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REVIEW ARTICLE
Subgaleal haematoma extending into the orbit following blunt head trauma as a cause of permanent blindness: A case illustrated review
Amos O Adeleye
January-June 2017, 25(1):1-5
DOI:10.4103/0189-9171.207372  
Concurrent occurrence of subgaleal haematoma (SGH) and orbital subperiosteal haematoma (OSPH) is an unusual post-traumatic phenomenon. It is especially seen in cases of massive SGH. This report is a review, illustrated with a personal clinical experience, of this clinical disease association. Extensive literature review using the PubMed search engine for all cases of blindness from SGH and OSPH in the English language was conducted for this report. Vision-threatening complications of massive traumatic SGH that is associated with OSPH are rare but well described. The resulting orbital bleed most commonly involves the extraconal orbital roof. It is essentially an orbital epidural haematoma. Its aetiopathogenesis is that of an orbital space occupying lesion (SOL) causing clinical evidence of raised intraorbital pressure (IOP) including chemosis, proptosis, ophthalmoplegia, exposure keratopathy and orbital cellulitis and blindness. The visual impairment is usually temporary and responds well to prompt intraorbital decompression. However, permanent blindness ensues if suboptimal treatment including missed diagnosis and or delayed treatment is offered.
  15,855 568 2
ORIGINAL ARTICLES
PTERYGIUM: Recent trends and perspectives—A review of pathogenesis and current management options
Helen A Ginger-Eke, Chimdia E Ogbonnaya, Chinyelu N Ezisi
July-December 2018, 26(2):89-98
DOI:10.4103/njo.njo_5_18  
Objectives: (1) To review literature on the current understanding of the nature and pathogenesis of pterygium. (2) To highlight the recent advances in the treatment of pterygium. Materials and Methods: Relevant subheadings were entered into PubMed search engine and 165 articles addressing our objectives were retrieved and reviewed. Results: Pterygium may be proliferative rather than degenerative in nature. There is a strong correlation with ultraviolet radiation. Genetic alterations occur, such as point mutations of proto-oncogenesis such as Kirsten-Ras and alterations in the expression of tumor suppressor genes (TSGs) (p53 or p63), alteration of matrix metalloproteinase in limbal and corneal tissues, ultraviolet radiation (UVR) genetically mediated expression of various cytokines, growth factors, and growth factor receptors. Oxidative stress may play a role, evidenced by the expression of certain proteins in pterygium tissues presumed to have a protective role against oxidative stress-induced apoptosis. High prevalence of human papilloma viruses (HPVs) in pterygium tissue samples suggests a possible role for HPV. Several techniques of surgery have evolved over time including the modified bare-sclera techniques, sliding, “merest sclera,” adjunctive therapies with mitomycin C, 5-fluorouracil, corticosteroids, conjunctival autograft, limbal autograft, amniotic membrane graft, use of fibrin glue, and subconjuctival injection of bevacizumab. Conclusion: Advances in the understanding of pterygium have led to emerging treatment options that may not only reduce recurrent rates, but may also enable the use of less invasive treatment methods. Recommendation: Ophthalmologists working in hot climates should update their knowledge on the current concepts in the pathogenesis and management of pterygium to obtain better results.
  10,264 1,210 3
REVIEW ARTICLES
Microbial keratitis—A review of epidemiology, pathogenesis, ocular manifestations, and management
Chinyelu N Ezisi, Chimdia E Ogbonnaya, Obiekwe Okoye, Edak Ezeanosike, Helen Ginger-Eke, Obinna C Arinze
January-June 2018, 26(1):13-23
DOI:10.4103/njo.njo_2_18  
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.
  10,183 1,099 3
REVIEW ARTICLE
Spectacles in children- Do's and don'ts
Reena Sharma, Vaibhav Jain, Meenu Babber, Anupama Tandon
July-December 2015, 23(2):31-34
DOI:10.4103/0189-9171.170958  
Purpose: To assess the best method to prescribe spectacles in children. Source of Data: References have been collected from a MEDLINE search from 1975 to 2014. Older articles deemed not to be very contributory and those with foreign languages without any translation were omitted. The search was done using the words - spectacles, children, glasses, and prescription. Study Selection: To help and decide a proper prescription of glasses in children. Data Extraction: Internet for indexed PubMed articles. Conclusions: Children have visual needs that differ from adults, and therefore, the prescription of glasses has to be given with utmost care. They are interested in their near world and the eyes are going through a process of emmetropization. A cycloplegic refraction cannot be avoided. Many guidelines have been given based on the experience of pediatric ophthalmologists/optometrists. The basic principles, however, remain the same and should be adhered to the treatment of myopia, hypermetropia, astigmatism, and anisometropia. It is equally important to look at the spectacle frame and lenses to ensure that the prescription is used by the child.
  10,375 892 -
ORIGINAL ARTICLES
Reliability and utility of impression cytology in the diagnosis of dry eye
Fahad Abdullah Al Wadani, Rajshree Nambiar, Khalid M Abdul Wahhab, Tariq Al Asbali, Ajit Nambiar, Ata Ur Rahaman
July-December 2016, 24(2):51-56
DOI:10.4103/0189-9171.195194  
Introduction: Dry eye disease is a multifactorial disease of the tears and ocular surface that can result in ocular discomfort and visual impairment. There are numerous tests to evaluate the ocular status in dry eye disease. Among the different tests for diagnosing dry eyes, Impression Cytology is considered a practical and minimally invasive investigation. Objective: The aim of this study was to characterize ocular surface symptoms typical of dry eyes, study pattern of dry eye in various systemic diseases, assess whether impression cytology samples could be used to define conjunctival surface changes and describe changes in conjunctival cells. We also aimed to compare the sensitivity of impression cytology with other diagnostic tests. Methods: A cross sectional study was conducted among 100 patients with symptoms of dry eye. After eliciting a complete history which included any systemic disease, occupation and drug intake these patients were subjected to various tests like Schirmers test, Tear Break Up Time (TBUT), Lissamine green staining and Conjunctival impression cytology. Results: All clinical tests have limited diagnostic value if performed individually, but impression cytology showed the highest sensitivity. Conclusion: It is recommended that impression cytology is an ideal method of investigating ocular surface disorders when diagnosis is not clinically obvious or when clinical diagnosis needs substantiation. It is recommended that major ophthalmic centers should develop and introduce this technique into routine clinical practice.
  5,467 3,673 -
Long-term evaluation of laser retinopexy in retinal breaks: A review and the importance of lifetime follow-up
Gonen Baser, Murat Uyar, Aziz Serkan Topaloglu, Emine Seker Un, Sevim Yaman Yildirim, Sinan Bilgin
January-June 2014, 22(1):30-33
DOI:10.4103/0189-9171.142753  
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.
  8,348 420 2
Ocular axial length measurement among normal adults using magnetic resonance imaging
Joshua O Aiyekomogbon, Abdulkadir L Rafindadi
January-June 2017, 25(1):6-10
DOI:10.4103/0189-9171.207373  
Background/Introduction: Macrophthalmia and microphthalmia are cardinal signs of many orbito-ocular and systemic diseases which are seen in northern Nigeria. Some cases of refractive error may also be directly related to the ocular axial length (AL). The need for an imaging parameter that will aid their early diagnosis is necessary, as visual compromise is a major consequence if they are not diagnosed and managed appropriately. Aim and Objectives: To use magnetic resonance imaging, to determine the normal AL of the eyeball and to establish the association, if any, between AL and inter-zygomatic line (IZL), age and sex. Materials and Methods: The study was conducted over a 6-month period (29th November 2011 to 28th May 2012) at the Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria. The anterio-posterior dimension of the globes (AL) and the length of IZL were measured at the level of the lens for 340 normal ocular globes of 170 patients on T1-weighted MR images. Results: The normal ranges for ocular measurements were as follows (mean ± SD): AL of the right globe, 23.32 ± 1.34 mm (range 22.0–24.7) and AL of the left globe, 23.29 ± 1.22 mm (range 22.10–24.51). The length of the IZL was 103 ± 4.78 mm (range 98.2–107.78). All measurements in male patients were significantly higher than those in female patients (P < 0.001). Conclusion: The results obtained from this study may help ophthalmologists, radiologists and other clinicians to quantitatively evaluate patients with macrophthalmia, microphthalmia and/or refractive errors.
  6,935 595 -
The knowledge, perception, and attitude of patients living with glaucoma and attending the eye clinic of a secondary health care facility in South-East, Nigeria
Eberechukwu Ogbeanu Achigbu, Chimdi Memnofu Chuka-Okosa, Kingsley Ihedioha Achigbu
January-June 2015, 23(1):1-6
DOI:10.4103/0189-9171.164498  
Background: In the developing countries, most patients present with advanced disease or glaucoma blindness. This has been attributed to lack of awareness and poor knowledge as major contributing factors. The outcome of glaucoma management, however, depends largely on the understanding and perception of the illness by the patients. Objectives: This study aims to determine the knowledge, perception, and attitude of patients living with glaucoma and attending the Eye Clinic of the Imo State Specialist Hospital Owerri Imo State, Nigeria. The information obtained can be utilized by the health authorities in planning eye health education programs. Subjects and Methods: This was a cross-sectional study involving all previously diagnosed glaucoma patients attending the eye clinic of the hospital during the study period. Data were collected on knowledge, perception, and social disclosure attitude of the subjects using a structured questionnaire. Results: Twenty-nine males and 25 females participated in this study. The majority (42.6%) had only primary school education with petty trading accounting for 38.9% of the different occupations. The mean age at presentation was 60.9 years. The majority (88.8%) identified their eye problem as glaucoma, 46.3% knew it caused a progressive, irreversible loss of vision, and most (68.5%) did not know glaucoma to be familial. Approximately 67% of the subjects rated their management as satisfactory, 37% considered the drugs expensive, 70% and 13%, respectively had no, and negative perception of glaucoma surgery while 87.0% had a poor disclosure attitude. Conclusion: The subjects had a good knowledge of their diagnosis but a poor knowledge of the disease process. There was also an appreciable poor disclosure attitude and a negative perception of glaucoma surgery. Education and interaction with eye care personnel and other glaucoma patients using focal groups may bring about the desired change.
  6,279 604 2
Prevalence and pattern of strabismus in primary school pupils in benin city, Nigeria
Benedicta Aghogho Akpe, Oseluese Anastatsia Dawodu, Ebele Gloria Abadom
January-June 2014, 22(1):38-43
DOI:10.4103/0189-9171.142755  
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.
  6,037 559 7
REVIEW ARTICLE
Wound geometry as it relates to tunnel valvular competence in manual small incision cataract surgery
Megbelayin Emmanuel Olu
January-June 2014, 22(1):1-6
DOI:10.4103/0189-9171.142743  
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.
  5,877 529 -
Ethical Dilemmas in Contemporary Ophthalmic Practice in Nigeria
Emmanuel Olu Megbelayin
July-December 2014, 22(2):59-65
DOI:10.4103/0189-9171.154609  
Background: Ethics, as a branch of both philosophy and theology, is a systematic study of what is right and wrong with respect to conduct and character. As an intellectual discipline, ethics seeks to provide good reasons for our moral choices. Aim: The aim was to discuss common plausible clinical scenarios that pose ethical questions in typical ophthalmic set-ups in Nigeria and suggest modalities of resolving them. Methods: Involved extensive literature search on ethics and medical jurisprudence. Result: There is hardly an area in medicine that does not have an ethical aspect. For example, there are ethical issues relating to abortion, organ donations, birth control, euthanasia, etc., Ethics in Ophthalmology have not been the focus of scholarly articles particularly in our African environment. Yet there is increasing consciousness of patients' right to self-determination that cuts across all areas of human endeavors. Conclusion: Ethics, and not the law, establishes the ultimate standard for evaluating conduct. Still, there is a moral obligation to obey the law, and thus ethical analyses need to take into account the relevant statutes and court decisions.
  5,806 421 -
ORIGINAL ARTICLES
The impact of cataract surgery on subjective visual functions and quality of life in patients with cataract in Northwestern Nigeria
Sadiq M Abdullahi, Mahmoud B Alhassan, Olufemi E Babalola
July-December 2016, 24(2):57-61
DOI:10.4103/0189-9171.195195  
Purpose: To determine the impact of cataract surgery on visual functions (VFs) and quality of life (QoL) in patients with cataract at the National Eye Center, Kaduna. Methods: VFs and QoL questionnaires were administered to the patients preoperatively and 6 weeks postoperatively. Correlation was assessed among subjective VF, QoL, and visual acuity (VA). The preoperative and sixth-week postoperative VA, VF scores, and QoL scores were compared. A paired t-test was used for comparison between before and after surgery. Results: Two hundred and seventy-one patients were studied. The age range of the patients was 45 to 85 years with a mean age of 64.2 years (SD ± 6.51). There was significant improvement in overall VF and QoL following cataract surgery (P < 0.0001). Mean VF scores preoperatively and at 6 weeks postoperatively were 28.6 (SD ± 7.9) and 15.1 (SD ± 3.5), respectively. The overall mean QoL scores were 23.7 (SD ± 9.0.) preoperatively and 13.5 (SD ± 1.1) postoperatively. This difference was statistically significant P < 0.0001. Bilateral cataract surgery patients had greater gain in VF and QoL than those that had uniocular surgery. Conclusion: This study demonstrated that cataract surgery is effective in improving overall VF and vision-related QoL, which resulted in functional independence. The second eye surgery confers additional gains in terms of VF and QoL in patients with bilateral cataract.
  4,487 1,688 1
Spectrum of glaucoma presentation in a Nigerian tertiary hospital
Olusola Olawoye, Sarimiye Tarella
January-June 2014, 22(1):11-15
DOI:10.4103/0189-9171.142747  
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.
  5,389 585 4
REVIEW ARTICLE
Comprehensive management of pediatric cataract in Africa
Adedayo Omobolanle Adio, Henrietta Nwachukwu
January-June 2016, 24(1):1-11
DOI:10.4103/0189-9171.179918  
Worldwide, childhood blindness is 0.75/1000 children giving an estimated number of 1.4 million suffering from blindness worldwide. Of the blind children worldwide, congenital cataract is the major cause in African countries. The management of cataract in children poses a challenge to the African ophthalmologist, and the earlier in life cataract develops, the more difficult it is to manage. A description of the common causes, clinical presentation, methods of modern surgical removal, and suggested typical postoperative management of this condition is given along with common complications and challenges that may be encountered.
  5,340 602 -
ORIGINAL ARTICLES
Retinoblastoma in Onitsha, Nigeria
Sebastian N N Nwosu, Nonso E Okpala, Chinasa A Nnubia, Cyriacus U Akudinobi
January-June 2019, 27(1):8-11
DOI:10.4103/njo.njo_20_18  
Objectives: This study aims to determine the incidence, pattern, and problems of management of retinoblastoma at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Case files of all patients with histology-proven retinoblastoma between October 2012 and September 2017 were reviewed. Information obtained included age, sex, disease duration, presenting features, and treatment. Results: There were 31 patients, 14 males (45.2%) and 17 females (54.8%), who had the disease in 38 eyes; age range was 5 months to 6 years; and median was 2.4 years. Disease duration was 3 weeks to 3 years and median was 8.8 months. Seven patients (22.6%) had bilateral disease, 11 (35.5%) had the disease only in the right eye, whereas 13 (41.9%) had the disease in the left eye; 32 (84.2%) eyes had no visual potential at presentation. The most common clinical features were leukocoria in 23 (60.5%) eyes and proptosis in 20 (52.6%). While all patients with advanced disease had enucleation or modified exenteration, only 15 (48.4%) accepted chemotherapy with two completing the full course and five not returning after the first course. Five (16.1%) had distant metastasis, namely, brain 2 (6.5%) and orbit, jaw, and skull 1 (3.2%) each. Conclusions: Retinoblastoma is seen at the Guinness Eye Center at the rate of about one case in 2 months. Most patients present late with proptosis and, in some cases, fungating necrotic tumor mass with distant metastases. There is a high default rate with treatment as only two patients completed the full course of chemotherapy.
  5,432 461 -
Types of glaucoma in a University Health Centre in Al-Ahsa, Saudi Arabia: A pilot study
Abdullatif Sami Al Rashed, Hamad Abdulaziz Al Subaie, Hisham Sameer Al Hathloul, Khalid Abdullah Al Shehab, Mansour Abdullah Al Naim, Kaberi Feroze Kaliyadan, Ansari Mukhtar Aleem
January-June 2015, 23(1):12-15
DOI:10.4103/0189-9171.164495  
Objective: The objective was to assess the profile of different types of glaucoma in a University Health Centre in Al-Ahsa, Saudi Arabia. Materials and Methods: It is a retrospective study in which the files of the patients at King Faisal University Health Centre were reviewed. The data collected included: Age, sex, race, visual acuity, the slit lamp examination findings, the intraocular pressure (IOP) as the average of 3 readings, the cup-to-disc ratio (CDR), the visual field changes, and the details of treatment received. Results: Eighty glaucomatous eyes from 50 patients were included in the study. The mean age was 54.8 ± 12.7 years, and the mean IOP was 19 ± 3.9 mmHg that ranged from 11 to 28 mmHg. The mean CDR mean was 0.48 ± 0.16 that ranged between 0.3 and 0.9. Ninety-one percent of the visual field defects were arcuate scotomata. Primary open-angle glaucoma (POAG) (60%) was the most predominant type of glaucoma, followed by primary angle closure glaucoma (ACG) (21.3%), secondary OAG (7.5%), and secondary ACG (6.3%). As for the anti-glaucoma medications, 88% of the studied patients were on more than one medicine. Conclusion: This pilot study has demonstrated that POAG may be the predominant type of glaucoma in Al-Ahsa, Kingdom of Saudi Arabia (KSA). A population-based study with a larger sample size is warranted to confirm the outcome and to provide a baseline data on the prevalence of types of glaucoma in this region of KSA.
  5,390 378 -
Comparison of endothelial cell loss by specular microscopy between phacoemulsification and manual small-incision cataract surgery
Somil N Jagani, Abhay A Lune, Renu M Magdum, Akash P Shah, Manisha Singh, Debapriya Datta
July-December 2015, 23(2):54-59
DOI:10.4103/0189-9171.170991  
Aim: To compare the endothelial cell loss between phacoemulsification and manual small-incision cataract surgery (SICS). Endothelial cell loss was also compared in phacoemulsification group by temporal clear corneal incision (CCI) and by superior scleral incision (SI) technique. Materials and Methods: A total of 200 eyes of 200 patients were included in the study. Cases were randomly divided into two equal groups. Group A had undergone phacoemulsification and Group B had under gone manual SICS. In Group A 50 cases were performed by temporal CCI and remaining 50 cases were performed by superior SI technique. Endothelial cell count was evaluated by using a noncontact specular microscope. Results: Mean endothelial cell loss (cells/mm 2 ) in Group A was 307.80 (12.33%), 397.79 (15.93%), and 421.69 (16.89%) on 1 week, 6 week, and 3 month postoperative period, respectively. In Group B, it was 270.86 (10.63%), 385.22 (15.12%), and 413.68 (16.24%) on 1 week, 6 week, and 3 month postoperative period, respectively. There was no clinical and statistically significant difference (P > 0.05) between the two groups. The mean endothelial cell loss in Group A by CCI was 340.68 (13.61%), 427.80 (17.08%), and 448.70 (17.92%) and by SI was 274.92 (11.05%), 367.78 (14.78%), and 394.68 (15.83%) on 1 week, 6 week, and 3 month postoperative period respectively. There was statistically significant difference in endothelial cell loss at 1 week (P < 0.05) but it was not statistically significant on 6 week and 3 month postoperatively (P > 0.05). Conclusion: There was no clinically or statistically significant difference in endothelial cell loss or visual acuity between phacoemulsification and manual SICS at 3 month postoperative period.
  5,232 534 3
REVIEW ARTICLES
Current trends in the management of Stevens–Johnson syndrome: A call for a paradigm shift in ophthalmic care in Nigeria
Ezeanosike Edak, Ezeanosike Obumneme Benaiah
January-June 2018, 26(1):1-7
DOI:10.4103/njo.njo_11_17  
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.
  5,234 446 -
CASE REPORTS
Management of bilateral orbital cellulitis in a 41-year-old man
Kator Chaha, Dominic Chinda, Sunday Olusegun Ajike
January-June 2014, 22(1):50-55
DOI:10.4103/0189-9171.142758  
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.
  5,087 404 1
An unusual case of unilateral multifocal choroiditis in a young male
Shrikant Deshpande, Meghana Deshpande, Prajakta Paritekar
July-December 2015, 23(2):71-74
DOI:10.4103/0189-9171.171002  
Multifocal choroiditis is a vision-threatening disease causing inflammation at the level of retinal pigment epithelium and outer retina. We present a unique case of unilateral multifocal choroiditis in a young nonmyopic male and its subsequent course. The patient developed visual loss due to the sub-retinal neovascular membrane (SRNVM) in macula due to multifocal choroiditis. The SRNVM regressed with repeated intra-vitreal injection of bevacizumab and the visual acuity improved from 6/24 at presentation to 6/12 after repeated intra-vitreal injections of bevacizumab.
  4,957 312 1
ORIGINAL ARTICLES
Pattern of refractive errors among ophthalmic outpatients of University of Uyo Teaching Hospital, Uyo, Nigeria
Emem Godwin Abraham, Emmanuel Olu Megbelayin
July-December 2015, 23(2):39-43
DOI:10.4103/0189-9171.170965  
Introduction: Uncorrected refractive error (RE) is the most common cause of visual impairment (VI) in the world. It has significant effects on individuals and community, restricting some educational and occupational employment opportunities of the otherwise healthy individual. A significant percentage of the world population is visually impaired/blind from uncorrected RE. Aim: To determine the pattern of REs in ophthalmic outpatients in a teaching hospital. Materials and Methods: Records of consecutive patients attending a tertiary eye facility who were diagnosed with RE and/or presbyopia from January 2010 to December 2011 were retrieved. Data were analyzed using Statistical Package for the Social Sciences 20.0. Result: Presbyopia coexisting with other forms of RE 273 (40.4%) and presbyopia only was seen in 215 (31.8%). Myopia only was seen in 77 (11.4%), astigmatism only in 18 (2.7%), and hyperopia only in 13 (1.9%). Conclusion: In line with the objectives of VISION 2020, the data presented in this study will help in planning result-oriented intervention programs in the state.
  4,616 441 1
CASE REPORTS
Bilateral orbital cellulitis: A case report and management challenges
Eberechukwu O Achigbu, Kingsley I Achigbu
January-June 2017, 25(1):52-55
DOI:10.4103/0189-9171.207374  
To report a case of bilateral orbital cellulitis in a conscious 11-year-old Nigerian girl and the management challenges. Bilateral orbital cellulitis secondary to rhinosinusitis is uncommon but has been reported in the literature in other countries where the diagnosis was made with the aid of necessary tools such as the computerized tomography scan among others. In this case, the challenge associated with the management of the index child is a reflection of the difficulties encountered in the treatment of patients in the developing countries and the importance of a good clinical judgment, early diagnosis, and prompt intervention in the management of bilateral orbital cellulitis. This is a case report of an 11-year-old Nigerian girl of the Igbo tribe. She presented with painful progressive protrusion of the eyeballs and swelling of the lids of 3 days duration. The left eyeball protruded 2 days after the right with no associated history of altered sensorium. A working diagnosis of bilateral orbital cellulitis secondary to rhinosinusitis was made. She was placed on parenteral and topical antibiotics until she recovered. Bilateral orbital cellulitis occurring in a conscious child is uncommon. Prompt and specific treatment should be started empirically, especially in developing countries where the facilities for investigation may not be available or the patients may be financially handicapped. This is particularly important to prevent the possible loss of vision and severe life-threatening complications. This study will be of interest particularly to the ophthalmologists, the otorhinolaryngologists, and the pediatricians.
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ORIGINAL ARTICLES
Impact of congenital color vision defect on color-related tasks among secondary school students in Ibadan, Southwest Nigeria
Mary Ogbenyi Ugalahi, Oluyemi Fasina, Olufunmilola A Ogun
January-June 2016, 24(1):20-24
DOI:10.4103/0189-9171.179914  
Aim: To assess the difficulties encountered by students with congenital color vision defects in daily living and school activities. Methods: A cross-sectional descriptive study conducted among students of public secondary schools in Ibadan, Nigeria. Structured questionnaires were administered to all consenting students to determine difficulties encountered in aspects of color matching and color recognition. Results: A total of 1635 students (male:female 1:1.1) were screened of whom 37 (2.3%) had congenital color vision defect. A statistically significant proportion (P < 0.0001) of them reported difficulties with color-related school work and day-to-day activities. Conclusion: Congenital color vision deficient students encounter some difficulty with school work and daily living activities, hence a need to identify them early and give appropriate career guidance.
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Ocular problems among public service retirees in a Southern Nigerian Metropolitan City
Ireju O Chukwuka, Chinyere N Pedro-Egbe, Alfred A Onua
January-June 2016, 24(1):16-19
DOI:10.4103/0189-9171.179916  
Background: Advancing age is a recognized risk factor for blindness and visual impairment worldwide. More than 82% of all blind people are 50 years or older. This therefore places a huge public health and socioeconomic burden on the populace, often leading to social dependence. Aim: To determine the pattern, profile, and risk factors of eye diseases among retired public servants in Port Harcourt City, Nigeria. Materials and Methods: Participants were retired public servants who consented to ocular examinations at their pension pay points in Port Harcourt during the 2012 World Sight Day. Visual acuity, ocular examinations including fundoscopy and intraocular pressure measurements were recorded and subsequently analyzed using Statistical Package for Social Sciences version 20. Results: Five hundred and ninety-two persons were studied; 455 males and 137 females (F: M = 1:3.3). The Mean age was 68.7 ± 7.6 years (range: 56–97 years). Using World Health Organization/International Agency for Prevention of Blindness criteria for visual assessment 239 (40.4%) had good vision, 203 (34.3%) had moderate visual impairment, 48 (8.1%) had severe visual impairment, while 102 subjects (17.2%) were blind. Cataract was the leading cause of blindness 56 (54.9%), followed by glaucoma 18 (17.7%), uncorrected refractive error 19 (18.6%), and diabetic retinopathy 9 (8.8%).Conclusion: Visual impairment and blindness are common causes of ocular morbidity among retirees of public service in Port Harcourt. It is therefore advocated that special eye health care intervention by governments and nongovernmental agencies be extended to these groups of people.
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REVIEW ARTICLES
Should glaucoma be publicly funded in arguments for funding glaucoma treatment?
Abdulkabir A Ayanniyi
July-December 2017, 25(2):59-66
DOI:10.4103/njo.njo_4_17  
Glaucoma adversely affects the visual function, impacting negatively on the individual with glaucoma (IWG)’s flourishing life. This work argues for the public funding of glaucoma. The arguments consider the plausible glaucoma’s harm to the IWG through impaired visual function, especially its adverse effects on their daily activities, health, education, work, economy and overall harm to Nigerian nation.
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