Bilateral Keratomalacia Secondary to Diet Induced Vitamin A Deficiency in an Ethiopian Young woman: A Case Report

BACKGROUND: Diet induced vitamin A deficiency is less commonly seen in otherwise healthy adults, due to large store of vitamin A in the body. Night blindness is the commonest manifestation of vitamin A deficiency in adults, whereas Keratomalacia is a rare manifestation.CASE REPORT: A 27 years old Ethiopian woman came to Jimma University Department of Ohthalmology with a compliant of protrusion of the globe content of both eyes within a week, after having redness and fear of light of both eyes for 2 months. She was a mother of twins and had low socioeconomic status. On general examination, she was cachectic with enlarged parotid glands. On ocular examination, she was bilaterally blind and had dry ocularsurface. There was bilaterally melted cornea with prolapsed uveal tissue. After several investigations she was diagnosed as bilateral Keratomalacia (stage X3B) secondary to diet induced vitamin A deficiency. She was supplemented with vitamin A and other nutritional supplementation. Topical lubricating drops and ointments were administered. Finally, conjunctival flap was done to preserve the globe.CONCLUSION: Although it is rare, treating physicians should be aware of the occurrence of Keratomalacia in adults which is potentially blinding. Early recognition and treatment of vitamin A deficiency at the stage of night blindness is essential in reducing blindness caused by Keratomalacia

Proportion of Glaucoma among Voluntary People Coming for Glaucoma Screening Program at Jimma University Department of Ophthalmology, Jimma, Ethiopia

BACKGROUND: Glaucoma is the second leading cause of blindness worldwide. Glaucoma screening has been controversial, and much of the controversy has centered on the value of mass or community screening.METHODS: The aim of this study was to determine the proportion of glaucoma among volunteer adults who were screened in Jimma University Department of Ophthalmology. A cross-sectional study was conducted among 459 volunteer residents of Jimma town and surrounding areas. The study subjects were aged 40 years and above, who came for community screening program after media announcement during the four consecutive weekends of November 2014. Comprehensive eye examination was done including best corrected visual acuity, intra-ocular pressure measurement, stereoscopic optic nerve evaluation, angle structure evaluation and visual field testing. Three diagnostic criteria for glaucoma were employed for all cases.RESULTS: Of all adults who came for screening, 47(10.24%) were diagnosed to have glaucoma, 59(12.85%) were glaucoma suspects, and 8(1.74%) had ocular hypertension. The proportion of glaucoma increased with increasing age, (P value= 0.001 (99%CI)). Primary open angle glaucoma was the most common form (42.55%) of all new cases while 4.4% of all screened adults were followed by normal tension glaucoma (29.79%), pseudoexfoliative glaucoma (19.15%), and primary angle closure glaucoma (6.38%) Around 5.7% of all glaucoma cases were found to be blind.CONCLUSION: The proportion of glaucoma in this community screening program in Southwest Ethiopia was 10.24% with primary open angle glaucoma being the commonest subtype. Glaucoma community screening should be promoted for early diagnosis and intervention to prevent irreversible blindness

Assessment of Risk Factors for Advanced Open Angle Glaucoma Presentation among Patients Visiting Jimma University Medical Center, Jimma, Ethiopia

Background: Glaucoma is the predominant cause of irreversible blindness, particularly the late presentation. The purpose of this study is to identify  the risk factors associated with late presentation in Jimma University Medical Center Methods: A case-control study was done among patients newly diagnosed to have open angle glaucoma (of any type) at Jimma University Medical  Center from July 2014 – January 2019. Cases were patients/eyes diagnosed to have any type of open angle glaucoma with advanced glaucomatous  disc features, whereas controls were patients diagnosed with early and moderate stages of glaucoma. Results: There were 205 (116 cases and 89 controls) participants. The mean age of the participants at the time of diagnosis was 58.3±13.4yrs. Family  history of blindness, presenting IOP, type of glaucoma and age were independently associated with late presentation. Patients with family  history of blindness had late advanced glaucoma five times higher than those with no family history of blindness. The presence of late glaucoma  among patients with presenting intra ocular pressure < 30mmHg is lower than those having ≥30mmHg (Adjusted Odds Ratio= 0.136). Primary open-  angle glaucoma patients were less likely to present with advanced glaucoma than pseudoexfoliative glaucoma patients (Adjusted Odds  Ratio=0.39). The chance of presenting with late glaucoma was increased by 3.4% for every one year increment of age. Conclusions: Presence of family history of blindness, high presenting intraocular pressure, pseudoexfoliative glaucoma and old age are risk factors  for late presentation of glaucoma.&nbsp

Clinical Presentation of Retinoblastoma in Ethiopia: A Case of Jimma University Medical Center Pediatric Oncology Unit, Southwest Ethiopia

BACKGROUND፡ Retinoblastoma (RB) is one of the most curable childhood cancers if early detected and treated. Late presentation complicates the management of RB results in dismal treatment outcome. Objective: The aim of this study is to report the clinical presentation pattern of retinoblastoma patients seen at Jimma University Medical center (JUMC).METHODS: The study was a retrospective review of retinoblastoma cases managed at JUMC between August 2016 and July 2020.RESULTS: Among pediatric oncology cases registered retinoblastoma, accounting 8.5 % (36/423) of all childhood cancer patients in the study period, 29 (90.6%) of them had unilateral retinoblastoma and 3(9.4%) of them had bilateral retinoblastoma. The average age at presentation for bilateral and unilateral retinoblastoma patients was 17 (range 3-30) months and 37.5 months (range 8-84) respectively. The first symptom observed by the family was leukocoria in 21 (65.6%) of the patients but 24(75%) of the patients presented with advanced stage (proptosis and fungating orbital mass) of the disease. The longest and the shortest lag time of presentation from the first symptom was 17 months and 2 weeks respectively with the mean lag time of 1.4 months in bilateral and 6 months in unilateralcases. Clinically, the majority of the eyes 24/35(68.6%) were extraocular tumors involving orbital tissues at presentation.CONCLUSION: Most of retinoblastoma patients presented at advanced stage of the disease and presented very late after the family observed the disease. Early detection strategies must be designed by the government and responsible stakeholders in mitigating the effects of late presentation