Prevalence and Aetiology of Visual Impairment and Blindness in Persons with HIV/AIDS on Highly Active Anti-Retroviral Therapy in Benin City, Nigeria.

BACKGROUND: The use of Highly Active Anti-Retroviral Therapy (HAART) has revolutionized the course and pattern of eye diseases in persons with HIV/AIDS which ultimately affects the visual status. OBJECTIVE: To determine the prevalence and etiology of visual impairment and blindness in people with HIV/AIDS on HAART in Benin City, Nigeria. METHODOLOGY: This was a descriptive hospital-based study on all HIV/AIDS patients on HAART in the United States President's Emergency Plan for AIDS Relief (PEPFAR) clinics of University of Benin Teaching Hospital seen from July to August 2018 and Central Hospital, Benin City in October 2019. Demographic data and other relevant questions related to the disease were obtained from participants and recorded in an interviewer administered questionnaire. Participants were examined and ocular findings recorded. The IBM SPSS software version 21 was used for data analysis and level of significance set at p<0.05. RESULTS: There were 451 persons comprising 104 (23.1%) males and 347 (76.9%) females. More participants, 176(39%) were within the age group 41-50 years, with a mean age of 46.6± 10.78 years, and age range of 14-75 years. Visual impairment was present in 105 (23.3%), blindness in 10 (2.2%) and 336(74.5%) had normal visual acuity. Refractive error was the most common cause of mild 34 (29.6%) and moderate 23(20%) visual impairment. Cataract 4(3.5%) was the predominant cause of blindness. There was no case of severe visual impairment recorded. CONCLUSION: The major causes of visual impairment and blindness in persons with HIV are not HIV-related diseases which may be an indication of improved management protocols.

CONTEXTE: L'utilisation de la thérapie antirétrovirale hautement active (HAART) a révolutionné le cours et le modèle des maladies oculaires chez les personnes atteintes du VIH/SIDA, ce qui affecte finalement l'état visuel. OBJECTIF: Déterminer la prévalence et l'étiologie de la déficience visuelle et de la cécité chez les personnes atteintes du VIH/SIDA sous HAART à Benin City, au Nigeria. MÉTHODOLOGIE: Il s'agissait d'une étude descriptive en milieu hospitalier sur tous les patients atteints du VIH/sida sous HAART dans les cliniques du Plan d'urgence du président des États-Unis pour la lutte contre le sida (PEPFAR) de l'hôpital universitaire de Benin vu de juillet à août 2018 et de l'hôpital central de Benin City en octobre 2019. Les données démographiques et d'autres questions pertinentes liées à la maladie ont été obtenues des participants et enregistrées dans un questionnaire administré par un enquêteur. Les participants ont été examinés et les résultats oculaires enregistrés. Le logiciel IBM SPSS version 21 a été utilisé pour l'analyse des données et le niveau de signification fixé à p<0,05. RÉSULTATS: 451 personnes ont été recensées, dont 104 (23,1%) hommes et 347 (76,9%) femmes. La plupart des participants, 176 (39%) étaient dans la tranche d'âge 41-50 ans, avec un âge moyen de 46,6± 10,78 ans, et une fourchette d'âge de 14-75 ans. La déficience visuelle était présente chez 105 (23,3%), la cécité chez 10 (2,2%) et 336 (74,5%) avaient une acuité visuelle normale. L'erreur de réfraction était la cause la plus fréquente de déficience visuelle légère (34, 29,6%) et modérée (23, 20 %). La cataracte, 4 (3,5 %), était la cause prédominante de cécité. Aucun cas de déficience visuelle grave n'a été enregistré. CONCLUSION: Les principales causes de déficience visuelle et de cécité chez les personnes séropositives ne sont pas des maladies liées au VIH, ce qui peut indiquer une amélioration des protocoles de prise en charge. Mots clés: Déficience Visuelle, Cécité, VIH/SIDA, HAART.

Impact of COVID-19 on Ophthalmic Outpatient Services in An Eye Care Center in Southern Nigeria.

BACKGROUND: Coronavirus disease-2019 (COVID-19) is a communicable disease and a global pandemic affecting different parts of the world including Nigeria. Measures to curb the spread of the causative virus included a nationwide lockdown. AIM: The aim of this study was to assess the impact of COVID-19 on ophthalmic outpatient services in an eye care center in Nigeria. METHOD: The medical statistics for all persons attending the Ophthalmic Outpatient Clinic from January to August 2020 and January to August 2019 was obtained. The statistics for January to August 2020 was compared with that of the corresponding months in 2019 for outpatient clinic attendance, gender, and number of children and adults. RESULTS: In the 2019 study period, the total number of patients attending the Ophthalmic Outpatient Clinic was 16,189. There were 6788 males, 9401 females, 2963 children, and 13,226 adults. In similar months in 2020, the total number of patients was 8,735, of which 3,934 were males, 4801 females, 1651 children, and 7084 adults. There was an overall decline of 46% in the number of outpatient attendance in 2020. The decline was 76.3% in April 2020 (peak of the lockdown). There was a rebound in outpatient visits in July 2020 (when the interstate travel ban was lifted) to 4.9 times that of April 2020; however, this was 56.9% that of July of the preceding year. CONCLUSION: COVID-19 pandemic impacted negatively on outpatient visits. A rebound in the number of visits was observed when the interstate travel ban was lifted, although far below the preceding year's value.

Terson Syndrome in a Patient with Idiopathic Thrombocytopenia.

BACKGROUND: The authors report a case of Terson syndrome in an adult with immune thrombocytopenia. Terson syndrome refers to an intraocular hemorrhage secondary to an intracranial hemorrhage or an acute rise in intracranial pressure. It is a rare but life-threatening complication and may be complicated with blindness in those who survive.

Ocular disorders in stroke patients in a tertiary hospital in Nigeria.

BACKGROUND: Stroke is a medical emergency of public health importance which affects the physical, mental, and emotional well-being of its victims. Management and rehabilitation are cumbersome for patients and caregivers. Ocular involvement and visual loss could further increase the burden of care. AIM: To determine the prevalence of ocular disorders in patients with stroke in a Tertiary Hospital in Nigeria. MATERIALS AND METHODS: A descriptive hospital-based study was performed on all consenting and conscious adult patients aged 18 years and above with a diagnosis of stroke made within 1-year who were admitted to the stroke ward or attended the stroke clinic of the Neurology Unit in the Department of Medicine, University of Benin Teaching Hospital, Benin City from October 2013 to December 2013. RESULTS: A total of 170 eyes of 85 patients were studied with a mean age of 66.08 years ± 10.99; range 43-88 years. There was a male: female ratio of 2.6:1. Ocular abnormalities were documented in 95.5% of the patients. A presenting visual acuity of ≥6/18 was found in 66.7%. Mild ptosis and exotropia were seen in 2.9% and 0.6% of the eyes respectively. Intraocular pressure was between 10-21 mmHg in 87.7% eyes while 11.8% eyes had afferent pupillary defects. Cataract was seen in 71.8% eyes and optic nerve head changes in 48.8% eyes which includes temporal disc pallor and glaucomatous optic neuropathy in 29.4% and 14.2% eyes, respectively. Abnormalities found in the retina include retinal hemorrhages in 10.6% eyes, cotton wool spots in 2.4% eyes, and hard exudates in 7.8% eyes. Retinal vascular abnormalities were documented in 32.4% eyes. Visual complaints following stroke were documented in 9.6% of the patients. CONCLUSION: Ocular abnormalities are present in patients with stroke, mostly due to predisposing risk factors for stroke, and age-related changes. Routine ophthalmic evaluation is suggested in the management of patients with cerebrovascular accident in our environment for better quality of care.

RETINAL DISEASES IN A TERTIARY HOSPITAL IN SOUTHERN NIGERIA.

BACKGROUND: Retinal diseases are an important and common cause of ophthalmic consultation. AIM: To determine the pattern of retinal diseases in the ophthalmic department of a tertiary hospital in Southern Nigeria. PATIENTS AND METHODS: A retrospective review of the case folders of patients with retinal pathologies seen between 2012 and 2013 was performed. Relevant demographic and clinical data was recorded. Analysis was performed for frequencies, proportions and percentages with the GraphPad Instat Software, Inc. version V2.05a program, San Diego, CA. RESULTS: There were 185 patients made of 94 (50.8%) males and 91 (49.2%) females with a peak age group of 61-70 years, (range 1-85 years) who made consultations for retinal diseases. Age related macular degeneration, 37(15.0%), and macula hole, 10(4.0%), were the common macula pathologies while retinal detachment, 11(4.5%), was the most common condition that required emergency vitreo-retinal surgical intervention. Diabetic retinopathy/maculopathy, 31(12.6%), hypertensive retinopathy 22(8.9%), and retinal vascular occlusion 12(4.8%), were the common retinal vascular diseases found. Bilateral visual impairment (low vision and blindness) from retinal diseases was present in 28(14.4%) persons. The common vitreo-retinal treatment options were use of intravitreal antivascular endothelial growth factors 32(13.0%), laser 16(6.5%), and vitreoretinal surgery in 22(8.9%) eyes. CONCLUSION: Retinal diseases remain an important cause of ophthalmic consultation and visual loss. Provision of facilities to manage these conditions will improve service delivery and quality of lives of affected patients.

Role of optical coherence tomography in posterior segment eye disorders: a review of two cases.

Optical Coherence Tomography produces high resolution tomographic in in vivo imaging of biological tissues. The study reviews OCT images of two patients with varied retinal pathologies to determine its usefulness in aiding evaluation and management of retinal diseases. The patients were imaged using OCT conventional fundus photography and angiography. A case each of premacular haemorrhage and idiopathic polypoidal choroidal vasculopathy, are presented highlighting the merits of OCT. OCT establishes the accurate diagnosis of retinal diseases and in monitoring response to therapy. It is complementary to clinical techniques of direct and indirect ophthalmoscopy, conventional fundus photography, fluorescein and indocyanine green angiography thus should be made readily available for use in the evaluation of retinal disorders to enhance their management.

Chorioretinal coloboma in a paediatric population.

AIM: To determine the validity of laser photocoagulation as a prophylactic treatment in the prevention of rhegmatogenous retinal detachment (RRD) in a group of paediatric patients presenting with chorioretinal coloboma. METHODS: Observational case series of consecutive patients aged 0-15 years with chorioretinal coloboma seen in a tertiary eye hospital were reviewed. Data were analysed with SPSS version 16, a P-value of <0.05 was considered significant. RESULTS: One hundred and ninety-eight patients (335 eyes) were identified. The prevalence of retinal detachment and ocular anomalies was 17.6 and 87.2%, respectively. Ocular anomalies included iris coloboma (71%), microcornea (45.1%), nystagmus (41.5%), strabismus (21.2%), and microphthalmos (19.1%). The prevalence of retinal detachment was 2.9% in those eyes that received prophylactic laser photocoagulation, whereas the risk of retinal detachment was 24.1% in eyes left untreated. Post-operative complications following retinal detachment surgery occurred in 86.7% eyes; the most frequent being recurrent retinal detachment (53.8%). The mean duration of follow-up was 1.59 ± 0.21 years (0-7 years) and 0.79 ± 0.16 years (0-8 years) in the group that had laser and in those that were treatment naive, respectively. CONCLUSIONS: Prophylactic laser treatment appears to have a protective effect for the prevention of RRD in eyes with chorioretinal coloboma. Measures towards prophylactic therapy should be instituted to reduce the risk of retinal detachment in choroid colobomatous eyes due to the problems in the management of these retinal detachments.

INITIAL EXPERIENCE WITH TRANSPUPILLARY DIODE LASER PHOTOCOAGULATION FOR RETINAL DISEASES.

BACKGROUND: Lasers are an invaluable treatment modality for the management of some retinovascular diseases. One of these lasers is the diode laser which is easy to procure and maintain. AIM: To review the outcomes of diode laser photocoagulation in patients with a variety of retinal conditions. PATIENTS & METHODS: A retrospective case series of all patients who had retinal laser photocoagulation between July 2012 and June 2014 with the semiconductor infrared diode laser was performed. Demographic and clinical data collected included age, sex, eye involved, visual acuity, diagnosis, associated systemic and ocular diseases, intra and post treatment findings, laser treatment parameters and follow up. RESULTS: A total of 22 eyes of 15 patients had diode laser treatment during the period under review comprising 8(53.3%) males and 7(46.7%) females with a mean age at presentation of 53.4±8.9 years. The indications for treatment were proliferative diabetic retinopathy in 18(81.8%) eyes of 11 patients, retinal vein occlusion in 2(9.1%) eyes of 2 patients and retinal breaks with lattice in 2(9.1%) eyes of 2 patients with fellow eye retinal detachment. Visual acuity in eyes with diabetic retinopathy improved in 9(50%) eyes, worsened in 3(16.7%) eyes and was unchanged/ stable in 6(33.3%) eyes. Regression of neovascularization was achieved in 2(100%) eyes with retinal vein occlusion. The retina of the 2(100%) eyes with breaks following retinopexy remained attached during the follow up period. The follow up period ranged from 2 days to 2 years with a mean duration of 13.5±15.8 months. CONCLUSION: The diode laser is an effective and beneficial treatment modality in the management of proliferative retinopathies and some retinal diseases.

Cysticercosis in the anterior chamber: a case report.

Cysticercosisis a public health problem and its occurrence in the anterior chamber of the eye israre. It occurs following ingestion of poorly cooked infested meat of pigs, sheep and dogs etc. Clinical evaluation and investigations were done to determine the cause of defective vision in a 45 year old female patient. A cyst was removed surgically from the anterior chamber by visco expression followed by a course of medication. The cyst was taken for histopathological examination. Investigations revealed mild eosinophilia on blood examination and an erythrocyte sedimentation rate of 95 mm/hr. Histology showed a cystic lesion with a thin fibrocollagenous wall and a hyalinised scolex within the lumen.A high index of suspicion is required for appropriate diagnosis and subsequent management of patients with anterior chamber cysticercosis.

Problems of management of primary congenital glaucoma in Benin City, Nigeria.

OBJECTIVES: To determine the problems encountered in the management of primary congenital glaucoma in developing countries. METHODS: A prospective study of new patients with a diagnosis of primary congenital glaucoma attending the eye clinic of the University of Benin Teaching hospital, Benin City, Nigeria over a 5 year period, from July 2001 to June 2006. The age, sex, presenting complaints and duration were recorded. They were examined by the aid of a pen torch, hand-held slit lamp and direct ophthalmoscope. Intraocular pressure and corneal diameter were measured under anaesthesia. The patients were followed up till June 2006 and the problems encountered in management were recorded. RESULTS: Eight children comprising 5 males (62.5%) and 3 females (37.5%) with primary congenital glaucoma were seen. All the patients (100%) presented with buphthalmos and 7 (87.5%) had corneal opacity. Four (50%) accepted surgery but only 2 (25%) eventually had surgery. Maximum follow-up was 7 months. CONCLUSION: Presentation with features of advanced disease, poor acceptability of surgery, poor follow-up and low surgical rate are problems associated with the management of congenital glaucoma in Benin City, Nigeria.