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   Table of Contents - Current issue
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July-December 2019
Volume 27 | Issue 2
Page Nos. 47-101

Online since Friday, February 7, 2020

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EDITORIAL COMMENTS  

Nigerian Journal of Ophthalmology Editorial Comments, July-December 2019 Edition p. 47
C. O Bekibele
DOI:10.4103/0189-9171.277889  
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ORIGINAL ARTICLES Top

Visual Outcome of Phacoemulsification with Multifocal Toric Intraocular Lens Implantation in “With the Rule” and “Against the Rule” Corneal Astigmatism: A Case Series p. 48
PK Chaturvedi, Jaya Kaushik, Vijay Mathur, Pradeep Kumar, Ishan Aggrawal
DOI:10.4103/njo.njo_10_19  
Phacoemulsification with implantation of multifocal toric intraocular lens (IOL) is now a well-established modality to treat cataract and corneal astigmatism in a single surgical procedure. The visual outcome of these multifocal toric IOLs has been deliberated in this study in corneas with preexisting With the Rule (WTR) and Against the Rule (ATR) astigmatism. Material and Method: Patients of either sex with diagnosed cataract in the age group 40–65 years and preoperative anterior corneal surface astigmatism between ±1.0 D and ±3.0 D suitable to be implanted with multifocal toric IOL were included in this study. The subjects were divided in WTR (n = 17) and ATR (n = 13) groups. After undergoing cataract surgery, their unaided distant visual acuity (UCDVA) and unaided near visual acuity (UCNVA) in log MAR scale were recorded on day 1, 1 week, 4 weeks, 8 weeks, and 12 weeks postoperatively. At 8 weeks and 12 weeks postoperatively, keratometry and refraction readings were also recorded and astigmatism was measured. Observation and Result: Mean UCDVA of both groups together at 4 weeks post-op was 0.088 (SD 0.098). At 8 weeks and 12 weeks postoperative period, the results were similar with mean UCDVA: 0.030 (SD 0.068). UCDVA was significantly better in ATR group group (0.014 ± 0.014) when compared with WTR group (0.042 ± 0.01). UCNVA was 0.33 ± 0.012 for both groups together. In WTR group, mean UCNVA was 0.34 ± 0.08 and in ATR group it was 0.31 ± 0.01 at 12 weeks postoperative period and had no statistically significant difference.
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Microbial Contamination of Topical Therapeutic Ophthalmic Medications in Cape Coast Metropolis, Ghana p. 56
Samuel Kyei, Raphael Mensah, Godwin Kwakye-Nuako, Emmanuel Kwasi Abu
DOI:10.4103/njo.njo_38_18  
Objectives: The study sought to evaluate the microbial contamination of in-use therapeutic ophthalmic medications in the Cape Coast Metropolis. Methods: Residual content of topical therapeutic ophthalmic medications were retrieved from patients who were prescribed these medications for at most 2 weeks in the Cape Coast Metropolis. Yet to be dispensed medication of the same batches were obtained from the dispensaries of the same facilities where the patients were prescribed the medications, to serve as controls. The sample was inoculated on different routine laboratory culture media and the microbes isolated were identified using standard microbiological techniques. Antimicrobial susceptibility test was performed to ascertain the resistant status of the isolates. Results: A total of 145 samples were collected, of which 100 medications were from patients using these for the treatment of various conditions whereas 45 were yet to be dispensed medications from the dispensaries. The bacteria identified were Pseudomonas spp., Klebsiella spp., Bacillus spp., Staphylococci aureus, other Staphylococci spp., Salmonella spp., Escherichia coli, Enterobacter spp., Serratia spp., Shigella spp., and Proteus spp. For fungi, Aspergillus spp., Penicillium spp., Cladosporium spp., and Alternaria spp. were found. The most occurring bacteria was Pseudomonas spp. and Aspergillus spp. was the most occurring fungi. None of the medications retrieved from the dispensaries was contaminated as they showed no positive cultures. All bacterial isolates showed 100% susceptibility to gentamicin only but proved resistant to other conventional antibiotics. Some of the fungal isolates were resistant to Fluconazole and Ketoconazole at lower doses of 0.5 mg/mL but susceptible to Ketoconazole at the high dose of 15 mg/mL. Conclusion: The degree of contamination found in the in-use ophthalmic medications was higher than the recommended safe contamination levels. Most of the microbes were resistant strains of bacteria with Pseudomonas spp. being the most occurring resistant strain. Aspergillus spp. was the most common fungal contaminant.
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Common Forms of Strabismus in a Tertiary Eye Clinic in Southwest Nigeria p. 62
Bolutife A Olusanya, Mary O Ugalahi, Olusola Ayeni, Olufunmilayo I Fawole, Aderonke M Baiyeroju
DOI:10.4103/njo.njo_8_19  
Background: Strabismus occurs worldwide and is associated with undesirable psychosocial impact and negative social prejudice. However, there is a dearth of information on the different subtypes of strabismus in Nigerian patients. The aim of this study is to describe the common forms of strabismus among patients of an eye clinic in southwestern Nigeria. Methods: We retrospectively reviewed all new patients seen at the eye clinic of our hospital between January 1999 and December 2008. Patients with a diagnosis of strabismus were identified from the clinic registers and their case records were reviewed. Information on age, gender, cause, and type of squint as well as associated ocular/systemic disease was retrieved from the case records. Results: A total of 240 patients had strabismus, giving a relative frequency of 1.2%. Mean age of patients with strabismus was 19.8 (±19.7) years while male-to-female ratio was 0.98:1. Esotropia (53.8%) was more common than exotropia (44.2%). The mean age of patients with esotropia was 12.8 years compared with 27.9 years for patients with exotropia (P < 0.001). Sensory strabismus was the most common form of strabismus, occurring in 83 (34.5%) patients, while accommodative esotropia was found in only 5.8% patients. Conclusion: The relative frequency of strabismus in this study is fairly similar to other reports from Nigeria and Africa. Secondary strabismus was quite common whereas primary forms of strabismus such as accommodative esotropia appear to occur less frequently among our patients in comparison to Caucasian populations.
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A Survey of Teachers’ Knowledge, Attitudes, and Practices Related to Pupils’ Eye Health and School-Based Eye-Health Services p. 68
Nkiruka N Okoloagu, Obiekwe Okoye, Stella Onwubiko, Chukwuemeka Eze, Boniface Eze, Chimdi Chuka-Okosa
DOI:10.4103/njo.njo_10_18  
Objective: This article aims to assess the knowledge, attitudes, and practices of primary school teachers (PSTs) in relation to their pupils’ eye health and school-based eye health services. Materials and Methods: This was a descriptive cross-sectional questionnaire-based survey of PSTs in the Nkanu West Local Government Area, Enugu State, Nigeria. The study’s instrument was a pilot-tested, researcher-administered 16-item questionnaire with subscales measuring participants’ sociodemographics, and knowledge, attitudes, and practices related to their pupils’ eye health and school-based eye health services. Data were analyzed using the Statistical Package for the Social Sciences software for Windows, version 18.0. Descriptive statistics yielded frequencies, percentages, and proportions. Analytical statistics included the Chi-square test, for categorical variables, and Student’s t test for continuous variables. A P-value <0.05 was considered statistically significant. Results: There were 207 participants, including 40 (19.3%) males and 167 (80.7%) females (M:F = 1:4.2) aged 42.2 ± 8.67 SD years. Only 31 (15.0%) participants had good knowledge of their pupils’ eye health and school-based eye health services, and almost half (48.0%) obtained their information from family and friends. Two hundred (96.6%) participants had a positive attitude and 45.4% reported good practices. Conclusion: The majority of the PSTs had poor knowledge and practices related to their pupils’ eye health and school-based eye health services. However, most of the teachers displayed a positive attitude toward their pupils’ eye health and school-based eye health services. A structured health education workshop is advocated to correct the gaps in teachers’ knowledge and practices.
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Prevalence and Causes of Visual Impairment Among Nigerian Children Aged 3 to 5 Years p. 76
Tokunbo S Obajolowo, Dupe S Ademola-Popoola, Fatai O Olatunji
DOI:10.4103/njo.njo_2_19  
Objectives: This article determines the prevalence and causes of visual impairment (VI) in children aged 3 to 5 years in Ilorin East Local Government Area of Kwara State, Nigeria. Methods: The study was a descriptive, cross-sectional, school-based study of 464 children enrolled by multistage sampling. The sample size was calculated based on the prevalence of ocular morbidity of 19.9% found in a previous Ilorin study by Ayanniyi et al. (Causes and prevalence of ocular morbidity among primary school children in Ilorin, Nigeria. Niger J Clin Pract 2010;13:248-53) using the Fisher’s formula. Visual acuity (VA) of selected children was assessed using the Lea symbols chart. Children meeting the referral criteria of VA worse than 20/30 (6/9.5), two lines difference in VA between the eyes, visible anterior and posterior segment anomalies, and untestable children with the Lea symbols thereafter had a comprehensive eye examination. Results: Seventy (15.1%) of the children screened were 3 years’ old, 176 (37.9%) were 4 years, whereas 218 (47%) were 5 years’ old. Nine hundred twenty-eight eyes of 464 children were screened; 707 (76.2%) eyes in 332 (71.6%) children had VA 6/9.5 or better, whereas 184 (19.8%) eyes in 112 children (24.1%) had VA worse than 6/9.5 and 37 (4%) eyes in 20 children (4.3%) were untestable. An identifiable cause of VI was found in 36 eyes of 23 children, giving a prevalence of 5%. The causes of VI were myopia (2.5%), astigmatism (1.8%), hypermetropia (0.2%), anisometropic amblyopia (0.2%), and strabismus (0.2%). Conclusion: The prevalence of vision impairing conditions in this age group underscores the importance of preschool vision screening to ensure early detection and treatment to prevent the permanent damage of amblyopia.
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Accuracy of Refractive Outcome Using Optical Low Coherence Reflectometry in Silicone Oil-Filled Eyes Undergoing Intraocular Lens Implantation with Silicone Oil Removal p. 82
C. K Minija, P. Mahesh Shanmugam, K. Padmaja, Nidhi Dubey, Rajesh Ramanjulu, K. C Divyansh Mishra
DOI:10.4103/njo.njo_7_19  
Aim: To assess the accuracy and consistency of intraocular lens (IOL) power calculation using optical low coherence reflectometry device (OLCR), LENSTAR LS-900, in silicone oil-filled eyes undergoing combined IOL implantation and silicone oil removal (SOR). Setting: Sankara Eye Hospital, Bangalore, Karnataka, India. Design: Retrospective study. Method: This study comprised 49 silicone oil-filled eyes of 47 patients who underwent combined IOL implantation with SOR. All patients were measured with OLCR before performing phacoemulsification and IOL implantation in silicone oil mode. The predicted refraction as calculated with OLCR was correlated with the postoperative spherical equivalent. Results: The mean deviation of the spherical equivalent was −0.74 diopters (D). The mean difference between predicted refraction and postoperative spherical equivalent was −0.34 D. The mean axial length of the eyes was 23.53+1.86 (range 21.49–30.03 mm). Conclusion: OLCR is a safe device that provides precise biometry and accurate IOL power calculation in silicone oil-filled eyes.
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Ultrasonographic and Clinical Correlation of Optic Disc Cupping − A Report p. 86
Sowmya Raveendra Murthy, Ankita Sharma
DOI:10.4103/njo.njo_4_19  
Presence of total cataract precludes the view of optic nerve head (ONH) and makes diagnosis of glaucoma difficult in presence of normal intraocular pressure. So, we studied the reliability of B scan in detecting ONH cupping and correlating with clinical findings. Aim: We aimed to note the diagnostic value of ultrasound echography (B scan) in determining the ONH cupping in patients with dense cataract. Methods: We included 195 eyes with total cataract and correlated the cupping noted in these eyes with clinical cupping noted postoperatively. Results: Clinical cupping was present in 50 patients and B scan could predict it in 13 patients. The sensitivity of B scan in predicting ONH cupping was found to be 16% (95% confidence interval 0.17–0.29) with specificity of 97.8% (95% confidence interval 0.94–0.99). A decrease in cup:disc ratio of 0.6 or less led to a decrease in sensitivity. Conclusions: Our study suggests that ultrasound echography may provide a qualitative assessment of the ONH cupping in glaucoma in some cases wherein there is media opacity such as cataract that precludes view of the ONH during fundoscopy. B-scan ultrasonography is done as a part of routine preoperative evaluation in cases where there is dense cataract and helps identify associated normal pressure glaucoma.
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CASE REPORTS Top

Isolated Corneal Chemical Eye Injury Following Splash From Plantain Stem Sap: A Case Report and Review of Literature p. 90
Bassey A Etim, Affiong A Ibanga, Dennis G Nkanga, Martha-Mary E Udoh
DOI:10.4103/njo.njo_13_18  
Purpose: This article reports a case of corneal injury following a splash from the sap of plantain stem. Case Report: A 54-year-old female presented with a history of plantain stem sap splash into her right eye of 7-h duration with associated ocular pain, tearing, photophobia, and blurring of vision. On ocular examination, visual acuity was 6/18 OD; slit lamp examination revealed a well-delineated fluorescein-positive corneal epithelial defect with associated mild stromal edema. Left eye examination was essentially normal. She washed her face and eyes with water immediately after the splash and further had eye irrigation by attending ophthalmologist on presentation. The patient was immediately commenced on prednisolone, moxifloxacin, cyclopentolate, and ascorbate eye drops and tetracycline ointment. Corneal edema resolved in 4 days whereas the epithelial defect was completely healed by day 12 and visual acuity was restored to 6/6. Conclusion: Although farmers are exposed daily to various types of eye injuries from parts of plants, this report highlights corneal eye injury following plantain stem sap splash in a farmer who did not use protective eye goggles while working in the farm and how prompt institution of treatment can sight loss and loss of corneal integrity.
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Superior Segmental Optic Nerve Hypoplasia Presenting With Exotropia and Nystagmus – Case Report p. 94
Sowmya Raveendra Murthy, Khushboo Gupta, Nivedhitha Nikhil
DOI:10.4103/njo.njo_21_18  
Superior segmental optic nerve hypoplasia (SSONH) is a developmental disorder of the disc with unclear pathogenesis causing inferior altitudinal field loss. Dissociated vertical deviation (DVD) usually occurs with unequal visual input owing to early strabismus like infantile esotropia. Occurrence of DVD in a case of SSONH as a presenting complaint has never been reported earlier. We report a case of a young boy with SSONH presenting with exotropia and DVD. Our case shows the occurrence of dissociated strabismus like DVD in child with inferior altitudinal field loss owing to SSONH which is noted as a rare association
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Is Couching Rare in the Pediatric Age Group? A Report of Bilateral Couching in a Child p. 97
Mary O Ugalahi, Anibe S Ata, Bolutife A Olusanya, Aderonke M Baiyeroju
DOI:10.4103/njo.njo_6_19  
Background: Couching, an ancient procedure for cataract surgery, is unfortunately still being practiced in many developing countries. There are several reports of couching in adult populations; however, literature is sparse on its occurrence in children. Case report: We report a case of a 10-year-old boy who had bilateral couching on account of congenital cataracts due to presumed congenital rubella syndrome. The patient had initially presented to our clinic during neonatal period and was scheduled for surgery. Unfortunately, surgery was not performed due to various reasons which were either patient related or health system related. He represented to the eye clinic 6 years post-couching with complaints of poor vision. Conclusion: This report aims to highlight the fact that couching is, indeed, being performed on children’s eyes, especially as a consequence of inefficiencies in the eye healthcare delivery system.
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LETTER TO THE EDITOR Top

Ophthalmology in Nigeria: Challenges and Success p. 100
Kehinde Fasasi Monsudi, Dupe S Ademola-Popoola, Abayomi Olusola Ayodapo
DOI:10.4103/njo.njo_14_18  
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