Objectives: To determine the human and material resources available for primary eye care delivery in Nkanu West Local Government Area (LGA), Enugu state. Materials and Methods: This was a Cross-sectional descriptive survey of the health facilities in the area. The location, and distribution of these facilities were determined using the health map of the LGA. At each centre, using a questionnaire, data on human and material resources were obtained. Statistics was performed using Chi-square test for discrete/categorical variables and student t-test for continuous variable. In all comparisons all P values < 0.05 with the associated odds ratios, at 95% confidence intervals was considered statistically significant. Results: There were 119 primary eye care workers (ECW) in Nkanu West LGA out of which 102 participated in the study giving a survey participation rate of 85.7% (102/119). The participants comprised 98 females (96.1%) and 4 males (3.9%), (M: F=1.0:25.0), with a mean age of 33.4 years. The majority of the participants (78.4%) possessed basic qualification of Community Health Extension Workers (CHEW). The health facilities were not evenly distributed in the four health districts. There are 18 PEC facilities, 15(83.3%) stocked some basic drugs used for eye care; none of the centres stocked all the basic drugs. An inventory of equipment for primary eye care delivery in the 18 centres showed that none of the centres had adequate basic equipment. None of the centres had adequate basic material resources for eye care. Conclusion: Human resources were adequate for PEC delivery in the LGA. There were inadequate material resources and uneven distribution of health facilities.

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Objective: To compare the cycloplegic effect of 1% Atropine to 1% cyclopentolate plus 1%Tropicamide (CT) combination in children. Methods: This was a cross-over interventional study among children aged 0–15 years in our eye clinic in year 2017. The children were selected using a stratified sampling method. Each child had a non-cycloplegic refraction then refraction after instillation of a drop of 1% Cyclopentolate and 1% Tropicamide 5 minutes apart in the left eye.Parents were given 1% Atropine drops to be instilled twice daily for three days in the same eye before the return visit 3 weeks after and refraction was repeated. Results: The children were aged between 4 months and 15years with a higher number of females (60.7%). The difference between the mean of the spherical equivalent of non-cycloplegic refraction and that for CT combination was statistically significant (P < 0.05) at one hour while the mean of the spherical equivalent of refraction with atropine was comparable to that with CT combination. There was no significant difference between the mean of the spherical equivalent of refraction done with an auto-refractor and that done by retinoscopy. Conclusion: African children aged 0–15 years should have cycloplegic refraction using retinoscopy or auto-refractor one hour after instilling CT combination as a substitute for 1% Atropine.

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Colobomatous cyst of the eye (microphthalmos with cyst) is a congenital abnormality that consists of a small, malformed eye with a coloboma through which a cystic herniation of glial tissue protrudes into the orbit. The precise causes of a colobomatous cyst are not known and the anomaly is usually detected at birth affecting one or both orbits. We present a 2-year-old girl with right eye swelling since birth. The swelling had been gradually increasing in size with an associated loss of vision in the eye. Examination of the right eye showed an enlarged, well-defined, oval-shaped trans-illuminating cystic mass lesion protruding out of the right orbital cavity with skin covering. Magnetic resonance imaging revealed a well-defined oval-shaped cystic mass lesion that was hypointense on T1 weighted and hyperintense on T2-weighted image protruding out of the right orbital cavity. The ipsilateral globe was microphthalmic, and was displaced, and compressed posteriorly by the cystic mass lesion. The remaining orbital structures, including the optic nerve, were also compressed and difficult to visualize. Based on the clinical and radiological features, a diagnosis of orbital colobomatous cyst was established. She had enucleation with total lesion excision for treatment. This case is reported because of its rarity and associated developmental anomalies. Its management in the African setting is challenging, but feasible with early patient presentation and improved health facilities.

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Authors present two cases of acute loss of vision following severe facial trauma with eye ball luxation. The first case presented a temporal ejected globe with section of optic nerve and all the oculomotor muscles, the second case was incomplete avulsion of the eye to the lid margin with section of the optic nerve. Management was enucleation in the first case and reduction in the second case.

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Introduction: Endophthalmitis is a dreaded complication of cataract surgery. While the management of endophthalmitis with standard antibiotic combinations often suffice, occasionally some cases are not amenable and require greater astuteness and insight in management. Cases: In the first case, a non-bacterial endophthalmitis was suspected when there was no response to standard antibiotics given twice. The patient responded dramatically to a single dose of intravitreal amphotericin B 5mcg in 0.1ml. However, no laboratory confirmation was obtained, hence diagnosis was based on trial of therapy.The second was a case of Vancomycin Resistant Enterococcus faecium Endophthalmitis (VRE Endophthalmitis). Diagnosis was made after lack of response to standard intravitreal antibiotics, Amikacin and Amphotericin B. Potassium hydroxide (KOH) preparation was suggestive of a gram-positive organism, but showed no hyphate forms. In the absence of a positive culture, a direct staining of the vitreous smear showed organisms identifiable as Enterococcus feacium. There was a regrowth of the organisms after two vitrectomies, and the organism responded to intravitreal 200 mcg/0.1ml of linezolid, one of the newer oxazo-lidinones. However, final vision was only Hand motion even though the vitreous was largely clear. Optical coherence tomography (OCT) revealed a residual central serous retinopathy which did not respond to anti-VEGF therapy. Conclusion: Endophthalmitis can be caused by organisms not sensitive to the usual antibiotics. Use can be made of the KOH test and direct smear of vitreous aspirate to assist with diagnosis. Linezolid is effective against Vancomycin Resistant Enterococci but may be associated with central serous retinopathy.

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Herpes zoster ophthalmicus (HZO) is known to cause a variety of ophthalmic manifestations, of which cranial nerve palsies are rare. They are transient, self-resolving and late complications of the disease in the elderly. A 70 year old female with zosteriform rash on right hemi-face presented with headache and ocular complications of HZO. On examination, limited abduction of right eye, mild ptosis and anisocoria were noted. A diagnosis of HZO complicated by multiple cranial nerve involvement and post-herpetic neuralgia was made and managed with favorable outcome. This case highlights the importance of HZO as a cause of cranial nerve palsies in the elderly and a high index of suspicion is required for its management and long-term follow-up.

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Context: The clinical profile of optic neuritis varies in different communities; however, data in Nigerians is scarce. Aim: To describe the clinical profile of optic neuritis in Nigerians presenting at the eye clinic of the University of Benin Teaching Hospital. Study Setting and Design: A hospital-based retrospective study. Patients and Methods: The records of patients presenting with optic neuritis from January 2009 to December 2019 were retrieved. Information on demographics, clinical presentation and management was obtained. Data collected were analyzed with the IBM SPSS Statistics for Windows Version 21. Descriptive analyses such as frequencies, median and interquartile range were utilized. Fishers’ Exact test was used to test for association between categorical variables. A P-value of <0.05 was taken as statistically significant. Result: Thirty-four patients with optic neuritis were seen among a total of 25,224 new patients giving a proportion of 0.13%. Of the 34 patients with optic neuritis, 10 were males (male to female ratio of 1:2.4). Their ages were from 3 years to 69 years (median age 31.5 years and interquartile range 26). There was unilateral involvement in 23 (67.6%) and ocular pain in 11 (32.4%) patients. Visual acuity of 6/60 or worse at presentation was seen in 33 (73.3%) eyes. Papillitis was seen in 18 (52.9%), retrobulbar neuritis 12 (35.3%) and neuroretinitis 4 (11.8%) patients. Neurologic examination was normal at presentation in all the patients. Conclusion: This study showed that optic neuritis affected more females, was more unilateral, and there was a low incidence of ocular pain. Also, optic disc swelling was a more frequent feature, and there was no association with multiple sclerosis or other etiology at first presentation.

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Objective: To evaluate the outcomes of cataract surgery following glaucoma filtering surgeries carried out at the University College Hospital, Ibadan. Methods: This study was a retrospective review of the records of patients who had cataract surgery following glaucoma filtering surgery. Outcomes of interest include change in visual acuity with cataract surgery following glaucoma filtering surgery, time from glaucoma filtering surgery to cataract surgery, change in intraocular pressure control with cataract surgery and glaucoma filtering surgery complications. Paired t-test and Chi-squared tests were carried out for differences in means and categorical data respectively. Results: Thirty-one eyes of 27 patients were evaluated. Mean (SD) age was 56.7 years (15.4). Sixteen (59.3%) patients were males. The median time from glaucoma surgery to cataract surgery was 21 months (6-180 months). The number of eyes with visual acuity > 6/18 increased from four (13%) pre-operatively to 19 (61.3%) post-cataract surgery. There was no statistically significant difference (P = 0.295) between mean intraocular pressure before surgery (15 mmHg, SD = 5.5) and at last follow-up visit (16.6 mmHg, SD = 7.4). Conclusion: Outcomes of cataract surgery following glaucoma filtering surgery can be optimized with careful patient selection and meticulous perioperative care.

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Context: Retinopathy of prematurity (ROP) is an important cause of blindness in children worldwide. It affects premature children especially when there is sub-optimal neonatal care and no screening and treatment program in place. Nigeria has the third highest number of premature births in the world, but no national program for ROP screening. Aim: To explore the coverage and challenges affecting ROP screening including the perspectives of ophthalmologists and paediatricians. Methods and Material: Mixed methods were used to obtain information in two phases. In the first phase, a Google form was designed and sent to paediatricians and ophthalmologists in Nigeria to find out the coverage of ROP screening and treatment. The second phase involved visiting some large centres to administer a semi-structured questionnaire with some qualitative questions. Statistical Analysis Used: The quantitative responses from the structured questionnaire were also inputted into the excel sheet and presented with charts and maps. Themes in the transcripts were analyzed manually by thematic analysis using deductive reasoning. Results: A total of fifty-nine multispecialty tertiary hospitals were identified. Responses were received from 40 (68%) of them. Forty percent of the centres that responded were doing ROP screening. The challenges include inadequate human and material resources, difficulties with coordination of program and follow up of patients, high work-load in the paediatric eye units for few available specialists, financial constraints on hospital managements and on patients and poor collaboration between ophthalmic and neonatal units. Conclusions: ROP screening/treatment coverage is poor in Nigeria, and is bedeviled by inadequate human and financial resources. More data from screening centres is needed for advocacy to governmental and non-governmental agencies in order to expand ROP screening coverage, and design a program for sustainable and efficient ROP screening in Nigeria.

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