Pediatric Corneal Transplantation in Uyo, Nigeria: Early Experiences.

ABSTRACT: The burden of avoidable blindness from corneal disease is significantly higher where access to specialist eye care, the cost of treatment and the treatment infrastructure including eye banking, are beyond the reach of the impoverished masses. Corneal transplantation in children is challenging: it is more technically complex; patients often require multiple examinations under general anaesthesia to optimize treatment outcomes. There is also the increased risk of several complications including graft dehiscence, infection, rejection, and inappropriate patient or caregiver care. However, when successful, it restores vision. We present a report of our initial experience with penetrating keratoplasty in 2 children with blinding corneal disease in Uyo, Nigeria. Corneal transplantation history was retrieved and data (including data on age, sex, aetiology of corneal disease, indications for corneal transplantation, pre-operative and post-operative visual acuity and intraocular pressure measurements) was extracted for this report. Both patients had standard penetrating keratoplasty performed by one surgeon, under general anaesthesia. Case one was a 10-year-old male presenting with profound visual impairment from congenital hereditary endothelial dystrophy. His best corrected post-operative visual acuity was 6/24. Case two was a 3-year-old male with vision loss due to a corneal leucoma following treated herpes simplex keratitis. Post-operatively, his best corrected visual acuity improved to 6/12. Corneal graft tissue remained clear at more than 3 years of follow-up. Although amblyopia was a notable co-morbidity, corneal transplantation significantly improved their vision. Corneal banking services are advocated for in resource-limited settings where the magnitude of corneal blindness is greatest.

The fellow eye of retinal detachment patients: Vision and clinical presentation.

Background: The fellow eye of a retinal detachment is at risk of developing a retinal detachment and other visually debilitating disease. Aim: To investigate the rate of bilaterality of retinal detachment (RD), the presenting visual acuity (VA), and the presence of ocular morbidity in the fellow eye of patients with RD. Patients and Methods: A multicenter, prospective, cross-sectional study examining the fellow eye of consecutive patients who were diagnosed with different types of RD. The patients were seen within one year and examined in four Nigerian eye hospitals and clinics. Demographics, VA, and clinical findings at the presentation were reported on examination of the fellow eyes. Results: Twenty-seven (11.4%) out of 237 patients (264 eyes) had an RD in the fellow eye. The mean age of all study patients was 46.2 ± 16.8 years, M/F: 161 (67.9%)/76 (32.1%). The rates of bilaterality for rhegmatogenous, exudative, and tractional RDs were 4.2%, 11.1%, and 31.1%, respectively. Diagnosis of RD in an eye was associated with a risk of developing fellow eye rhegmatogenous retinal detachment (RRD) (P < 0.001) and tractional RD (P < 0.001), respectively. RRD in an eye was associated with a 17% risk of developing RD in the fellow eye (ß = -1.6, OR = 0.202, P < 0.001). The BCVA in the fellow eye of the three types of RD varied significantly (P < 0.001). The fellow eye was blind in 25.2% of RRD, 54.1% of tractional retinal detachment (TRD), and 11.1% of exudative retinal detachment (ERD). Bilateral RD eyes were blind in RRD (85.7%), TRD (71.1%), and ERD (50%). One hundred and seven eyes (40.5%) of the total 264 RD eyes studied had other fellow eye events at the presentation. Conclusion: A patient with an RD in one eye is at significant risk of developing a blinding RD in the fellow eye. This risk varies with the type of RD and is highest with TRD. However, RRD, the commonest type of RD, can benefit from prophylactic treatment to the fellow eye RD predisposing lesions.

Visual Status of Patients with Retinitis Pigmentosa: A Multicenter Study.

AIM: To determine the degree of visual loss associated with retinitis pigmentosa (RP) in Nigerians at first ophthalmic clinic presentation METHODOLOGY: Multicenter, prospective, cross-sectional study in four collaborating retina clinics within Nigeria between January and December 2018. The primary outcome measure was the World Health Organization's visual status classification at presentation. Clinical examination, including a Snellen's visual acuity, refraction, anterior segment examination using a slit lamp biomicroscope, and dilated fundus examination using a +90D or +78D, was done in all consecutive RP patients. We analyzed the data using SPSS (version 22), P < 0.05. RESULTS: Of 8614 patients seen within the study period, fiftyfour eyes of 27 patients diagnosed to have RP with a mean age of 44.1years ± 17.6 years (ranging between 5­73 years) constituted the study population. Eighteen (66.7%) were males and 9 (33.3%) females. The hospital-based prevalence of RP was 0.31%. Ten patients (37.0%) presented with myopia. RP was bilateral in all cases and non-syndromic. Bilateral low vision and blindness were noted in 44.4% and 22.2% of patients respectively. CONCLUSION: About a quarter of patients with RP presenting to the retina clinics would have some degree of visual morbidity. Educating eye care providers and patients about the disease would improve understanding, encourage early clinic visits, manage visual morbidity and enhance rehabilitation when necessary.

OBJECTIF: Déterminer le degré de perte visuelle associée à la rétinite pigmentaire (RP) chez les Nigérians lors de la première présentation en clinique ophtalmique MÉTHODOLOGIE: Étude multicentrique, prospective et transversale dans quatre cliniques de rétine collaboratrices au Nigeria entre janvier et décembre 2018. Le principal critère de jugement était la classification de l'état visuel de l'Organisation mondiale de la santé à la présentation. Un examen clinique, comprenant une acuité visuelle de Snellen, une réfraction, un examen du segment antérieur à l'aide d'un biomicroscope à lampe à fente et un examen du fond d'œil dilaté à l'aide d'un +90D ou +78D, a été effectué chez tous les patients consécutifs atteints de RP. Nous avons analysé les données à l'aide du SPSS (version 22), P < 0,05 RÉSULTATS: Sur les 8614 patients examinés pendant la période d'étude, 54 yeux de 27 patients diagnostiqués comme ayant une RP et âgés en moyenne de 44,1 ans ± 17,6 ans (entre 5 et 73 ans) ont constitué la population étudiée. Dix-huit (66,7 %) étaient des hommes et 9 (33,3 %) des femmes. La prévalence de la RP dans les hôpitaux était de 0,31 %. Dix patients (37,0 %) présentaient une myopie. La RP était bilatérale dans tous les cas et non syndromique. Une basse vision et une cécité bilatérales ont été constatées chez 44,4 % et 22,2 % des patients respectivement. CONCLUSION: Environ un quart des patients atteints de RP se présentant dans les cliniques de la rétine auraient un certain degré de morbidité visuelle. L'éducation des prestataires de soins ophtalmologiques et des patients sur la maladie permettrait d'améliorer la compréhension, d'encourager les visites précoces dans les cliniques, de gérer la morbidité visuelle et d'améliorer la réadaptation si nécessaire. Mots clés: Rétinite pigmentaire, Nigeria, basse vision, cécité.

Polypoidal Choroidal Vasculopathy Amongst Nigerians; A Multicenter Study.

OBJECTIVE: To investigate the prevalence and presentation of polypoidal choroidal vasculopathy (PCV) in Nigerians. METHODS: A cross-sectional, multicenter, hospital-based, descriptive study. Data were collected prospectively between January and December 2018, from consecutive patients diagnosed to have a retina disease at the general outpatient and retinal clinics of four eye departments in Nigeria. All participants had visual acuity, refraction, intraocular pressure, anterior segment examination, and dilated fundus examination. Some patients had fundus fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA). Systemic comorbidity was determined by medical history and systemic evaluation. Diagnosis of PCV was based on clinical findings, and in some patients using OCT. RESULTS: A total of 8,614 patients were seen and 15 patients (18 eyes) were diagnosed to have PCV giving a yearly hospital-based prevalence of 0.17%. The mean age at presentation was 63.27 ± 11.5 years (range 44-84 years). There were nine females (60%). The male: female ratio was 1.5:1. Twelve (66.7%) of the 18 eyes were blind, 16.7% had severe visual impairment while 11.1% had mild visual impairment. Seven eyes (38.9%) had vitreous hemorrhage. Of the 12 blind eyes, 50% had vitreous hemorrhage (P = 0.463). Nine patients (60%) had systemic hypertensive as comorbidity (P = 0.016). CONCLUSION: PCV is a cause of vision loss among Nigerians. Majority of the eyes were blind and 50% of blind eyes had vitreous hemorrhage. Since Indocyanine Green Angiography is the most appropriate imaging technology and is mostly unavailable in Nigeria, efforts should be made to address this need and improve the diagnostic accuracy.

EHR health seeking behavior of patients attending eye clinic in Southern Nigeria.

BACKGROUND: Health-seeking behavior is important as it reveals the preventive, curative, and rehabilitative actions taken by individuals to rectify perceived ill-health. AIM AND OBJECTIVES: To identify existing eye health-seeking behavior, factors influencing such behavior, and suggest ways in which the system can respond to the needs of the target population in order to reduce visual impairment and blindness. METHODS: This was a descriptive cross-sectional study; 600 respondents were interviewed using a semistructured pretested questionnaire administered to every fifth new patient attending the eye clinic of University of Calabar Teaching Hospital (UCTH) for a period of 5 months by a single interviewer. People unable to respond appropriately were interviewed alongside their caregivers. RESULTS: Poor distant vision was the most frequent ocular complaint in this study. The mean duration of complaint before presentation to any health facility was 370.65 ± 889.48 days with a range of 0-9,125 days. Nature of eye complaint was the most significant factor that determined how early respondents sought help (P < 0.001). Place of residence, nature of eye complaint, and employment status were significant determinants of the choice of place of first presentation for ocular complaints. CONCLUSION: There is need for improved eye health education and awareness for prompt presentation to an appropriate eye care professional at the onset of symptoms and even case finding for potentially blinding eye conditions.