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   2018| July-December  | Volume 26 | Issue 2  
    Online since February 13, 2019

 
 
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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.
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Knowledge, beliefs, and practices regarding diabetic eye disease among patients with diabetes at the lions diabetic centre, university of calabar teaching hospital, Nigeria
Bassey A Etim, Dennis G Nkanga, Chineze T Agweye, Ofem E Enang, Affiong A Ibanga, Martha-Mary E Udoh, Utam A Utam
July-December 2018, 26(2):99-103
DOI:10.4103/njo.njo_12_18  
Objective: To assess the knowledge, beliefs, and practices among participants with diabetes mellitus (DM) receiving care at a tertiary government hospital in Calabar, Nigeria, on DM and diabetic eye disease. Materials and Methods: A hospital-based, cross-sectional study where serial recruitment of consenting participants was performed. Ethical approval was obtained from the hospitals’ ethics committee. Data were obtained using a structured interviewer-administered questionnaire. Data were collated and analyzed using the SPSS for Windows (version 20; SPSS Inc., Chicago, Illinois, USA). Categorical variables were presented as frequencies and continuous variables as means. Results: Of the 123 study participants, majority 87 (70.7%) were females and 36 (29.3%) were males. Forty-three (35%) had a duration of DM greater than 10 years. A total of 54 (44%) had good knowledge of DM. One hundred and six (86.2%) had the knowledge that regular eye checkups for a diabetic person was important, and 92 (69.9%) knew that DM could affect vision, whereas 84 (68.3%) believed that DM frequently affects vision. Eye-health-seeking behavior was good in 83 (67.5%) of participants, and an ophthalmologist was the medical personnel sought for by most participants. Conclusion: The knowledge of diabetic eye disease as a potential cause of vision loss among study participants was good. However, the knowledge on DM was poor in majority of study participants. The beliefs and practice toward eye-health were also good. Sustained health education including eye health education will most likely improve the knowledge base of DM and encourage early presentation for eye evaluation in patients with DM.
  3,575 381 2
Macular changes in diabetic patients using optical coherence tomography and fundus photography
Ifsa Sami, Reena Sharma, Namita Sharma, Brahma Deo Sharma, Brijesh Singh
July-December 2018, 26(2):111-117
DOI:10.4103/njo.njo_1_18  
Aim: To identify and compare macular changes in patients with diabetic mellitus (DM) using optical coherence tomography (OCT) and fundus photography (FP). Setting and Design: This prospective comparative study was conducted at a tertiary care center. Materials and Methods: We examined 200 eyes of 107 diabetic patients with slit-lamp biomicroscopy, color FP using TOPCON fundus camera, and cirrus OCT. Fasting blood sugar (FBS), postprandial blood sugar (PPBS), and hemoglobin A1c (HbA1c) were measured. The clinical diabetic retinopathy (DR) and OCT findings were compared. Statistical Analysis: SPSS version 20, using Pearson’s Chi-square test, Student’s t-test, and analysis of variance. Results: Mean age of patients was 53.59 ± 10.8 years, with 68.2% males. Only six (5.5%) patients had type 1 DM. Mean FBS, PPBS, and HbA1c were 137.08 ± 34.4 mg/dL, 218.13 ± 70.5 mg/dL, and 6.65% ± 2.8%, respectively. The mean HbA1c of patients with OCT changes (7.08% ± 2.9%) was higher than those with normal OCT (5.52 ± 2.18) (P value < 0.001, t statistic—0.001). The retinopathy was found in 55 eyes (27.50%) on OCT and 74 (37%) eyes on FP. Of 126 eyes with normal fundus, 75 eyes (59.52%) had OCT changes. The mean central foveal, parafoveal, and perifoveal macular thickness in OCT were 260.95 ± 65.16, 322.78 ± 47.96, 281.73 ± 36.77 μm, respectively. The eyes with retinopathy had increased foveal (P < 0.001) and peripheral (parafoveal and perifoveal) thicknesses (P < 0.001). Conclusion: The OCT showed changes in the absence of clinical retinopathy in 59.2% eyes (P value < 0.001), indicating a role in detecting subclinical retinopathy. The eyes with clinical retinopathy however had a thicker fovea, implicating a more severe disease and retinopathy. Higher HbA1c values were associated with higher chances of OCT changes.
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Sonographic evaluation of lens thickness in diabetes mellitus in a Nigerian tertiary hospital
Anthony A Thomas, Olugbemiga O Ayoola, Rosemary Ikem, Toyin H Onakpoya, Ayokunle S Dada, Temitope Bello
July-December 2018, 26(2):104-110
DOI:10.4103/njo.njo_8_18  
Objectives: To noninvasively evaluate the lens thickness in type 2 diabetic patients using ultrasound, and to correlate age, disease duration, fasting blood sugar (FBS), and proteinuria with lens thickness. Materials and Methods: The study was performed in Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, a secondary and tertiary referral center. The study population consisted of 100 type 2 diabetic patients with age and sex-matched controls. Antero-posterior lens thickness, age, duration of diabetes, FBS, and proteinuria were assessed. Results: The lens was thicker in the diabetic group than in the controls (3.76 ± 0.45 versus 3.56 ± 0.34 mm; P = 0.001). There was a positive correlation between patient’s age and lens thickness (r = 0.533, P = 0.001 for the controls; and r = 0.335, P = 0.001 for diabetics). There were no significant correlations between lens thickness with duration of diabetes, proteinuria, or FBS. Conclusion: The lenses of type 2 diabetes were thicker than those of the control patients.
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The relationship between vertical cup–disc ratio and body mass index in a population of adult Saudi females
Fahad Al Wadani, Kaberi B.K Feroze, Reem Al Yahya
July-December 2018, 26(2):121-127
DOI:10.4103/njo.njo_6_18  
Purpose: The vertical cup–disc (C/D) ratio is useful clinically in optic-disc assessment in glaucoma suspects and diagnosing glaucomas and is thought to also be influenced by many ocular and systemic factors. The body mass index (BMI) is said to be an important parameter which influences vertical C/D ratio and different studies have shown different correlation between these two variables. The aim of the study was to assess the relationship of vertical C/D ratio with BMI in a population of Saudi adult females. Methods: One hundred and one female participants in the age group 18 to 40 years were included in a cross-sectional study after obtaining information regarding demographic data, ocular/systemic diseases, and surgeries by an oral interview. The BMI was calculated as ratio of body weight divided by the square of the body height. C/D ratio was recorded with direct ophthalmoscopic examination and examination with 90-D (Volk) lens. Analysis of variance was used to examine the BMI on vertical C/D ratio. A P-value <0.05 was considered to be statistically significant with confidence interval of 95%. Results: The mean BMI was 22.7 (±4.49) and the mean C/D ratio was 0.22 (±0.14). No significant relationship between increasing vertical C/D ratio and BMI P-value 0.154 was found. Conclusion: This study, conducted as a pilot study to investigate the relationship between C/D ratio and BMI in a young female Saudi population, found no significant relationship between vertical C/D ratio and BMI. This relationship is important as it helps to rule out effect of BMI on C/D ratio parameters in this population.
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Retinal detachment in morning glory disc anomaly: Prevalence and outcome of treatment
Ashish A Ahuja, Olukorede O Adenuga, Jayant Kumar, Naresh B Kannan, Kim Ramasamy
July-December 2018, 26(2):128-132
DOI:10.4103/njo.njo_4_18  
Purpose: To determine the prevalence of retinal detachment (RD) in eyes with morning glory disc anomaly (MGDA) and the outcome of treatment. Materials and Methods: Retrospective study of cases of MGDA seen over a 5-year period at a tertiary eye hospital in South India. All the patients had a thorough ophthalmological and systemic examination. Prevalence of RD was determined and outcome of surgery in treated eyes analyzed. Results: Fifteen patients with a mean age of 11.1 years were diagnosed with MGDA during the study period. Two patients had bilateral anomaly. RD was present in four (23.5%) eyes, and three (17.6%) eyes had features of spontaneously settled RD. Three eyes with RD had vitrectomy with successful anatomical reattachment in two eyes and good visual outcome in one eye. Conclusion: RD is a common association of MGDA. Late presentation is frequent, and visual outcome limited following surgical intervention.
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CASE REPORTS
An uncommon case of intraoperative retrobulbar hemorrhage following sub-tenon’s anesthesia: A case report
Olusola O Olawoye, Patrick O Idam, Folahan A Ibukun
July-December 2018, 26(2):133-136
DOI:10.4103/njo.njo_18_18  
A 51-year-old woman presented to the eye clinic with complaint of poor vision OS. She had a visual acuity of 6/6−2 OD and Hand Motion OS. Pupillary examination revealed a round active pupil OD and a relative afferent pupillary defect OS, open angles on gonioscopy OU, cup/disc ratio of 0.5 OD and 1.0 OS and intraocular pressure of 19-mmHg OD and 39-mmHg OS. A diagnosis of bilateral primary open angle glaucoma was made. She was subsequently booked for bilateral trabeculectomy following failed medical therapy. Preoperatively, she had O’Brien facial block and sub-Tenon’s anesthesia prior to commencement of right trabeculectomy surgery. She coughed persistently and strained intensely throughout surgery. She was subsequently noted to have persistent shallowing of the anterior chamber toward the end of surgery with associated proptosis, chemosis, and subconjunctival hemorrhage. A diagnosis of intraoperative retrobulbar hemorrhage (RBH) was made, and she had prompt lateral canthotomy and 500-mg stat dose of tab acetazolamide. Following reduction of the proptosis, the eye was padded and she was placed on tab acetazolamide 250 mg 8 hourly, tab chymotrypsin/trypsin 500 mg 8 hourly, tab paracetamol 1 g 8 hourly, and tab prednisolone 60 mg daily. She was subsequently discharged on the 4th postoperative day following resolution of clinical features and improvement in bleb morphology. Sub-Tenon’s anesthesia rarely causes intraoperative RBH. Prompt recognition and urgent surgical intervention is key to successful management of this condition.
  2,807 222 -
ORIGINAL ARTICLES
Effect of benzalkonium chloride–preserved timolol maleate on dry eye disease in a black African population, southwestern Nigeria
Oluyemi Fasina, Segun I Olaniyan
July-December 2018, 26(2):118-120
DOI:10.4103/njo.njo_9_18  
Objective: Benzalkonium chloride, a commonly used preservative in many ophthalmic preparations, has been postulated as a cause of ocular surface toxicity, resulting in dry eye disease in patients on long-term treatment with topical medications. This study aims to determine the effect of benzalkonium chloride–preserved timolol maleate on dry eye disease in an African population. Materials and Methods: Information was retrieved from the data generated at a cross-sectional study on the prevalence of dry eye disease conducted in a randomly selected local government area, southwestern Nigeria, and analysis was conducted on participants with glaucoma and using benzalkonium chloride–preserved timolol maleate (cases), and age- and sex-matched controls. Results: One hundred and seventy-four participants were included in this study with a mean age of 65.05 ± 11.65 years. There was no significant association (P > 0.05) between the use of benzalkonium chloride–preserved timolol maleate and tear-film break-up time, Schirmer 1 test, fluorescein staining score, and overall diagnosis of dry eye disease in the patients. Conclusion: Benzalkonium chloride–preserved timolol maleate did not contribute significantly to dry eye disease in the studied population.
  2,406 240 2
CASE REPORTS
Orbital kaposi sarcoma in a female retroviral disease negative nigerian and a review of literature
Rita O Momoh, Eno A Chude, Evaristus O Oboh, Darlington E Obaseki
July-December 2018, 26(2):137-139
DOI:10.4103/njo.njo_11_18  
An orbital location of Kaposi sarcoma (KS) is rare, and none has been reported in Nigeria to the best of our knowledge. We report the multidisciplinary management of a case; a 50-year-old human immune-deficiency virus, seronegative female who presented with a painless, progressive swelling of the left eye of two years duration that was histologically confirmed as orbital KS. Occurrence of KS in the orbit is rare; we highlight the need for a very high index of suspicion for this tumor as well as the challenges of managing this unsightly indolent tumor in Nigeria.
  2,255 186 -