Iridoschisis in a Nigerian patient

We report iridoschisis in a female who presented at the age of 85 years with a ten year history of complaints of gradual and progressive deterioration in vision in both eyes (left eye worse than the right eye). The examination was notable for the presence of peripheral anterior synechiae inferiorly and few loose iris fibrils some of which were adherent to the corneal endothelium in both eyes while others floated within the aqueous humor. The anterior chamber was shallow and there was marked inferior/inferotemporal sectoral iris atrophy with splitting of the anterior layer of the iris. The pupils were slightly irregular in but reactive in both eyes and there were lenticular opacities in both eyes.Keywords: Glaucoma, iridoschisis, iris atroph

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

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

Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020.

OBJECTIVES: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. DESIGN: Descriptive case study. SETTING: Neonatal intensive care units in Nigeria. PARTICIPANTS: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). METHODS AND ANALYSIS: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. RESULTS: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. CONCLUSION: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential

Anterior segment and ocular adnexal lesions in patients with human immunodeficiency virus infection and acquired immunodeficiency syndrome at a tertiary hospital in Southwestern Nigeria

Background: Ocular manifestation of human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) affects various ocular structures including the anterior segment and ocular adnexae and may be a cause of ocular morbidity. The aim of the study is to determine the pattern of lesions affecting the anterior segment and ocular adnexae in patients diagnosed with HIV/AIDS whether on highly active antiretroviral therapy or not and confirmed positive for retroviral disease by western blot attending an antiretroviral therapy clinic in Southwestern Nigeria. It is a prospective, cross-sectional study on anterior segment and ocular adnexae lesions in patients with HIV/AIDS. Materials and Methods: A total of 318 consecutive patients with the confirmation of a diagnosis of HIV/AIDS attending the antiretroviral therapy clinic within the study period from 2009 to 2010 had visual acuity evaluation, a detailed ocular examination by slit-lamp biomicroscopy, and binocular indirect ophthalmoscopy. The data generated were analysed using SPSS (Statistical Package for the Social Sciences) version 16. Ethical clearance was obtained from the hospital research ethics committee. Results: Two hundred and ninety-five (92.8%) patients of the 318 recruited had anterior segment manifestations, whereas ocular adnexal lesions were present in 134 (42.1%) patients. Multiple ocular pathology of the anterior segment and ocular adnexal was present in some of the respondents recruited. There were more female respondents. One hundred and twenty-three patients (38.7%) recruited for the study were in the 40–49 years of age group with a mean age of 47.2 years (SD = 9.42 years). The most common anterior segment lesion was corneal opacity in 18 patients (5.6%), and the most common ocular adnexal lesion was pingueculum in 56 respondents (17.6%). Other HIV/AIDS-associated adnexal lesions present include hypertrichosis in 25 patients (7.9%), herpes zoster ophthalmicus (HZO) in 13 (4.1%), and squamous cell carcinoma of the conjunctiva in 4 (1.3%) patients. The most common HIV-associated anterior segment pathology was HZO-associated keratouveitis seen in four patients (1.3%) and herpes simplex keratitis in one patient (0.3%). Conjunctival microangiopathy was the most common HIV-associated ocular adnexal lesion. The relationship between viral load values and lesions involving both anterior segment and ocular adnexal disease was statistically significant as these patients tended to have higher viral loads when compared with those without lesions (P < 0.05). Conclusion: Anterior segment and ocular adnexal lesions were frequent in patients with HIV/AIDS attending a tertiary health institution in urban Nigeria. HIV/AIDS-defining ocular illnesses including HZO, conjunctival microangiopathy, and ocular surface squamous cell neoplasia are not uncommon in these patients. Potentially debilitating ocular disorders may be avoided by instituting periodic ocular examinations