings, severe ptosis, axial proptosis and ophthalmoplegia in both eyes. Our impression was that of Class 5 orbital cellulitis according to Chandler's classification. His laboratory investigations revealed positive growths of Staphylococcus otherwise his laboratory investigations were all normal. He responded well to intravenous cefuroxime and oral oflaxacin and metronidazole with diclofenac and was discharged from hospital within 1 week. We conclude that prompt hospitalization and appropriate intravenous and oral antibiotics can successfully treat this orbital emergency.