Intravitreal Antivascular Endothelial Growth Factors for Retinopathy of Prematurity in Ibadan: Method of Administration

Purpose: To outline the method of administration of intravitreal antivascular endothelial growth factor (anti‑VEGF) for retinopathy of prematurity (ROP) for the purpose of improved eye care among neonates. Background: ROP is a major potential, but largely preventable cause of blindness in the pediatric population. ROP has been shown to be a  two‑stage event with an initial disruption to normal retinal vessel growth, which is then accompanied by the second stage of vessel development. Preterm infants have undeveloped retinas, with avascular areas at the periphery. Subsequently, as the infant grows, these undeveloped retinas lacking an adequate supply of oxygen then stimulate angiogenic factors for the development of new vessels. Some predisposing risk factors include inappropriate oxygen therapy and lower birth weights. Initially, ROP was documented to be sporadic in most regions of Africa, but due to the recent advancement in medical facilities and personnel training, more preterm babies are surviving, thereby increasing the rate of ROP. Our hospital, the University College Hospital, Ibadan, has been assessing preterm babies for signs of ROP in conjunction with the neonatologists for the last four years, with various stages of ROP being diagnosed and treated. Intravitreal use of anti‑VEGF has been accepted as a valuable therapy in preventing the development of advanced cases of ROP. The purpose of this study is to describe the method of administration of this important medication. Conclusion: Intravitreal anti‑VEGF may prevent avoidable blindness in babies with ROP. However, to prevent devastating complications, appropriate  techniques and the guidelines given in this study should be considered to minimize complications. Keywords: Antivascular endothelial growth factor, methods of administration, retinopathy of prematurit

Changing indications for intravitreal anti-vascular endothelial growth factor injections at the university college hospital, Ibadan, Sub-Saharan Africa

Background: To review the current indications for intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, in order to make recommendations for planning of services.Methods: The medical records of 172 patients who had intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections from January 2016 to December 2019 were retrieved. Socio-demographic and clinical data were extracted, analysed, and compared with data from the previously published audit report covering 2010 to 2012.Results: Three hundred and thirty injections were given to 182 eyes in this cohort of patients. The mean age was 61.1±16.3 years (range <1-90 years), with a male to female ratio of 1.1:1. Retinal vein occlusion, 64 (35%) remained the most common indication for anti-VEGF injections in the eyes treated. This was followed by choroidal neovascular membrane/wet age-related macular degeneration which accounted for 42 (23%) as reported previously. However, cases of proliferative diabetic retinopathy/ diabetic maculopathy needing anti-VEGF were noticed to have almost doubled from about 8 (10%) in the previous study to 15 (27%) in the present study. In addition, idiopathic polypoidal choroidal vasculopathy, 18 (10%) ranked above proliferative sickle cell retinopathy in the present study. Retinopathy of prematurity (ROP), neovascular glaucoma, retinal artery macro-aneurysm and myopic choroidal neovascular membrane were the new emerging indications.Conclusion: There is an expanding indication for anti-VEGF in the management of retinal vascular diseases in the health facility and adequate measures should be put in place for early diagnosis and management. Patients should be counselled on the availability of this treatment option

Coronavirus Disease 2019 Virus among Ophthalmologists in Nigeria: Knowledge, Attitude, and Perceptions

Background: Globally, there is still much to learn about the evolving coronavirus disease 2019 (COVID‑19) virus, its transmission, prevention, and treatment. Therefore, this study investigates the knowledge, perception, and screening practices of COVID‑19 infection in the ophthalmology practice in Nigeria. Materials and Methods: This survey was a descriptive, cross‑sectional survey conducted among practising ophthalmologists and ophthalmologists in training in Nigeria in an online survey. Data compiled were then analyzed using the IBM SPSS software version 22.0 with two‑tailed P < 0.05 considered to indicate statistical significance. Results: A total of 206 ophthalmologists/ophthalmologists in training were recruited for this study. Most of the respondents, 97 (47.1%), practiced in centres in South‑West Nigeria and were board‑certified ophthalmologists 96 (46.6%). In general, the majority of the respondents, 182 (88.3%), had good knowledge regarding the COVID‑19 virus, its transmission, prevention as it regards the ophthalmic practice, 134 (74.8%) either agreed or strongly agreed that the ophthalmologist is at a higher risk of contracting the virus from infected patients even if the patient is asymptomatic. COVID‑19 infection was perceived as very serious by the majority of the respondents, 135 (65.5%), although 128 (62.1%) felt that all routine cases should be seen only following a low‑risk assessment. Conclusion: As the world races toward complete vaccination of the population against this fatal infection, continued training is required to ensure the best practices among ophthalmologists to bridge the present knowledge gaps, corrects myths, misconceptions, and ensure the safety of both the patient and the ophthalmologist

Learning Styles of Fresh Clinical Students in Ophthalmology at the University of Ibadan, Nigeria: A Pilot Study

Background: The College of Medicine, University of Ibadan, Nigeria, is using a new curriculum for its learners. Therefore, knowing thelearning styles of the learners will help the teachers formulate appropriate teaching strategies. The aim of the pilot study was to determine thelearning styles of the 1st‑year clinical students rotating through ophthalmology with a view to recommending appropriate teaching strategies tothe teachers for the smooth running of the new curriculum. Methodology: The first fifty set of students sent to the department of ophthalmology for ophthalmology rotation was used as a pilot. A total of 47 students completed the study. Three students voluntarily did not participate in the study. Design: VARK questionnaire‑assisted testing of learning styles was used for the study. It consists of 16 questions with four options testing each domain of visual (V), auditory (A), write or reading (R), and kinesthetic (K) ways of learning. Multiple responses were allowed. The total responses were computed at the end to give an idea of the learning styles of the students. Results: A total of 1192 responses were received from 47 students (25 males and 22 females), with a male‑to‑female ratio of 1.1:1. The Auditory and kinesthetic ways of learning were responsible for 669 (56%) responses. There was no statistically significant difference among the sexes. Conclusion: The most preferred  learning styles were the auditory and kinesthetic ways of learning. Teachers should consider direct instructions and more hands‑on teaching of their students while formulating a teaching plan. Keywords: Auditory, kinesthetic, learning styles, medical students, teaching, VARK questionnair

Challenges of retinoblastoma management in a Nigerian tertiary eye care facility

Background: Retinoblastoma is the most common intraocular childhood malignancy. Its management is, however, not without challenges especially in a developing country like Nigeria. This study sought to present the clinical profile and treatment outcome of patients with retinoblastoma managed in a Nigerian tertiary eye care facility highlighting the challenges with a view to improving the management of the disease. Materials and Methods: A retrospective, single-institution, and institutional review board-approved review of all patients diagnosed with retinoblastoma between January 2012 and December 2015 was done. Data obtained from case files of patients include demographic characteristics, presenting complaint, laterality of disease, tumor stage using the International Intraocular Retinoblastoma Classification, treatment, and outcome. Information obtained from phone calls to the caregivers were also summarized. Results: The review included 54 eyes of 41 patients between the ages of 2 months and 5 years. The mean age at presentation was 24.4 ± 11.4 months. There were 18 males (43.9%). Duration of symptoms before presentation ranged from 2 weeks to 2 years. Tumor was bilateral in 13 (31.7%) patients. Leukocoria was the most common presenting complaint observed in 32 (59.2%) eyes. Groups D and E were the most common intraocular tumor stage documented in 16 (29.7%) and 15 (27.8%) eyes, respectively. Most patients (29, 70.7%) defaulted from treatment after the first or second presentation. Only 6 (21.4%) of 28 patients offered enucleation or modified exenteration either at presentation (Class E) or after chemoreduction (orbital disease) consented. Conclusion: Late presentation, high default rate, and noncompletion of treatment were the major challenges facing retinoblastoma management in this center