Purpose: To review updated knowledge on the epidemiology, pathogenesis, clinical features, and treatment of microbial keratitis (MK). Source of Data: International and local journals containing current literature on MK were sourced through the Internet. Study Selection: Findings consistent with our objectives were compiled and reviewed. Data Extraction: Data were extracted using endnotes. Results: MK is a sight-threatening ocular infection caused by bacteria, fungi, and protist pathogens. The pathogenesis comprises molecular mechanisms describing microbial activities which involve virulence and host factors responsible for ocular tissue damage and progression in keratitis. Clinical features include redness, pain, tearing, blurred vision, and inflammation, but symptoms vary depending on the causative agent. The primary treatment goal is the elimination of causative organism in addition to neutralization of virulence factors and healing of damaged host tissue. A timely review of our current understanding of MK with the recent advances in its treatment will ensure improved management outcomes. Conclusion: Optimal outcome from management of MK will require an updated knowledge of its pathogenesis, clinical features, and treatment protocols, especially in sub-Saharan Africa where its prevalence is on the increase.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

X-linked juvenile retinoschisis is a hereditary macular dystrophy that is transmitted in the X-linked recessive mode. Clinical signs include a macular star with or without peripheral retinoschisis responsible for decreased visual acuity. This study dealt with a 12-year-old boy who came in for a consultation for progressive decline in visual acuity. His distance visual acuity without correction was scored at 5/100; the right eye (RE) improved to 10/100 after the correction of a myopic astigmatism; and the unimproved left eye was scored at 20/100. The eye fundus showed perimacular radial lines without increased separation for the right eye with some microcysts and a macular hole on the left. An examination of the retinal periphery of both the eyes found inferotemporal retinal splitting. The electrophysiological assessment showed a major dysfunction on the electroretinogram.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Aim: To investigate the risk factors associated with amblyopia among primary school pupils in Kosofe town, Lagos State, Nigeria. Materials and Methods: A descriptive, cross-sectional, school-based study was conducted, in which a multistage random sampling technique was employed for recruiting the children. Data were collected using self-administered questionnaires by the parents or caregivers and from detailed ocular examinations performed by the investigators. Data analysis was performed using the IBM Statistical Package for Social Sciences software version 20.0. Results: A total of 1702 children participated in the study, with over 90% of the children being aged 4–10 years. Most (78.5%) of the mothers were aged 20–39 years at childbirth, and the mean age was 30.5 ± 7.8 years. Amblyopia was detected in 24 (1.41%) children. Following multivariate logistic regression analysis, children whose mothers had no formal education at childbirth had an 11-fold greater risk of having amblyopia [odds ratios (OR) = 11.25, 95% confidence intervals (95% CI) = 1.25–1.49], while those with birth weight <2500 g were 10 times more likely to have amblyopia at the time of examination (OR = 10.15, 95% CI = 0.70–0.90). In addition, children with a positive family history of crossed eyes had an eightfold greater risk of having amblyopia (OR = 8.14, 95% CI = 0.24–0.46). Conclusion: Mother’s educational qualification at childbirth, low birth weight, and a positive family history of crossed eye were found to be strongly associated with the development of amblyopia.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Fireworks are an important part of festivals in India, especially Diwali. The use of these fireworks often result in ocular trauma with a loss of vision. The aim of this study was to determine the pattern of eye injuries from fireworks during the Diwali festival and the visual outcome at a tertiary eye hospital in south India. Materials and Methods: The cases of ocular trauma from fireworks over a 3-year period were retrospectively reviewed. Information regarding patient’s age, gender, laterality, the type of firework, whether user or bystander, best-corrected visual acuity (BCVA) at presentation, the details of injuries, diagnosis, management, and BCVA at last follow-up visit were documented and analyzed using Epi Info 7.1.5.0 software. Results: A total of 114 eyes of 110 patients were analyzed. The study population comprised 89 (81%) males and 21 (19%) females, with a male-to-female ratio of 4.2:1. The median age was 14.0 years, with 61 (56%) patients aged <18 years. One hundred (88%) eyes had closed globe injury (CGI), whereas 14 (12%) eyes had open globe injury (OGI). Thirty-five (35%) eyes with CGI and 8 (57%) eyes with OGI had a BCVA of <3/60 at presentation. This improved with management with only 12 (12%) eyes with CGI and two (14%) eyes with CGI and 2 (14%) eyes with OGI having a BCVA of <3/60 at the last follow-up visit. These differences in visual acuity were not statistically significant with P-values >0.5. Twenty-two (19%) eyes developed long-term complications such as glaucoma, retinal detachment, and phthisis bulbi. Conclusion: Ocular trauma from fireworks commonly affects young boys and often results in serious, preventable, vision-threatening complications. The enforcement of existing legislation, health education, and public awareness are essential if the current trend in India is to be reversed.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Objective: To determine the causes of visual loss among students in special education centers for the blind in Abia and Ebonyi States, Nigeria. Materials and Methods: The study was a descriptive, cross-sectional study of students in two schools selected by random sampling of the schools for the blind in South East Nigeria. The students were interviewed and had a general examination. Ocular examination included visual acuity assessment, anterior and posterior segment examination, intraocular pressure measurement, and refraction. Responses and examination findings were recorded on the World Health Organization’s Programme for the Prevention of Blindness eye examination record for children with blindness and low vision. Results: Ninety-two students were studied. The most common etiological causes of visual loss were cataract and hereditary diseases (23.9% each) followed by glaucoma (18.5%). Other causes were abnormalities since birth of unknown etiology (9.7%); childhood factors such as measles (2.2%) and cortical blindness/idiopathic nystagmus/primary optic atrophy (7.6%); trauma (7.6%); cerebral hypoxia (2.2%); harmful traditional practices (2.2%) and intrauterine factors such as drugs and alcohol (1.1%). Avoidable causes of blindness were seen in 64.2%. Conclusion: Cataract and hereditary diseases are the main reason for enrolment into blind schools in the region. To reduce the burden of childhood blindness, there is a need for interventions targeting improved antenatal care, discouraging harmful traditional practices, training of community level health workers for eye care/case detection, low vision and pediatric ophthalmic care.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: Macula involvement in early glaucoma changes of the retina is still inconclusive. The objective of the study was to compare the precision of parameters of peripapillary retinal nerve fiber layer (pRNFL) thickness and the macula in the diagnosis of early primary open angle glaucoma (POAG). Purpose: To evaluate the pRNFL and perifoveal inner macula thicknesses in the early diagnosis of POAG using optical coherence tomography angiography (Angio-OCT). Materials and Methods: Fifty-five subjects were included in a prospective, cross-sectional study divided into three groups: early glaucoma (EG) group (46 eyes of 25 patients with early POAG), glaucoma suspects (GS) group (34 eyes of 20 subjects), and control group (20 eyes of 10 healthy subjects). The mean age of the respective groups was 65.47 ± 9.59, 56.53 ± 9.31, and 51.65 ± 4.16. All subjects underwent Angio-OCT scanning using RTVue-100 "Оptovue." The optic nerve head scan was used for the pRNFL and Retina Thickness Map 5 × 5 mm scan for perifoveal inner macula region. Parameters analyzed were total average, superior, inferior, temporal, and nasal thicknesses of both regions. Results: There was thinning in both pRNFL and perifoveal inner macula thicknesses in the EG group compared to the N group. Mann–Whitney intergroup analysis revealed statistically significant differences between the EG and the N groups in all parameters of the perifoveal inner macula thickness, while for the pRNFL thicknesses, there were differences only in total average, superior, and inferior thicknesses. The temporal and nasal perifoveal inner macula thicknesses were parameters with highest areas under the receiver operating characteristic curve (0.907 and 0.900, respectively). Conclusion: In early detection of glaucomatous optic neuropathy in POAG, parameters of perifoveal inner macula thickness are diagnostically more significant compared to pRNFL thickness using the Angio-OCT.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Procedures for surgical removal of the eye, previously termed destructive eye surgeries, include evisceration, enucleation, and orbital exenteration. The surgical removal of an eye is a difficult but occasionally inevitable decision that ophthalmologists sometimes undertake, as these procedures result in a permanent loss of vision and disfigurement. Eye removal procedures are commonly performed in Nigeria as evidenced by the number of publications from different centers in the country. The aim of this review is to evaluate the indications for these procedures, and identify any variation over time. This is aimed at providing information to the general ophthalmologists when faced with the difficult decision on surgical removal of an eye. A review of all published reports from different parts of the country on the subject was made, and the most common indication for these procedures was retinoblastoma in children, and ocular trauma in adults. Currently, evisceration procedures are more commonly performed when compared with enucleation or exenteration in many centers in Nigeria.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Cysticercosis describes human soft tissue infestation with the larval form of the pig tapeworm Taenia solium. It may affect the brain parenchyma, orbital or intraocular tissues, striated muscle, viscera, subcutaneous tissue, or skin. Clinical presentation depends on the location. We report a case of an 8-year-old boy presenting with painful proptosis and inferior globe displacement from myocysticercosis of the left superior rectus muscle. The radiological findings of a thick cyst capsule appearing as a well-defined hyperdense ring with a central hypodense core and a hyperdense focus within the core representing the scolex were classical of the disease. The patient responded well to oral antihelminthic and steroid therapy with no residual deficits. Cysticercosis is endemic in developing countries. The increased awareness of the different disease presentations will result in a high index of suspicion which is needed for early diagnosis and institution of appropriate treatment.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Endogenous endophthalmitis is a very rare but potentially devastating intraocular inflammation resulting from haematogenous spread of pathogens to the eye. We present a case of a 26-year-old male adult who had a nail puncture injury to the sole of his right foot and developed swelling of the that foot and leg associated with severe pain and fever five days later. While being managed in a private clinic as a case of cellulitis of the right leg, he developed ocular pain, redness and diminution of vision in the right eye but was attended to five days later by the ophthalmologist who made a diagnosis of endogenous presumed bacterial endophthalmitis in an already blind right eye secondary to septicaemia. With 15 days of systemic antibiotics, the ocular and systemic findings resolved. The eye became pthisical on follow-up. Endogenous endophthalmitis is associated with poor visual prognosis and early intervention is the only sure way to improve visual outcome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Bardet–Biedl syndrome (BBS) is a genetic disorder characterized by retinal dystrophy, obesity, postaxial polydactyly, renal dysfunction, learning difficulties, and hypogonadism. Retinal dystrophy in the form of rod-cone dystrophy is the most common diagnostic handle prompting investigation for BBS. We report a novel case of rod sparing or a cone-selective variant of retinopathy in BBS. To the best of our knowledge, this is the first report of such a case from India.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Purpose: To highlight the importance of measurement of central corneal thickness (CCT) which is an indirect indicator of corneal endothelial dysfunction after cataract surgery. Materials and Methods: This was a randomised control trial involving 101 patients who presented with cataract. Cataracts were graded using Lens Opacities Classification system grading. Fifty-one patients underwent small incision cataract surgery (SICS) and 50 underwent phacoemulsification (PHACO). Patients with any other ocular pathology were excluded. Results: There was significant improvement in the best corrected visual acuity (BCVA) comparable in both groups. There was a statistically significant increase in central corneal thickness on day 7th and 30th post op. The change in the CCT and BCVA was comparable between SICS and PHACO on day 30th post op. Conclusion: The increase in CCT suggests that there was some endothelial cell loss leading to change in corneal thickness but not to the extent of causing visual impairment. SICS and phacoemulsification surgery are comparable in respect to visual rehabilitation. Manual SICS is still a safe and cost-effective option in the developing world. Proper case selection, diligent surgery, and adequate postoperative care are essential to maintain a clear cornea.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Ocular biometry is essential in many clinical and research applications; for example, axial length is essential in intraocular lens power calculation prior to cataract and refractive surgeries, making diagnosis of staphyloma, etc. Various factors affect their values. We intend to study the distribution of ocular biometrics among cataract patients in our environment. Materials and Methods: This is a cross-sectional observational study. One hundred fifty-one patients with bilateral cataract scheduled for cataract surgery during the 1-year study period (July 2016–June 2017) were consecutively recruited for the study. Medical records including age and gender were collected. Ocular biometric data including axial length (AL), anterior chamber depth (ACD), cataractous lens thickness (LT), and vitreous chamber depth (VCD) values were measured for both eyes before cataract operation for either eye, using an optical biometer (ophthalmic A/B ultrasound system: CAS-2000BER, England). All the metric data were observed by the same experienced ophthalmic technician to avoid interobserver error. Result: The mean AL was 23.51 [95% confidence interval (CI), 23.33–23.64], mean ACD was 3.22 mm (95% CI, 3.12–3.30), mean LT was 4.23 mm (95% CI, 4.17–4.29), and the mean VCD was 16.06 mm (95% CI, 15.89–16.20). AL was longer among those ages less than 30 years, ACD was decreasing with increasing age, and the mean LT was higher for ages 30 years and above. The median ACD was decreasing with increasing age up to ≥50 years, whereas the median LT increased with increasing age. The male–female variation in mean AL and mean VCD were statistically significant (P < 0.001 by Mann–Whitney U test); however, the mean ACD and mean LT were not statistically significant (P = 0.110 and 0.496, respectively, by Mann–Whitney U test). The median AL was higher in males than females (24.00 vs 23.00), with an interquartile range (IQR) of 23.50 to 24.00 mm in males, and for females was 22.50 to 24.00 mm. The median ACD was a little higher in males than females (3.30 vs 3.10 mm), with IQR was 2.90 to 3.50 mm in males, and for females was 2.80 to 3.40 mm. Conclusion: Age and sex should always be considered in making inferences from biometric data in ophthalmic practice.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objective: To describe the pattern of ocular abnormalities among students attending schools for the hearing impaired in Ibadan, Oyo State, Nigeria. Materials and Methods: This was a descriptive cross-sectional study conducted from February to March 2016 among hearing-impaired students who were older than 10 years. Students were selected from four schools using systematic random sampling. The students’ sociodemographic characteristics, visual complaints, ocular, and family history were recorded using an interviewer-administered semistructured questionnaire. Ocular examination and refraction was conducted on each student. Data were analyzed using IBM-SPSS Statistics for Windows 22 (IBM Corp., Armonk, NY, USA) with the test of association performed using the chi-square test and level of statistical significance set at P-value <0.05. Results: A total of 335 students participated in the study. Mean age was 17 ± 2.9 years (range 11–39 years). The prevalence of ocular abnormalities among the participants was 56.1%. These included allergic conjunctivitis 8 (2.4%), retinitis pigmentosa 3 (0.9%), phthisis bulbi 3 (0.9%), cataract 2 (0.6%), and Wardenburg syndrome 2 (0.6%). Seventy-five (22.4%) respondents were with coexisting ocular abnormalities. Conclusion: The prevalence of ocular abnormalities was found to be high among the hearing impaired, with refractive error being the most common. It is necessary for the eye care providers and other stakeholders to provide eye health education as well as affordable and accessible eye care services for hearing-impaired students so as to improve their overall quality of life.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: External ocular photography (EOP) has become an essential tool in the day-to-day practice of ophthalmology as it entails the imaging of the external eye, ocular adnexa, face, and the anterior segment of the eye. The aim of this study was to assess the practice of EOP among ophthalmologists in Nigeria with a view to providing baseline information that will be useful in the advancement of ophthalmic practice. Materials and Methods: An online cross-sectional survey among practicing ophthalmologists in Nigeria. Information regarding reasons for external photography, type of camera, ownership of camera and barriers to external photography were obtained. The data obtained were analysed using IBM Statistical Package for the Social Sciences version 22.0 software for Windows (IBM Corp., Armonk, NY, USA). Results: A total of 183 out of 355 ophthalmologists completed the survey (51.5% response rate), with a mean age of 43.9 ± 8.1 years. Of the respondents, 84.7% use EOP in their practice with 53.6% making use of smartphones. Indications for the use of EOP were documentation (71.0%), teaching purposes (54.2%), patient’s communication (47.1%), and surgical/treatment planning (45.8%). Among the users of EOP, 87.1% obtained consent and only 5% use written informed consent. There is an association between obtaining consent and younger years in practice (P = 0.005). Conclusion: The use of EOP is high among ophthalmologists in Nigeria and with its increasing popularity comes the need for ethical and medicolegal considerations, especially in oculoplastic practices. Most importantly, whenever the effective concealment of patient’s identity and privacy cannot be guaranteed during clinical photography, the use of oral consent may be inadequate.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objective: To report the outcomes of pediatric cataract surgery over a 7-year period in a mission hospital in northern Nigeria. Patients and Methods: We retrospectively examined the notes of 230 consecutive children aged 16 years and younger, who underwent bilateral cataract surgery by a single surgeon. The patients’ demographic, preoperative, and postoperative clinical details were analyzed. Details regarding the eye with the better postop vision were used in the analysis. Results: A total of 230 patients were included, of which 148 (64.4%) were boys. Age at presentation ranged from 1 month to 16 years, with a mean of 4.89 years and standard deviation of 4.21 years. Median delay for presentation was 12 months, with an interquartile range of 4–36 months. Visual acuity at presentation in the selected operative eye was normal in 2 (0.91%) patients and blind in 179 (81.4%) patients. Best-corrected postop vision was normal in 63 (31.5%) patients, visually impaired in 62 (31.0%) patients, severely visually impaired in 23 (11.5%) patients, blind in 52 (26.0%) patients, and not recorded in 30 (13.0%) patients. A total of 114 (49.8%) patients were prescribed glasses. Median follow-up was 1 month (interquartile range 0.5–3 months). Conclusion: Although a majority of the children were blind in the operative eye prior to surgery, over a quarter achieved normal vision after surgery. Factors that may improve outcomes in this setting include prescribing glasses to all and facilitating increased follow-up.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Stevens–Johnson syndrome (SJS) is a severe blistering mucocutaneous disorder, which affects the skin and at least two mucous membranes that very often includes the eyes. The ophthalmic complications, though considered the most devastating of all the complications of the disease in survivors, are often a time the last to be attended to, with consequent life-changing sequelae. Medical therapy has been the mainstay of ophthalmic care in our locality, and these have not been shown to improve the long-term outcome of the disease. Glass rod synechiolysis, previously practiced in some centers, has been largely abandoned. Appropriate proactive interventions such as lubrication, topical antibiotics, and steroids are advocated in the acute phase. Surgical management to remove the membranes and the use of improvised symblepharon rings prevent adhesions. Amniotic membrane grafting or mucous membrane grafting for lid margin keratinization and forniceal scarring if implemented will also take advantage of a window of opportunity to ameliorate the severity of the long-term sequelae requiring more specialized and expensive interventions for vision restoration. The critical role of the ophthalmologist in the management of patients with SJS for the prevention of corneal blindness, therefore, cannot be overemphasized.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]