Vision 2020 the Right to Sight: Where exactly are we in Nigeria?

No Abstract

Bilateral Spontaneous Hyphaema in Juvenile Xanthogranuloma: A case report and literature review

Background: A four-month-old Nigerian male was presented with spontaneous hyphaema in both eyes initially thought to be due to trauma or possibly non accidental injury. There was associated secondary glaucoma and skin lesions typical of juvenile xanthogranuloma. This condition, to the best of our knowledge, has not yet been reported in Nigeria. Case report: There was redness in the right eye with no associated tearing or photophobia. On examination, there was visually directed reaching in both eyes, with central, steady and maintained fixation, corneal haze and 15% hyphaema. The left eye, which appeared normal, later also developed 10% hyphaema, upon which an impression of juvenile xanthogranuloma was entertained. Laboratory investigations, including a clotting profile, were all within normal limits. Examination under anaesthesia showed progressively increasing buphthalmos and vitreous haemorrhage in the left eye with high intraocular pressure and large cup disc ratios. Histology showed irregularly disposed spindle-shaped cells in the dermis that were intimately associated with small capillaries containing red blood cells. Occasional tuton-like giant cells were seen with hyperkeratosis and papillomatosis of the epidermis which is consistent with juvenile xanthogranuloma. Conclusion: Ocular complications provide the primary concern in this condition and could eventually lead to blindness. Therefore, a high index of suspicion is the key to the prevention of blindness. Keywords: juvenile xanthogranuloma, hyphaema, glaucomaNigerian Journal of Opthalmology Vol. 15 (2) 2007: pp. 61-6

Refractive Error Status in Bayelsa State, Nigeria

Background: Refractive errors affect the whole spectrum of the population without regard to age, gender, race and ethnic group. Uncorrected refractive errors have severe consequences for the individual, family and society. This study , is the first of its kind, to document the distribution of refractive errors in Bayelsa State. Methods: Records of patients who presented between January 2004 and October 2005 in Okolobiri General Hospital—the government-subsidized eye clinic in Okolobiri, Bayelsa State—for treatment were examined. Myopia was defined as ≥- 0.50DS; hyperopia as ≥+ 1.00DS; while astigmatism was defined as ≥- 0.25DC. Emmetropia was defined as spherical power of –0.25D to +0.75D. Results of the right eye were used for analysis. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 10. Results: A total of 654 patients were analyzed. There were 319 male and 335 female patients (48.8% and 51.2% respectively)with an age range of 5 – 86 years. Mean age was 42.18 years (SD 13.1, 95% CI = 41.17 – 43.19 years). Significant refractive errors were observed in 355 cases (54.3%), while 299 (45.7%) were emmetropic. Of the 355 with refractive error, 181 (51%) were men and 174 (49%) were woman. Astigmatism was the commonest refractive error (n=162, 45.7%) followed by myopia (n = 113, 31.8%) and hyperopia (n = 80, 22.5%). The range of refractive power was as follows: astigmatism, - 0.25DC to – 1.75DC. Myopia, - 0.50D to - 9.00D; hyperopia, + 1.00DS to + 11.00DS; More male patients have hyperopia and myopia while more female patients have astigmatism. Presbyopia as indicated by the use of near addition, was present in 490 (74.9%) of the subjects. Conclusion: Significant refractive error was present in over half of patients presenting in the period under analysis. The range of refractive errors recorded will assist in planning self-sustaining low-cost refractive error services in the state.Key words: refractive error, presbyopia, astigmatism, Bayelsa State, Nigeria

Microstructural Characterisation of Resistance Artery Remodelling in Diabetes Mellitus

This is the final version. Available on open access from Karger Publishers via the DOI in this recordIntroduction: Microvascular remodelling is a symptom of cardiovascular disease. Despite the mechanical environment being recognised as a major contributor to the remodelling process, it is currently only understood in a rudimentary way. Objective: Amorphological and mechanicalevaluation of the resistance vasculature in health and diabetes mellitus.Methods: The cells and extracellular matrix of human subcutaneous resistance arteriesfrom abdominal fat biopsieswere imagedusing two-photon fluorescence and second harmonic generationat varying transmural pressure.The results informed a two-layer mechanical model.Results: Diabetic resistance arteries reducedin wall area as pressure was increased. This was attributed to the presence of thick, straight collagen fibre bundles that bracedthe outer wall.The abnormal mechanical environment caused theinternal elastic lamina and endothelial and vascular smooth muscle cellarrangementsto twist. Conclusions: Our resultssuggest diabetic microvascular remodelling is likely to be stress-driven, comprisingat least two stages: 1. Laying down of adventitial bracing fibres that limit outward distension, and 2. Deposition of additional collagen in the media, likely due to the significantly altered mechanical environment. This work represents a step towards elucidating the local stress environment of cells, which iscrucial to build accurate models of mechanotransduction in disease.British Heart FoundationMedical Research Council (MRC)National Institute for Health Research (NIHR

Global Retinoblastoma Presentation and Analysis by National Income Level.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs

Travel burden and clinical presentation of retinoblastoma: analysis of 1024 patients from 43 African countries and 518 patients from 40 European countries

BACKGROUND: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe. METHODS: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries. RESULTS: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease. CONCLUSIONS: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral

Herpes Zoster ophthalmicus and HIV seropositivity in South-south Nigeria

Herpes zoster is a painful vesiculobullous dermatitis which occurs as a result of previously established varicella zoster virus infection. It is a wellestablished fact that Herpes zoster ophthalmicus is a well known marker of human immune deficiency virus infection even in Africans. The aim of this study is to determine if indeed the herpes zoster condition is a marker for the immune deficiency condition called AIDS in our locality and whether the positivity is related to age or not. A total of 20 consecutive patients thatpresented between 2003 and 2006 with herpes zoster ophthalmicus were examined retrospectively as to their Human Immune deficiency virus (HIV) status. Their presentation, clinical findings and clinical course are alsoanalyzed. Of the 20 patients examined, there was a male preponderance of 4:3 with most patients above 40 years (35.4% between 41-50 years) and half of them were married. Out of the twelve (n=12, 60%) patients whose serum was tested for human immunodeficiency virus, eight (n=8, 40%) were negative, while four (n=4, 20%) were positive for the virus .Eight were not tested. Using 40 years of age as the cutoff, those above 40 years (12 in number), two (n=2, 25%) were seropositive while 9were negative (75%). For those below 40 years (8 in number), two (n=2, 25%) were positive while six were negative (75%).Upon treatment with antivirals (Zovirax ) in the majority of cases there was complete resolution in 8 (57%) of the patients with most of the sequelae occurring in those of them who are seropositive.Correlation of impaired immune status with Herpes zoster affectation was found to be more obvious in the younger than 40 years group.Treatment with antivirals gave good resolution in most cases. Blinding complications were found more in those who were seropositive. Keywords: herpes zoster, HIV infection, Nigeria

Ophthalmic survey of an old people's home in Nigeria

No Abstract. Nigerian Journal of Medicine Vol. 15(3) July-September 2006: 288-29

Ophthalmic manifestations of children with Down syndrome in Port Harcourt, Nigeria

Adedayo Omobolanle Adio,1 Samuel Otabor Wajuihian21University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria; 2Department of Optometry, University of KwaZulu-Natal, Durban, South AfricaAim: The aim of this study was to provide a profile of oculo-visual anomalies in children with Down syndrome (DS) in Port Harcourt, Nigeria.Methods: This comparative study assessed the visual functions of 120 children (42 DS and 78 developmentally normal children). The visual functions evaluated and the techniques used were: visual acuity (Snellen illiterate chart and Lea picture charts), refraction (static retinoscopy with cyclopegia), ocular alignment (cover test), near point of convergence (pen and rule), and external examinations and fundoscopy.Results: A total of 42 children with DS (22 males, 20 females, mean age 11.43 &amp;plusmn; 6.041 years) and control group of 78 normal children (36 females, 42 males) with mean age 6.63 &amp;plusmn; 1.98 years were examined. Of the 42 DS children, visual acuity was less than 6/18 in eight and one of the DS and control groups, respectively. Visual acuity could not be checked conventionally in eleven participants from the DS group due to poor response. The main findings were: DS compared to control group showed refractive errors of 76.2% (half of which was from myopia) vs 14.1% (only 10% due to myopia). There was a statistically significant difference in total refractive errors between the Down syndrome group and the control group (P = 0.001, &amp;Chi;2 = 18.29). Strabismus was 9.5% (75% esotropia) vs 0%, and there was a statistically significant difference (P = 0.001, &amp;Chi;2 = 5.01), nystagmus was 4.8% v 0%, conjunctivitis 19.05% vs 8.97%, and keratitis 7.14% vs 0%, which was statistically significant (P = 0.05, &amp;Chi;2 = 2.90).Conclusion: Refractive errors were prevalent in a sample of children with DS in Port Harcourt, Nigeria, whereas the prevalence of ocular diseases was low when compared to age-matched control participants. This study highlights the need for ophthalmic care in children with DS. Routine eye care such as the use of spectacles when necessary is recommended for people with DS at all ages to improve their educational and social needs as well as overall quality of life.Keywords: Down syndrome, refractive errors, strabismus, ocular disease

The State Of Peadiatric Eye Care in Nigeria: A Stiuational Review and Call for Action.

The fight against childhood blindness is being given top priority by the World Health Organization especially in regions of the world, like Nigeria where the gross income per capita is relatively low with up to 60.9% of them living in absolute poverty as at 2010. Avoidable causes of blindness in children needs to be eliminated through the development of sustainable and equitably distributed high quality children eye care services as part of our national health care system. However enough attention has not been given to achieve this yet. The purpose of this editorial is to highlight the challenges in childhood eye care in this country as well as discuss ways the current negative trend can be reversed. KEYWORDS: Paediatric; Nigerian child; Ophthalmology; Subspecialt