A Review of Neuro-ophthalmologic Emergencies

Background: Neuro-ophthalmic emergencies are relatively uncommon, however their outcome cause severe morbidity and even mortality. The ocular manifestations of these disorders are pointers to a more dangerous central nervous system or systemic pathology. The review aims to highlight the major ocular disorders that constitute neuro-ophthalmologic emergencies with a view to increasing the index of suspicion of these visual/life threatening disorders among primary care physicians, neurologists and ophthalmologists.Method: The available literature on neuro-ophthalmologic emergencies was reviewed, using available journals and internet based search engines and resources. Keywords employed were Neuro-ophthalmology Emergency and Ocular Morbidity.Result: The incidence of this group of emergencies is lower than that of other ophthalmic emergencies such as ruptured globe and retinal detachment; however they are associated with higher morbidity and even mortality. These emergencies can be grouped into four major categories for ease of diagnosis. Nigerian literature on neuroophthalmologic emergencies was unavailable.Conclusion: The key to prevention of morbidity and mortality from neuro-ophthalmologic disorders is to have a good knowledge of the  manifestations of these disorders and a high index of suspicion.Keywords: Neuro-ophthalmology; Emergency; Ocular Morbidit

Temporal versus Superior Limbal Incision: Any difference in visual outcome? Initial report of 40 retrospective cases

Aim: To compare the visual outcome of a superiorly placed limbal incision with a temporal limbal incision in extracapsular cataract surgery. The main outcome measures are visual acuity and the degree of stigmatism based on refraction.Method: A retrospective non randomized comparative study. Medical records of 40 patients (40 eyes) who had uni-ocular extra-capsular cataract extraction over a 6-month period were used for the study. Relevant dataextracted included age and sex, presenting visual acuity, type of incision used for cataract extraction, visual acuity, and refraction results at the 13th postoperative week. The exclusion criteria were any visible ocularcondition that could affect visual acuity such as corneal scar, glaucoma or vitreous loss.Results: A total of 40 cases were studied; 22 (55%) males and 18 (45%) females. About 65% (26) were aged 50-89 years; mean 50.12 years (SD=23.28). Twenty six patients (65%) had temporal limbal incision while 14 had superior limbal incision. Of these. 76.9% of the temporal limbalincision group had VAs of 6/18 or better 6 weeks after surgery, compared to 64.3% for the superior limbal incision group (table 5). This difference was statistically significant (P=0.01). At the 13th postoperative week, 20eyes (76.9%) had corrected visual acuities of 6/12 or better for the temporal incision group, and 6 eyes (42.9%) in the superior limbal incision group (table 6). This difference was however not statistically significant(P=0.07). Most eyes (76.2%) in the temporal incision group had between 0.25DC-2.00DC of astigmatism compared to 46.2% in the superior limbal incision group who also had higher degrees of astigmatism (53.8%). This finding was however not statistically significant (P = 0.15) Conclusion: Temporal limbal incision has been shown to have a better visual outcome at 6 weeks postoperative (p=0.01) and a lower level of astigmatism compared to superior limbal incision at 13 weeks postoperative.Key words: ECCE: temporal versus superior incisio

Neuroprotection in Glaucoma: A Review

Background: Glaucoma, globally the second most common cause of blindness and the commonest cause of preventable visual disability, is a progressive neurodegenerative disease of the retinal ganglion cells and their axons .Neuroprotection is an evolving area in the management of glaucoma. This review aims to highlight the current neuroprotective agents under investigation and the promise they hold for future management of glaucoma.Method: The available literature on the use of Neuroprotection in Glaucoma was reviewed using available journals and internet based search engines such as pubmed and Medline. Keywords employed were Neuroprotection and Glaucoma.Results: There is ongoing research on neuroprotective agents in management of glaucoma. A few of the currently available anti glaucoma medications also have neuroprotective functions. The mainstay of glaucoma management however remains lowering of intraocular pressure. Nigerian literature on neuroprotection was not available.Conclusion: It has become increasingly obvious that glaucoma represents a complex multifactorial disease that produces an accelerated rate of ganglion cell atrophy related to a numerous pathogenic mechanisms that not only most certainly involve IOP, but also include defective auto regulation and ischaemia; neurotrophic factor deficiency; glutamate mediated excitotoxicity, immune related phenomenon; intracellular calcium influx and free 3 radical damage. IOP lowering still remains the mainstay of treatment. Neuroprotection has promise for preventing retinal cell ganglion death independent of IOP. It therefore presents an exciting development in the pursuit for a treatment modality for this debilitating disease.Keywords: Neuroprotection; Glaucoma

Causes of Vitreous Haemorrhage In Port Harcourt; A 3 Year Review.

Background: Vitreous haemorrhage is one of the causes of visual loss and arises from a number of risk factors. This study aims to expose the causes of vitreous haemorrhage in our environment and evaluate the pattern of visual loss.Methods: A 3 year retrospective review of medical records of patients presenting in the outpatient clinic of the eye department in University of Port Harcourt Teaching Hospital was carried out between 2007 and 2009.Demographic data and causative factors of vitreous hemorrhage were amongst the information culled from the records and analysed.Results: Twenty-six patients were seen over the period under review out of which 18 of them were males. The age range was 12-70 years. Trauma accounted for 73.1% of all the causes of vitreous haemorrhage.Conclusion: Trauma is a significant cause of vitreous haemorrhage in our environment affecting the younger age group. The poor presenting visual acuity reflects the severity of causes of vitreous haemorrhage in our environment. Awareness needs to be increased on the causes and risk factors of vitreous haemorrhage.Keywords: Vitreous haemorrhage;Aetiology; Vision loss; Nigeria

Incidence and risk factors for retinal vein occlusion at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Objective: The objective of the following study is to determine the  incidence of retinal vein occlusion (RVO) and identify the risk factors in RVO in patients presenting to a tertiary hospital in Rivers State.Materials and Methods: The medical records of consecutive patients with RVO who presented to the retina clinic of the eye Department of University of Port Harcourt Teaching Hospital over a 5 year period were retrieved. Information extracted from the data included the demographic data of patients, presenting visual acuity, history of systemic and ocular disease, blood pressure and intraocular pressure. Data was analyzed using the Statistical Package for Social Sciences 20.0. (IBM Corporation and its licensors 1989,2011).Results: Out of the 364 patients seen at the retina clinic during this period, 27 (7.4%) had RVO. Seven patients had bilateral disease. The incidence of RVO in the retinal clinic was 7.4%. Systemic hypertension, diabetes   mellitus, hyperlipidemia and glaucoma were the main risk factors recorded in our patients. Central retinal vein occlusion (CRVO) 20 (74%) was morepredominant than branch retinal vein occlusion (BRVO) 7 (26%). 21 eyes of patients with CRVO had visual acuities of < 3/60, while 7 eyes of patients with BRVO had visual acuities less than 3/60. Vitreous hemorrhage 10 (52.6%) was the most common complication encountered. All cases of non.perfused vein occlusion 4 (14.8%) were seen in patients who had CRVO.Conclusion: The incidence of RV in our hospital is high. RVO is a significant cause of visual impairment, with CRVO being more common. Identifying associated risk factors and treating these could help reduce the incidence of RVO.Key words: Incidence, Port Harcourt, retinal vein occlusion, risk factor

HIV Seroprevalence in Patients Undergoing Ophthalmic Surgery in the Niger/Delta Region of Nigeria

Aim: The aim of this study was to determine the number of HIVpositive cases undergoing ophthalmic surgery at two centresin Nigeria and to assess if routine testing is clinically oreconomically effective.Methods: All patients listed for ophthalmic surgery in two eyeunits in southern Nigeria during a six-month period in 2005,who underwent a routine set of pre-operative blood tests –including HIV test – after giving full-informed consent, wereincluded. Laboratory investigation of HIV status was byELISA. Details of the patients’ age, sex, diagnosis andpreoperative HIV status were noted on a spreadsheet database.Results: At the university teaching hospital, HIV was detected inone out of 87 cases (1.15%). At the other provincial hospital3 HIV positive cases were detected out of 41 ophthalmicsurgery patients (7.31%).Conclusion: The prevalence of HIV in Nigeria is high, althoughit varies between type of hospital and region. Ophthalmicsurgeons should bear this in mind whilst operating. Routinetesting of HIV status might not be absolutely necessary as itdoes not influence changes in surgical technique orpreparation but rather reinforces the need for safe and effectivepreventive measures

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

Outcome of Trabeculectomy in Advanced Glaucoma in a tertiary hospital in Rivers State, Nigeria

Aim: To evaluate the outcome of Trabeculectomy in advanced glaucoma in a hospital in Rivers State, Nigeria. Methods: This was a non-randomized interventional study in which each patient served as its own control. Patients with advanced glaucoma and demonstrable field defects and Mean defect &ge;-12 were included. The intervention employed was Trabeculectomy and IOP and visual acuity pre operative, as well as post op were collected and compared at pre- op, post -op day 1, one week, one month, 6 months. Data was analyzed using SPSS version 20. Results: Thirteen (13) eyes from ten (10) patients with advanced glaucoma were involved in the study. Mean age of study population was 53&plusmn;19.62 years. Mean of mean defect was -19.05&plusmn;5.23dB while mean of vertical cup disc ratio (VCDR) was 0.88&plusmn;0.04. Mean of Pre- op Visual acuity (log MAR) was 0.46 and dropped to 0.72 first day post-op but improved over 6 months to 0.42. The mean of IOP pre-op was 24.15mmHg and dropped to 11.23mmHg (58.24%) over 6 months (p=0.001). Conclusion: Trabeculectomy still remains the gold standard surgical treatment for glaucoma. In our study it resulted in a 58.24% drop in IOP over 6 months with mean visual acuity maintained at pre-op levels after 6 months follow up. It therefore is effective and safe surgical intervention in advanced glaucoma

Presumed Idiopathic Intracranial Hypertension: A Case Report and Literature Review

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