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   Table of Contents - Current issue
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January-June 2019
Volume 27 | Issue 1
Page Nos. 1-46

Online since Thursday, July 4, 2019

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ORIGINAL ARTICLES  

Evaluation of Ocular Pain During and After Intravitreal Injection of Antivascular Endothelial Growth Factors in South-West Nigeria p. 1
Oluwatoyin H Onakpoya, Judith G Akinwande
DOI:10.4103/njo.njo_22_18  
Aim: This article determines pain scores during and after intravitreal injections in black Africans so as to make evidence-based decisions in pain management. Settings and Design: This was a prospective cohort study conducted over 16 months following institutional ethical clearance on adults scheduled for intravitreal antivascular endothelial growth factor (anti-VEGF) therapy. Materials and Methods: Age, sex, indication for therapy, presence of diabetes mellitus, anti-VEGF agent, current dose of anti-VEGF taken, and quadrant of injection were recorded. Pain was measured with visual analog scale during the procedure and 15 min, 30 min, 1 h, and 3 h after procedure. Pain intensity was classified into no pain, mild, moderate, and severe. Data were analyzed using Statistical Package for the Social Sciences version 22.0, P-value below 0.05 was considered statistically significant. Results: A total of 49 eyes of 49 patients with male-to-female ratio of 1.2:1 and mean age of 66.61 ± 11.24 years were studied. Most common indication for anti-VEGF was diabetic retinopathy (17, 34.7%) and most patients (34, 69.4%) received bevacizumab. The mean pain score during injection was 36.33 ± 23.25; this progressively decreased with time to 0.20 ± 1.42 by 3 h postinjection (P < 0.001). Six (12.2%) patients experienced no pain at all during the injection, whereas mean pain score was significantly higher in those who had bevacizumab injections (P = 0.031) and diabetes (P = 0.013). Pain was mainly mild in severity during the injection and female patients tended to have more severe pains. Conclusion: Pain during intravitreal anti-VEGF in black Africans is mild, and it resolves within 3 h of the injection.
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Retinoblastoma in Onitsha, Nigeria Highly accessed article p. 8
Sebastian N N Nwosu, Nonso E Okpala, Chinasa A Nnubia, Cyriacus U Akudinobi
DOI:10.4103/njo.njo_20_18  
Objectives: This study aims to determine the incidence, pattern, and problems of management of retinoblastoma at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Case files of all patients with histology-proven retinoblastoma between October 2012 and September 2017 were reviewed. Information obtained included age, sex, disease duration, presenting features, and treatment. Results: There were 31 patients, 14 males (45.2%) and 17 females (54.8%), who had the disease in 38 eyes; age range was 5 months to 6 years; and median was 2.4 years. Disease duration was 3 weeks to 3 years and median was 8.8 months. Seven patients (22.6%) had bilateral disease, 11 (35.5%) had the disease only in the right eye, whereas 13 (41.9%) had the disease in the left eye; 32 (84.2%) eyes had no visual potential at presentation. The most common clinical features were leukocoria in 23 (60.5%) eyes and proptosis in 20 (52.6%). While all patients with advanced disease had enucleation or modified exenteration, only 15 (48.4%) accepted chemotherapy with two completing the full course and five not returning after the first course. Five (16.1%) had distant metastasis, namely, brain 2 (6.5%) and orbit, jaw, and skull 1 (3.2%) each. Conclusions: Retinoblastoma is seen at the Guinness Eye Center at the rate of about one case in 2 months. Most patients present late with proptosis and, in some cases, fungating necrotic tumor mass with distant metastases. There is a high default rate with treatment as only two patients completed the full course of chemotherapy.
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Comparison of Ocular Complaints and Visual Acuity Among Dry-Yam Grinders and Nongrinders in Two Selected Markets in Ibadan p. 12
Matthew I Olatubi, Adesola A Ogunfowokan, Rufus O Akomolafe, Funmilola A Faremi
DOI:10.4103/njo.njo_32_18  
Background: Dry-yam grinding like any other grinding process is usually associated with a lot of dust released into the atmosphere. Aims: This study examined and compared the eye complaints of dry-yam grinders and nongrinders, and evaluates the differences in their visual acuity (VA) test scores. This was with a view of determining influence of yam powder on the eye health of the grinders. Settings and Design: The study was conducted among grinders and nongrinders in two major markets in Ibadan. The study design was ex post facto. Materials and Methods: Participants were recruited using purposive sampling technique. Data were collected using interviewer-administered questionnaire and Snellen chart. Statistical Analysis Used: Frequency, mean, independent sample t-test, and Pearson’s moment correlation were use for statistical analyses. Results: Among 252 grinders and nongrinders who participated in the study, eye complaints such as foreign body in the eye (59.5% vs 29.0%) and headache (57.9% vs 37.3%) were more prevalent among grinders compared to nongrinders. More grinders had severe eye complaints (12.7% vs 3.2%). Mean eye complaints among the grinders were 6.92 ± 4.83 compared to 3.76 ± 4.37 among nongrinders. Dry-yam grinders exposed to yam powder had significantly more eye complaints and longer duration of complaints (P = 0.01). There was a weak positive linear correlation (0.167) between the duration of exposure to yam powder and severity of eye complaints. Grinders were observed to have a significantly lower VA on both the eyes (P = 0.01). Conclusion: Dry-yam grinders have more eye complaints than nongrinders. Grinders are encouraged to conform to safety dictates, such as using appropriate personal protective equipment and go for prompt eye assessment so that possible eye morbidity can be diagnosed and treated.
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Training Teachers on Vision Screening for School Children in Low-Resource Setting in Southwest, Nigeria p. 17
Olufisayo T Aribaba, Adegboyega S Alabi, Adewumi O Alabi, Adetunji O Adenekan, Adeola O Onakoya, Folasade B Akinsola
DOI:10.4103/njo.njo_15_18  
Background: There is a growing recognition that school teachers can be trained to deliver simple health and screening services and refer children for treatment if they have health problems. Although it is recognized that teachers are not replacement for qualified health personnel, they can be trained to provide simple vision screening for school children. Aim: This article aims to determine the ability of trained school teachers to participate in the school eye screening program by testing visual acuity (VA) of the primary and secondary school children aged 5 to 15 years using the Snellen’s chart in Ifo, Ifo Local Government Area of Ogun State. Materials and Methods: This study was a population-based descriptive cross-sectional study conducted among school children aged 5 to 15 years from 20 primary and secondary schools in Ifo, Ifo Local Government Area of Ogun State. Forty teachers (two per school) were trained to use the Snellen’s chart to measure VA and categorize vision into normal or impaired using the VA of 6/9 in the better eye as cutoff. After enumeration, the visual acuities of the school children were measured using the Snellen’s chart by the teachers and compared with visual acuities measured by the research team. Results: A total of 1308 school children (574 boys and 734 girls) had their VA tested using Snellen’s chart by 40 teachers and verified by the research team. The sensitivity of the teachers’ VA testing was 73.6%, with a high specificity of 93.8% and positive and negative predictive values of 45.7% and 98%, respectively. The teachers’ VA measurements showed a moderate agreement with that of the researchers with a Kappa score of 0.525. Conclusion: This study shows that school teachers can be trained to participate in school eye health program. Their involvement can make the program cheaper to establish, ensuring sustainable and better coverage among the targeted student population.
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Correlations Between Macula Vessel Density and Macula Thickness in Early Stage of Primary Open-Angle Glaucoma p. 22
Usman Bosso Abubakar, Marchenko Ludmilla Nikolaevna, Dzhumova Marina Fedrovna, Kachan Tatsiana Vladimerovna, Dalidovich Anastasiya Aleksandrovna, Mushtina Tatsiana Anatolivna
DOI:10.4103/njo.njo_31_18  
Background: Glaucomatous optic neuropathy is associated with both structural and vascular changes. The objective of this study was to assess the possible relationship between the vascular and structural changes in the macula region in early stage of primary open-angle glaucoma (POAG). Purpose: The aim of this study was to evaluate correlations between superficial macula vessel density and parafoveal inner macula thickness in patients with early-stage POAG using optical coherence tomography angiography (OCT-A). Materials and Methods: Sixty-three patients were included in a prospective, cross-sectional study who were divided into three groups: early glaucoma (EG) group (50 eyes of 29 patients with early POAG), glaucoma suspects group (36 eyes of 21 patients), and control group (25 eyes of 13 healthy individuals). The mean age of the respective groups was 65.58 ± 9.53, 56.54 ± 9.32, and 51.62 ± 4.13. All patients underwent OCT-A scanning using RTVue-100 “Оptovue” (Optovue, Inc. Fremont, California, USA). The retina map vessel density 3 × 3 mm and retina thickness map 5 × 5 mm scans were used to obtain parameters of the macula vessel density and the parafoveal inner macula thickness, respectively. Parameters analyzed were the total, superior, inferior, nasal, and temporal superficial macula vessel densities and parafoveal inner macula thicknesses. Although area under the receiver operating characteristic curves were calculated for all available parameters, Spearman rank-order correlations were used to evaluate possible correlations between the macula vessel density and the structural changes. Results: The early glaucoma group had significant reduction in both the superficial macula vessel densities and the parafoveal inner macula thicknesses compared to the control group (P < 0.05), but parafoveal inner macula thickness parameters had higher area under the receiver operating characteristic curves. The macula density and the macula thickness parameters were positively correlated but none was statistically significant (P > 0.05). Conclusions: In early POAG, there is no statistically significant correlation between the superficial macula vessel densities and the parafoveal inner macula thicknesses using OCT-A RTVue-100. The parafoveal inner macula thicknesses are diagnostically more significant than superficial macula vessel densities.
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Incidence and Pattern of Ophthalmic Emergencies in Onitsha Nigeria p. 29
Sebastian N N Nwosu, Chinasa A Nnubia, Cyriacus U Akudinobi, Nonso E Okpala, Akunne I Apakama
DOI:10.4103/njo.njo_30_18  
Objectives: This study aims to determine the incidence and pattern of ophthalmic emergencies at the Guinness Eye Center, Onitsha, Nigeria. Materials and Methods: Cases seen as emergency at the Guinness Eye Center Onitsha over a 6-month period were reviewed. Information obtained included age, sex, disease duration, presenting features, and posttreatment visual acuity. Results: Of 4118 new patients, 144 (3.5%) presented as emergency. There were 103 (71.5%) males and 41 (28.5%) females. The age range was 6 months to 85 years, and median was 26 years. The causes were trauma, 93 (64.6%), infections, 32 (22.2%), nontraumatic uveitis, 14 (9.7%), and anatomical peculiarities, 5 (3.5%). The major clinical diagnoses were uveitis, 45 (31.3%), open globe injury, 19 (13.2%), corneal ulcer, 18 (12.5%), ocular and adnexal burns, 11 (7.6%), traumatic hyphema, 9 (6.3%), and lid laceration, 8 (5.6%). Disease duration prior to presentation ranged from 1 h to 6 weeks with a median of 10 days. Eighty nine (61.8%) required immediate surgical intervention. At presentation, 90 (62.5%) were blind in the affected eye(s), and this reduced to 40 (27.8%) posttreatment. Conclusions: Ocular injuries and infections are the commonest ophthalmic emergencies in our hospital. Ophthalmic emergencies are associated with great ocular morbidity even after treatment. Preventive measures and early presentation are advocated, too.
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Risk Factors For Work-Related Eye Injuries Among Stone Quarry Workers: A Field Report p. 33
Chinyelu N Ezisi
DOI:10.4103/njo.njo_34_18  
Objectives: To determine the prevalence, types, and risk factors for work-related eye injuries in a Nigerian population of stone quarry workers. Materials and Methods: The study was a questionnaire-based cross-sectional ophthalmic survey of stone quarry and stone processing industry workers in Abakaliki, south-eastern Nigeria. Data on participants’ socio-demographics, job characteristics, clinical ophthalmic symptoms and previous work-related eye injuries were collected and analyzed using descriptive and comparative statistics. Statistical significance was indicated by P < 0.05. Results: The participants (n = 384; males 158, females 226) were aged 32 ± 11.8 SD years (range, 14–68 years). Of them, 140 (36.5%) reported previous work-associated eye injury. Industrial injuries accounted for uniocular loss of vision in 2 (0.52%) of these workers. The most common eye injury was Blunt ocular trauma 106 (58.2%). The majority 379 (98.7%) of the workers did not use eye protective devices. Risk factors for work-related eye injury included unprotected eye exposure 85 (46.2%) for quarry sites and 117 (62.2%) for stone processing plant sites, following nonuse of eye protective devices, time of the day: 99 (53.8%) quarry site and 103(57.2%) stone processing site, occurred in the afternoon representing the highest time of occurrence. Occurrence of eye injury was found to be higher in the younger age group, male gender working in the stone processing plant, being a nontechnical worker, afternoon duty, and nonutilization of personal protective eye device (PPED). Conclusion: Adequate health education, emphasizing these risk factors, should be mandatory while comfortable and standard eye protective devices should be enforced for prevention of work-related eye accidents and work environment should be modified to ensure safety of workers.
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CASE REPORTS Top

Unilateral Traumatic Optic Nerve Avulsion: A Case Report p. 41
Catherine U Ukponmwan, Mieriumhhe O Olowolaiyemo, Dumebi H Kayoma
DOI:10.4103/njo.njo_29_18  
Optic nerve avulsion is a rare presentation of ocular injury. We present a case of a male mechanic who sustained luxation of the globe and optic nerve avulsion as a result of ocular injury from a car antenna while at work. He became blind in that eye with a final visual acuity of no perception of light. The use of protective goggles at work is recommended.
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Unilateral Isolated Internal Ophthalmoplegia − Idiopathic Etiology p. 44
Sowmya Raveendra Murthy, Priyanka Sudhakar
DOI:10.4103/njo.njo_27_18  
Unilateral internal ophthalmoplegia is rare to occur as an isolated entity. Herein, we report a case of a young boy with isolated unilateral internal ophthalmoplegia, that is, mydriasis with absent near response without external ophthalmoplegia. There was neither light-near dissociation nor supersensitivity to dilute pilocarpine. Neuroimaging including magnetic resonance imaging and magnetic resonance angiography was normal. Follow-up for over 2 years showed no change in pupil size and reaction. The internal ophthalmoplegia was presumed to be idiopathic in nature.
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