The fellow eye of retinal detachment patients: Vision and clinical presentation.

Background: The fellow eye of a retinal detachment is at risk of developing a retinal detachment and other visually debilitating disease. Aim: To investigate the rate of bilaterality of retinal detachment (RD), the presenting visual acuity (VA), and the presence of ocular morbidity in the fellow eye of patients with RD. Patients and Methods: A multicenter, prospective, cross-sectional study examining the fellow eye of consecutive patients who were diagnosed with different types of RD. The patients were seen within one year and examined in four Nigerian eye hospitals and clinics. Demographics, VA, and clinical findings at the presentation were reported on examination of the fellow eyes. Results: Twenty-seven (11.4%) out of 237 patients (264 eyes) had an RD in the fellow eye. The mean age of all study patients was 46.2 ± 16.8 years, M/F: 161 (67.9%)/76 (32.1%). The rates of bilaterality for rhegmatogenous, exudative, and tractional RDs were 4.2%, 11.1%, and 31.1%, respectively. Diagnosis of RD in an eye was associated with a risk of developing fellow eye rhegmatogenous retinal detachment (RRD) (P < 0.001) and tractional RD (P < 0.001), respectively. RRD in an eye was associated with a 17% risk of developing RD in the fellow eye (ß = -1.6, OR = 0.202, P < 0.001). The BCVA in the fellow eye of the three types of RD varied significantly (P < 0.001). The fellow eye was blind in 25.2% of RRD, 54.1% of tractional retinal detachment (TRD), and 11.1% of exudative retinal detachment (ERD). Bilateral RD eyes were blind in RRD (85.7%), TRD (71.1%), and ERD (50%). One hundred and seven eyes (40.5%) of the total 264 RD eyes studied had other fellow eye events at the presentation. Conclusion: A patient with an RD in one eye is at significant risk of developing a blinding RD in the fellow eye. This risk varies with the type of RD and is highest with TRD. However, RRD, the commonest type of RD, can benefit from prophylactic treatment to the fellow eye RD predisposing lesions.

Visual Status of Patients with Retinitis Pigmentosa: A Multicenter Study.

AIM: To determine the degree of visual loss associated with retinitis pigmentosa (RP) in Nigerians at first ophthalmic clinic presentation METHODOLOGY: Multicenter, prospective, cross-sectional study in four collaborating retina clinics within Nigeria between January and December 2018. The primary outcome measure was the World Health Organization's visual status classification at presentation. Clinical examination, including a Snellen's visual acuity, refraction, anterior segment examination using a slit lamp biomicroscope, and dilated fundus examination using a +90D or +78D, was done in all consecutive RP patients. We analyzed the data using SPSS (version 22), P < 0.05. RESULTS: Of 8614 patients seen within the study period, fiftyfour eyes of 27 patients diagnosed to have RP with a mean age of 44.1years ± 17.6 years (ranging between 5­73 years) constituted the study population. Eighteen (66.7%) were males and 9 (33.3%) females. The hospital-based prevalence of RP was 0.31%. Ten patients (37.0%) presented with myopia. RP was bilateral in all cases and non-syndromic. Bilateral low vision and blindness were noted in 44.4% and 22.2% of patients respectively. CONCLUSION: About a quarter of patients with RP presenting to the retina clinics would have some degree of visual morbidity. Educating eye care providers and patients about the disease would improve understanding, encourage early clinic visits, manage visual morbidity and enhance rehabilitation when necessary.

OBJECTIF: Déterminer le degré de perte visuelle associée à la rétinite pigmentaire (RP) chez les Nigérians lors de la première présentation en clinique ophtalmique MÉTHODOLOGIE: Étude multicentrique, prospective et transversale dans quatre cliniques de rétine collaboratrices au Nigeria entre janvier et décembre 2018. Le principal critère de jugement était la classification de l'état visuel de l'Organisation mondiale de la santé à la présentation. Un examen clinique, comprenant une acuité visuelle de Snellen, une réfraction, un examen du segment antérieur à l'aide d'un biomicroscope à lampe à fente et un examen du fond d'œil dilaté à l'aide d'un +90D ou +78D, a été effectué chez tous les patients consécutifs atteints de RP. Nous avons analysé les données à l'aide du SPSS (version 22), P < 0,05 RÉSULTATS: Sur les 8614 patients examinés pendant la période d'étude, 54 yeux de 27 patients diagnostiqués comme ayant une RP et âgés en moyenne de 44,1 ans ± 17,6 ans (entre 5 et 73 ans) ont constitué la population étudiée. Dix-huit (66,7 %) étaient des hommes et 9 (33,3 %) des femmes. La prévalence de la RP dans les hôpitaux était de 0,31 %. Dix patients (37,0 %) présentaient une myopie. La RP était bilatérale dans tous les cas et non syndromique. Une basse vision et une cécité bilatérales ont été constatées chez 44,4 % et 22,2 % des patients respectivement. CONCLUSION: Environ un quart des patients atteints de RP se présentant dans les cliniques de la rétine auraient un certain degré de morbidité visuelle. L'éducation des prestataires de soins ophtalmologiques et des patients sur la maladie permettrait d'améliorer la compréhension, d'encourager les visites précoces dans les cliniques, de gérer la morbidité visuelle et d'améliorer la réadaptation si nécessaire. Mots clés: Rétinite pigmentaire, Nigeria, basse vision, cécité.

Polypoidal Choroidal Vasculopathy Amongst Nigerians; A Multicenter Study.

OBJECTIVE: To investigate the prevalence and presentation of polypoidal choroidal vasculopathy (PCV) in Nigerians. METHODS: A cross-sectional, multicenter, hospital-based, descriptive study. Data were collected prospectively between January and December 2018, from consecutive patients diagnosed to have a retina disease at the general outpatient and retinal clinics of four eye departments in Nigeria. All participants had visual acuity, refraction, intraocular pressure, anterior segment examination, and dilated fundus examination. Some patients had fundus fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA). Systemic comorbidity was determined by medical history and systemic evaluation. Diagnosis of PCV was based on clinical findings, and in some patients using OCT. RESULTS: A total of 8,614 patients were seen and 15 patients (18 eyes) were diagnosed to have PCV giving a yearly hospital-based prevalence of 0.17%. The mean age at presentation was 63.27 ± 11.5 years (range 44-84 years). There were nine females (60%). The male: female ratio was 1.5:1. Twelve (66.7%) of the 18 eyes were blind, 16.7% had severe visual impairment while 11.1% had mild visual impairment. Seven eyes (38.9%) had vitreous hemorrhage. Of the 12 blind eyes, 50% had vitreous hemorrhage (P = 0.463). Nine patients (60%) had systemic hypertensive as comorbidity (P = 0.016). CONCLUSION: PCV is a cause of vision loss among Nigerians. Majority of the eyes were blind and 50% of blind eyes had vitreous hemorrhage. Since Indocyanine Green Angiography is the most appropriate imaging technology and is mostly unavailable in Nigeria, efforts should be made to address this need and improve the diagnostic accuracy.

Comparative study of inverted internal limiting membrane (ILM) flap and ILM peeling technique in large macular holes: a randomized-control trial.

BACKGROUND: The anatomical success rate of macular hole surgery ranges around 93-98%. However, the prognosis of large macular holes is generally poor. The study was conducted to compare the anatomical and visual outcomes of Internal Limiting Membrane (ILM) peeling vis-a-vis inverted ILM flap for the treatment of idiopathic large Full-Thickness Macular Holes (FTMH). METHODS: This was a prospective randomized control trial. The study included patients with idiopathic FTMH, with a minimum diameter ranging from 600 to 1500 µm. The patients were randomized into Group A (ILM peeling) and Group B (inverted ILM flap). The main outcome measures were anatomical and visual outcome at the end of 6 months. Anatomical success was defined as flattening of macular hole with resolution of the subretinal cuff of fluid and neurosensory retina completely covering the fovea. RESULTS: There were 30 patients in each group. The mean minimum diameters in Group A and B were 759.97 ± 85.01 µm and 803.33 ± 120.65 µm respectively (p = 0.113). The mean base diameter in group A and B was 1304.50 ± 191.59 µm and 1395.17 ± 240.56 µm respectively (p = 0.112). The anatomical success rates achieved in Group A and B were 70.0 and 90.0% respectively (p = 0.125). The mean best-corrected visual acuity (BCVA) after 6 months was logMAR 0.65 ± 0.25 (Snellen equivalent, 20/89) in Group A and logMAR 0.53 ± 0.20 (Snellen equivalent, 20/68) in Group B (p = 0.060). The mean improvement in BCVA was 1.4 lines and 2.1 lines in groups A and B respectively (p = 0.353). BCVA≥20/60 was achieved by 13.3 and 20.0% in group A and B respectively (p = 0.766). CONCLUSION: The anatomical and functional outcome of Inverted ILM flap technique in large FTMH is statistically similar to that seen in conventional ILM peeling. TRIAL REGISTRATION: Clinical Trials Registry - India (Indian Medical Research) CTRI/2017/11/010474 .

AN AUDIT OF MINOR OPHTHALMIC SURGICAL INTERVENTIONS IN A TERTIARY EYE CARE FACILITY IN NORTHERN NIGERIA.

BACKGROUND: An estimated 285 million persons are visually impaired globally, and 39 million of them are blind. Majority of the blind population reside in developing countries. Over 60% of blindness is attributable to surgical causes of blindness. A surgical audit reveals areas of performance that require improvement. AIM: To assess the output and pattern of minor ophthalmic surgeries over a seven year period. METHOD: The minor ophthalmic surgical records of Jos University Teaching Hospital, Jos, Nigeria were retrospectively reviewed to obtain information on the patients'demographics, diagnosis, indication, type of surgery, type of anaesthesia administered, outcome of management, histology report and the rank of surgeon. The data obtained were analyzed using Epi Info Statistical version 3.4, Atlanta, Georgia USA. RESULTS: A total of 536 patients had minor ophthalmic operations at the Jos University Teaching Hospital between January 2008 and December 2014. There were 281(52.4%) males and 255(47.6%) females (χ(2)=9.4, p>0.1) with a mean age of 37.2 years (SD:24). Furthermore, 41(7.6%) patients had surgery in both eyes. The main anatomical sites of ocular morbidity were eyelid/lashes, conjunctiva and anterior segment observed in 237 (41.1%), 166(28.8%) and 94(16.3%) eyes respectively. Posterior segment lesions as indication for minor surgery was observed in 11(1.9%) eyes in the year 2013 and increased to 38(6.6%) eyes in 2014. Most (75%) minor surgical procedures were performed by resident doctors under supervision (χ(2)=13.7, p<0.05). A total of 584 procedures were performed comprising over 33 different types of minor surgeries. The main surgical procedures included pterygium excision in 104(17.8%) cases, eyelid repair in 74(12.7%) cases and incision and curettage for chalazion in 65(11.1%) cases (χ2=23.9, p<0.001). A recurrence rate of 31.6% and 6.1% was observed in eyes that had pterygium excision and incision and curretage for chalazion respectively; 83.8% of eyelids repaired had no postoperative sequelae while notching of the eyelid margin was observed in 9.4% of eyelids repaired. CONCLUSION: Minor ophthalmic surgeries constitute an important aspect of comprehensive eye care delivery with significant impact on control of blindness programmes. Most minor ophthalmic surgeries are performed on the ocular adnexa, hence the need for strengthening of the orbito-oculoplastic sub-specialty in the hospital.

Sturge-Weber syndrome in a 56 year old woman: a case report.

BACKGROUND: Sturge-Weber syndrome is a sporadic phacomatoses with angiomas involving the leptomeninges and skin of the face, typically in the ophthalmic and maxillary distributions of the trigeminal nerve. Glaucoma is a common ocular manifestation. Presentation is typically at birth with a facial angioma. METHOD: Case note of a patient with a diagnosis of Sturge-Weber syndrome was used and the relevant literature reviewed. RESULT: A 56 year old woman with pain, photophobia in the left eye of 6 months duration. She had lost vision in the eye about 20 years earlier and was born with a dark patch on the left side of her face. She had no previous history of convulsion. On examination, she had a port-wine stain involving the left side of her face. Examination of the left eye revealed a visual acuity of no light perception with episcleral haemangioma. There was a relative afferent pupillary defect and fundoscopy revealed a pale pathologically cupped disc with tortuous retinal vessels. The intraocularpressure was elevated. CONCLUSION: Sturge-Weber syndrome is a rare phacomatoses which may present with ocular complications such as glaucoma. If glaucoma is left untreated decreased vision and blindness result. People of any age therefore with port-wine stain in the ophthalmic distribution of the trigeminal nerve should have yearly eye examination and measurement of intraocular pressure, regardless of whether they have symptoms or not.