Ophthalmic Manifestations of Migraine in a Nigerian Tertiary Health Facility.

Background: Migraine is a group of headache syndromes, with a prevalence of 5%-25%. Migraine is a complex recurrent headache disorder, often unilateral, throbbing or pulsating in nature aggravated by physical activity, bright light, and loud noises. Symptoms associated with migraine without aura are nausea, anorexia, and varying degrees of ophthalmic problems ranging from visual aura, ocular symptoms, and ophthalmoplegia. Objectives: The study determined the pattern and ophthalmic manifestations of migraine in Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: This was an observational cross-sectional study. Ethical clearance was obtained from the research ethical committee of Aminu Kano Teaching Hospital (AKTH). A total of 254 patients diagnosed with migraine using international headache society criteria attending neurology clinic in AKTH were interviewed and examined using a structured questionnaire which captured the biodata, pattern of migraine and ocular symptoms associated with migraine. The data obtained were collated and analysed using Statistical Package for the Social Sciences, version 23. Results: Of the 254 patients examined, there were 95 (37.4%) males and 159 (62.6%) females, (M:F = 1:2) with mean age of 28.9 ± 9.7 years. Migraine without aura was the commonest type seen in 55.8% of patients. Most patients had unilateral headaches. About 52.8% and 57.5% had headaches that were throbbing in nature. The headache lasted for 72 h in 48.2% and 48 h in 30.3%. It was triggered by physical stress in 49.6% and lack of sleep in 46.5%. The commonest associated symptom was nausea in 44.9%, tinnitus in 39.0%, and vomiting in 29.1%. While the commonest ocular/visual symptom was photophobia in 76% of patients. Most of the patients had family history of migraine (62.8%). Migraine without aura (MWOA) was found to be significantly associated with female gender (P = 0.001; OR = 2.48; 95% CI: 1.45-4.25). Scotoma, fortifying spectra were significantly associated with migraine with aura (MWA; P = 0.0004; OR = 28.46; 95% CI: 11.53-70.35). Conclusion: Migraine is one of the most common types of primary headache. There is a female preponderance. Migraine has significant association with visual disturbances and ocular symptoms.

Outcome of Multiple Retinal Capillary Hemangioma Following Focal Laser and Intravitreal Bevacizumab Injection: A Case Report.

Retinal hemangioma has posed a therapeutic problem for ophthalmologists for almost a decade. The location of hemangioma in the retina is an important factor in determining the treatment options as well as the size of the tumor, clarity of media, and secondary features of the mass. A 22-year-old male presented to vitreoretina clinic at a tertiary eye hospital, with a history of sudden decrease of vision in the left eye for 1 year associated with mild ocular pains. Physical and systemic examination revealed no positive findings. On ocular examination, the visual acuity was 6/6 in the right eye and perception of light in the left eye, and there was no improvement with best correction. Anterior segment examination in both eyes was essentially normal. Dilated funduscopy revealed a well-circumscribed and elevated vascular orange reddish mass in the juxtapapillary area, temporal to the disc with dilated tortuous feeder blood vessels measuring 6.4 × 3.0 mm in the right eye and vitreous hemorrhage with tractional retinal detachment in the left eye. The small solitary lesion in the right eye was treated with focal laser. This was followed by intravitreal bevacizumab avastin 1.25 mg in 0.05 mL in the same eye, monthly three doses, with the aim of targeting the bigger lesion at the juxtapapillary area to reduce the risk of visual loss. Patient also had pars plana vitrectomy, endolaser photocoagulation, and silicon oil in the left eye. There was complete resolution of the tumor, which was not measurable after third dose of intravitreal avastin. Patient vision remained 6/6, and there was no recurrence at the last follow-up visit 3 years after treatment. Antivascular endothelial growth factors like avastin are effective in the treatment of retinal capillary hemangioma, thereby inducing complete tumor resolution as well as maintaining good vision in the early stages of the disease before complication occurs, as it is evident in this case study.

Power Plug of a Mobile Phone Charger in the Orbit: A Case Report of a Domestic Injury.

Background: This is the case of a girl who sustained orbital injury while playing with a mobile phone charger. Case Report: The patient presented to the tertiary hospital 5 h after she sustained a penetrating injury with the power plug of a mobile phone charger to the right upper lid. There was associated headache, tearing, bleeding, discharge, and inability to open the right eye. On Examination: She was ill-looking and anxious, not febrile or pale. Systemic examination did not reveal any abnormality. Unaided visual acuity in the right eye (OD) could not be tested, left eye (OS)-6/9. The right eyelid was completely closed with a penetrating power plug of the phone charger in the supero-lateral aspect of the upper eyelid. A diagnosis of penetrating power plug of a charger in the right upper lid and orbit was made. Computed tomography scan showed the power plug of the charger in the right orbit with a little blood collection in the right maxillary sinus. She underwent examination under anaesthesia, foreign body removal, and repair of the lid penetration. The findings were right upper lid penetration with ptosis, corneal epithelial erosion, phone charger power plug in the medial orbital wall, and cataract. The foreign body was removed, and lid and conjunctival lacerations repaired. Eight weeks post-operatively, ptosis had resolved, leaving the anterior polar cataract (<3 mm) and a best corrected visual acuity of (OD) 6/6 and (OS) 6/5. About 6 months afterwards, the cataract matured with a visual acuity of 6/60 for which she had right phacoemulsification with posterior chamber intra-ocular lens implant insertion. Conclusion: Prompt presentation and management lead to good visual outcomes in this patient.

The Effect of Highly Active Antiretroviral Therapy (HAART) on Accommodative-Convergence Mechanism among HIV/AIDS Patients in North-Western Nigeria.

Background: The introduction of Highly Active Anti-Retroviral Therapy (HAART) has led to a dramatic decrease in Human Immune Deficiency Virus (HIV) related morbidity and mortality in the developed as well as developing world. Whilst HAART has been effective in reducing rapidly progressive retinopathies, there are other ocular manifestations of HIV which are yet to be determined, characterised and addressed. The aim of the study was to determine the effect of HAART on Accommodative-Convergence mechanism among HIV/AIDS patients in Northwestern, Nigeria. Methodology: This was hospital-based cohort study carried out from April 2019 to November 2019. Participants that met the inclusion criteria were recruited and were separated into two groups A and B. Group A were those about to commence HAART referred to as HAART naive, while group B were subdivided into four groups; comprising of B1: those that had been on HAART for 0 - 2½ years, group B2: >2½ - 5 years, group B3: >5 - 7½ years, and group B4: >7½ - 10 years, termed as HAART experience. Information obtained from the patients included sex, age, marital status, Near Point of Convergence (NPC), Amplitude of Accommodation (AA), Presbyopic reading Addition (ADD), CD4+ T cell count, HAART regimen and duration on HAART therapy. Results: There were 400 participants aged 25 - 55years with a mean age of 37.86 ± 7.5years. The participant's NPC mean was 6.4 ± 1.47cm with a range of 2 - 18cm. Most of the participants 336 (84.0%) had an abnormal Near Point of Convergence compared to 64 (16%) with normal NPC values. The mean AA was 4.18± 1.34DS, ranging from 0.75 to 10.0DS and about 273 (68.2%) of the participant's AA was within 3 to 5DS. The mean presbyopic addition was 1.39± 0.98 DS ranging from 1.00 to 3.50DS whilst majority of the participants, 305 (76.2%) had an abnormal Reading Addition. Conclusion: The study showed that the HIV/AIDS patients on HAART exhibit an abnormally low AA, receded NPC and High presbyopic reading addition as compared to age matched HAART naïve. There was a statistically significant association between AA and HAART (p = 0.002) and HAART duration (p = 0.00), but there was no association with their CD4+ T cell levels and HAART regimen (p = 0.12, p = 0.08). There was no statistically significant association between Abnormal reading addition and HAART (p= 0.46), CD4+4 T cell levels and HAART regimen (p=0.53 and p= 0.59), but there was a statistically significant association with HAART duration (p= 0.00).

Clinicopathologic presentation of malignant orbito-ocular tumors in Kano, Nigeria: A prospective multicenter study.

Background: Malignant orbito-ocular tumors are major causes of morbidity and mortality in the developing countries. Their presentation, morphologic type, and management are challenging, and earlier reports were mostly retrospective surveys. Histological analysis is essential in making correct diagnosis. Here, we determined the clinical presentations and histopathologic types of orbito-ocular tumors in some tertiary hospitals in Kano, Nigeria. Materials and Methods: This was a prospective cross-sectional multicenter clinical and pathologic study conducted between June 2012 and May 2013. A structured pro forma was used to record findings, patient's biodata, clinical presentation, type of surgical intervention, and histological diagnosis. Data were analyzed with STATA version 11.0. Results: Sixty-seven eye tumors were observed among 61 patients. There were 43 males and 18 females (male-to-female ratio = 2.4:1). Patients had a mean of 13.4 ± 18.3 with a median of 4.0 (0.5-70) years with a double peak in age distribution. The most common features were visual loss (90.2%), leukocoria (59%), proptosis (55%), and fungating mass (49.2%). The symptoms were for ≥6 months in 57.4% and unilateral in 82.1%. B-scan showed retinal masses and calcifications in 13.5% and 4.5%, respectively. Confirmation by histology was achieved in 91% with the most common tumor being retinoblastoma, conjunctival squamous cell carcinoma (SCC), and rhabdomyosarcoma with frequencies of 38 (56.6%), 11 (16.4%), and 6 (9.0%), respectively. Six patients were HIV positive and all had SCC. Conclusions: Retinoblastoma was the most common malignant orbito-ocular tumor observed in this study. Patients often present late to the hospital with visual loss.

RésuméContexte: Les tumeurs malignes orbito-oculaires sont des causes majeures de morbidité et de mortalité dans les pays en développement. Leur présentation, type morphologique et la gestion sont difficiles, et les rapports précédents étaient principalement des enquêtes rétrospectives. L'analyse histologique est essentielle en faisant un diagnostic correct. Ici, nous avons déterminé les présentations cliniques et les types histopathologiques de tumeurs orbito-oculaires dans certaines hôpitaux tertiaires à Kano, au Nigeria. Matériels et méthodes: Il s'agissait d'une étude clinique et pathologique multicentrique prospective transversale. menée entre juin 2012 et mai 2013. Un formulaire pro forma a été utilisé pour enregistrer les résultats, les données biographiques du patient, la présentation clinique, type d'intervention chirurgicale et diagnostic histologique. Les données ont été analysées avec STATA version 11.0. Résultats: Soixante-sept tumeurs oculaires étaient observés chez 61 patients. Il y avait 43 hommes et 18 femmes (ratio hommes / femmes = 2,4: 1). Les patients avaient une moyenne de 13,4 ± 18,3 avec un médiane de 4,0 (0,5 à 70) années avec un double pic dans la répartition par âge. Les caractéristiques les plus courantes étaient la perte de vision (90,2%), la leucocorie (59%), proptosis (55%) et masse fongative (49,2%). Les symptômes étaient ≥ 6 mois chez 57,4% et unilatéraux chez 82,1%. B-scan a montré rétinienne masses et calcifi cations dans 13,5% et 4,5%, respectivement. La confirmation histologique a été réalisée dans 91% des cas. étant un rétinoblastome, un carcinome épidermoïde conjonctival (SCC) et un rhabdomyosarcome avec des fréquences de 38 (56,6%), 11 (16,4%), et 6 (9,0%), respectivement. Six patients étaient séropositifs et tous étaient atteints de SCC. Conclusions: Le rétinoblastome était le cancer le plus courant tumeur orbito-oculaire observée dans cette étude. Les patients se présentent souvent tardivement à l'hôpital avec une perte de vision.

The astigmatic effect of pterygium in a Tertiary Hospital in Kano, Nigeria.

AIM: This study aims to determine the effect of pterygium excision on the degree of corneal induced astigmatism and visual acuity. PATIENTS AND METHODS: This was a prospective interventional study conducted between September 2012 and June 2013. Consecutive patients with pterygium who met the inclusion criteria were recruited into the study. They had a basic eye examination, and those with existing comorbidity were excluded. Selected patients had pterygium excision using the bare sclera technique with intraoperative application of Mitomycin C. Detailed pre- and post-operative evaluation and refraction was done. RESULTS: There were 45 eyes of 33 patients aged 28-75 years. The mean age was 56.12 + 12.38 years. Six eyes had Grade I, 29 eyes had Grade II and 10 eyes had Grade III pterygium. The mean value for preoperative astigmatism was 2.12 ± 1.09 diopter cylinder (DC) while that for postoperative astigmatism was 0.72 ± 0.50 DC (P = 0.000). Surgery was associated with statistically significant increase in postoperative visual acuity. (P = 0.000). CONCLUSION: This study has shown that the degree of pterygium-induced astigmatism reduces significantly following surgical excision. Pterygium excision was associated with improvement in visual acuity.

Cycloplegic effect of atropine compared with cyclopentolate-tropicamide combination in children with hypermetropia.

BACKGROUND: Cycloplegic refraction is important in assessing children with hypermetropia. Atropine, though the gold standard cycloplegic agent for refraction in children, has a long duration of action and more severe side effects compared to short-acting cycloplegic agents. The aim of the study was to compare the cycloplegic effect of atropine with cyclopentolate and tropicamide combination in children with hypermetropia. SUBJECTS AND METHODS: This was a crossover interventional study in children with hypermetropia. Cycloplegic refraction using two separate regimens of cycloplegic drugs was done on all subjects. Data were analyzed using the statistical software SPSS version 22.0. The mean spherical equivalent values of regimen 1 (atropine 1%) and regimen 2 (cyclopentolate 1% and tropicamide 1%) were presented as mean and standard deviation. A P ≤ 0.05 was considered statistically significant. RESULTS: One hundred and twenty-six eyes of 63 subjects aged 5-12 years were examined. The mean spherical equivalent values for regimen 1 and regimen 2 for the right eyes were 4.73 ± 2.1 DS and 4.54 ± 1.9 DS, respectively (P = 0.59). The mean spherical equivalent values for regimens 1 and 2 for the left eyes were 4.74 ± 2.0 DS and 4.54 ± 1.8 DS, respectively (P = 0.56). CONCLUSION: The combination of 1% cyclopentolate and 1% tropicamide could be a useful alternative to atropine 1% for cycloplegic refraction in children with hypermetropia.