Transactions of the Ophthalmological Society of Nigeria
The Transactions of the Ophthalmological Society of Nigeria an Official journal of the Ophthalmological Society of Nigeria publishes proceedings from the annual congress of the Society. They comprise of referenced abstracts of presentations during the congress. The scope of articles include clinical, laboratory and community medicine, basic medical sciences, medical technology, as well as the economics and management of health care delivery, especially in the African environment as they relate to the eyes. Articles are considered on the basis of subspecialty of Ophthalmology affected, including but not restricted to cornea and anterior segment, glaucoma, low vision, orbit and oculoplasty, vitreoretinal, neuro-ophthalmology, Paediatric ophthalmoloy, and public health ophthalmology.
Real World Experience of Intravitreal Faricimab for Retinal Vascular Disease in Ibadan
BACKGROUND Retinal vascular diseases constitute a leading cause of global visual impairment.1 This challenge is amplified in developing countries like Nigeria, where the intersection of increasing diabetes prevalence and limited access to subspecialty retinal care creates a growing unmet medical need.2 Evidence-based treatment guidelines from the American Academy of Ophthalmology have established intravitreal Anti-Vascular Endothelial Growth Factor (Anti-VEGF) agents as the standard of care for centre-involving Diabetic Macular edema with vision loss3, Retinal Vascular Occlusion-related macular edema4, and neovascular Age-related Macular Degeneration5. Nevertheless, the treatment paradigm faces practical limitations due to the frequent injection schedules required by current anti-VEGF monotherapies, resulting in considerable patient and healthcare system burden. Faricimab (Vabysmo®) introduces a breakthrough bispecific approach by simultaneously targeting Vascular Endothelial Growth Factor-A (VEGF-A) and angiopoietin-2 pathways.6 This dual mechanism reduces vascular permeability and neovascularization while stabilizing blood vessels and decreasing VEGF-A sensitivity, achieving longer treatment intervals than conventional anti-VEGF agents.7-11 Following faricimab's recent introduction in Nigeria, we present our initial real-world experience at University College Hospital, Ibadan. METHODS A retrospective case series of patients who received intravitreal faricimab injections for retinal vascular diseases at the Department of Ophthalmology, University College Hospital, Ibadan. Patients’ demographic characteristics, diagnosis, baseline and follow-up best corrected visual acuity (BCVA), optical coherence tomography findings, number of injections, and adverse events were obtained from the patients’ records and analysed. Cases included diabetic macular edema (DME), central retinal vein occlusion with macula edema (CRVO + ME), and choroidal neovascular membrane (CNVM) from wet age-related macular degeneration. RESULTS Ten patients were treated with faricimab, including 4 cases of DME, 3 cases of CRVO with macular edema, and 3 cases of wet AMD with CNVM. Their ages ranged from 56 to 79 years. Visual acuity (VA) improvements were observed after the first injection in 8 cases. Notable outcomes included: Case 1 (CRVO) - VA improved from counting fingers to 6/12; Case 2 (CRVO) - VA improved from counting fingers to 6/18; Case 7 (CNVM) - VA improved from 6/60 to 6/12 after switching from bevacizumab; Case 10 (CNVM) - VA improved from 6/36 to 6/12 after failed bevacizumab and aflibercept therapy. Complete resolution of macular edema and subretinal fluid was achieved in 8 cases after the first injection and all cases after the third injection. Two cases (20%) developed sterile intraocular inflammation with elevated intraocular pressure (28-40 mmHg) occurring 1-2 weeks after the third injection, which resolved with topical anti-inflammatory and anti-glaucoma medications. CONCLUSION Real-world application of faricimab in Ibadan demonstrates significant therapeutic potential for retinal vascular diseases, with patients achieving rapid visual and anatomical improvements. Careful surveillance for inflammatory responses remains essential, particularly after the second injection. Region-specific randomized controlled trials are needed to establish evidence-based treatment algorithms for our population.
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Interrelationship between glycated hemoglobin and fasting blood sugar on status of diabetic retinopathy among type 2 diabetic patients at a tertiary hospital in northwestern Nigeria
INTRODUCTION Diabetic retinopathy (DR) is the most common cause of preventable blindness in the world's adult working population.1 More than 60% of patients with type 2 diabetes mellitus (DM) will develop some degree of retinopathy after 20 years with the disease.2 DR is the most common complication of DM and is expected to increase substantially by 2045.3 Glycated hemoglobin (HbA1c) reflects the average blood glucose level over about three months, but may mask clinically significant glycemic fluctuations.4 Current screening methods may be missing those at highest risk of DR. Glycemic gap refers to the difference between the estimated average glucose derived from HbA1c and the measured fasting blood sugar (FBS). Glycemic gap can act as a useful surrogate marker of glycemic fluctuation.5 METHODS The study was a hospital-based observational cross-sectional study involving 329 patients selected consecutively. The study population were type 2 diabetic patients attending routine diabetic clinic at Aminu Kano Teaching Hospital (AKTH). Patients with chronic kidney disease and media opacities were excluded. All participants underwent: Fasting blood samples for HbA1c and FBS, collected at the same time Comprehensive ophthalmic examination including dilated fundoscopy and fundus photography Early Treatment Diabetic Retinopathy Study (ETDRS) grading of DR Calculation of Glycemic Gap = FBS - [(28.7 × HbA1c) – 46.7]5 RESULTS The participants’ ages ranged from 26 to 77 years with a mean of 53.78 ± 11.58 years. The prevalence of diabetic retinopathy was 28.9%. The mean glycemic gap for the entire study population was 10.0 mg/dl, with a range of -63.5 mg/dl to +52.8 mg/dl. Among the participants, 187 (56.8%) had a positive glycemic gap and 142 (43.2%) had a negative glycemic gap. There was a significant association between the level of glycemic gap and the presence of diabetic retinopathy (p = 0.015). Patients with positive glycemic gap were significantly more likely to have diabetic retinopathy compared to those with negative glycemic gap (Table 1). DISCUSSION The prevalence of DR in this study is comparable to the global prevalence6 and the prevalence figures from a pooled analysis of various hospital-based studies in Africa7 and in Enugu8 and Katsina9 states. The mean glycemic gap was lower than that reported by Sonoda10 and slightly higher than that reported by Caprnda11. This may be due to differences in the study design. A significant association was found between glycaemic variability (GV) measured as glycemic gap and diabetic retinopathy, aligning with findings from several recent studies. 5,12,13,14 However, studies by Sonoda10 and Caprnda11 reported no association. This discrepancy may be attributed to differences in the methods used to evaluate GV, as both studies utilized the mean amplitude of glycemic excursions index. A positive glycemic gap drives DR through repetitive oxidative stress and endothelial dysfunction, triggering pericyte loss, VEGF upregulation and blood-retinal barrier breakdown. CONCLUSION This study showed a significant association between glycemic gap as a marker for glycemic variability and diabetic retinopathy.
Clinical features of patients presenting with choroidal melanoma at Eye Foundation Hospital Ikeja, Lagos, Nigeria
BACKGROUND Ocular melanomas are the most common primary intraocular tumors in adults, with the choroid being the most frequently affected uveal site.1,2 Their incidence is highest among populations of European ancestry and lowest among Asian and African populations.1,2 Clinical presentation varies depending on tumor location. Diagnosis is typically non-invasive, relying on slit-lamp examination, fundus evaluation, and ultrasonography.3 This case series describes four patients seen between 2010 and 2025 with choroidal melanomas, highlighting their clinical presentations, fundus findings, and ultrasonographic features (A- and B-scan). CASE SERIES Case 1 A 58-year-old female of British (Caucasian) origin presented with a 6-week history of progressive vision loss in the right eye. Visual acuity (VA) was 3/60 (right) and 6/6 (left). Fundoscopy revealed a large pigmented mushroom-shaped lesion in the inferotemporal quadrant, within 2 disc diameters of the optic disc, measuring approximately 8 disc diameters, with adjacent subretinal fluid. Cup–disc ratio was 0.2. The left fundus was normal. Ultrasound B scan showed an inferotemporal dome-shaped mass with low reflectivity on A-scan and orbital shadowing.(Table 1, Figure 1a) A diagnosis of right choroidal melanoma was considered, and patient was referred to an ocular oncology center in her home country. Case 2 A 46-year-old male of African descent presented with complaints of an overhanging shadow in the superior visual field of the right eye. VA was 6/6 bilaterally. Fundoscopy showed a dome-shaped hyperpigmented inferonasal mass overlapping the optic disc, measuring 8 disc diameters, with perilesional orange pigments but no sentinel vessels or subretinal fluid. The left fundus was normal. Ultrasound revealed a mushroom-shaped mass with homogeneous opacity on B-scan, low internal reflectivity on A-scan, choroidal excavation, and orbital shadowing.(Table 1, Figure 1b) A diagnosis of right choroidal melanoma was made, and the patient was referred to the oncology unit of a tertiary hospital. Case 3 A 45-year-old female of African descent presented with reduced vision in her left eye. VA was 6/6 (right) and 6/18 (left). Fundoscopy showed a large parapapillary hyperpigmented mass (>12 disc diameters) in the nasal and superonasal quadrants, with indistinct margins and extensive subretinal hemorrhage obscuring the optic disc. Ultrasound demonstrated a large dome-shaped choroidal mass with low reflectivity, choroidal excavation, orbital shadowing, and associated exudative retinal detachment.(Table 1, Figure 1c) A diagnosis of left choroidal melanoma was considered, and the patient was referred to the teaching hospital’s ocular oncology service. Case 4 A 29-year-old male of African descent presented with a 1-month history of progressive visual loss, diplopia, and floaters in the right eye. He had previously received 3 intravitreal bevacizumab injections at another facility without improvement. His initial diagnosis was not available for review. VA was 6/12 (right) and 6/6 (left). Fundoscopy showed a large superotemporal choroidal mass overlapping the optic disc (~10 disc diameters), with associated exudate and exudative retinal detachment. The left eye was normal. Ultrasound revealed a large dome-shaped choroidal mass with exudative detachment. A-scan showed low internal reflectivity with choroidal excavation and orbital shadowing.(Table 1, Figure 1d) Right choroidal melanoma was diagnosed, and a Positron Emission Tomography (PET) scan was requested, but the patient was lost to follow-up. DISCUSSION This case series highlights the rarity of choroidal melanoma in our setting: only four patients were diagnosed over 15 years (2010–2025). This reflects the lower incidence of ocular melanoma in African populations, possibly due to the protective effect of increased choroidal melanin in darker skin.4,5 Ultrasonography was the principal diagnostic tool, with consistent findings across cases: dome- or mushroom-shaped masses, low internal reflectivity on A-scan, homogeneous opacities on B-scan, choroidal excavation, orbital shadowing, and frequent association with subretinal fluid or exudative retinal detachment.6,7 Outcomes of management of reported cases were not available to the authors.The low awareness of intraocular tumors in Africa may delay diagnosis.8,9 Increased clinical vigilance is therefore warranted, even in populations with low incidence.
Prevalence of Common Ocular Disorders Among Secondary School Students in Yola North, Adamawa State, Nigeria
Introduction: Early eye screening is recommended for detecting ocular disorders in children. Schools offer a strategic platform for such public health interventions. Up to about 26% of school-aged children experience visual impairment, emphasizing the need for the timely identification and treatment of eye disorders among this population. Aim: This study assessed the prevalence and pattern of common ocular disorders among secondary school students in Yola North Local Government Area, Adamawa State, Nigeria. Methods: A school-based cross-sectional study was conducted from January to February 2024, utilizing a multistage sampling technique. Students from both public and private schools were recruited. Eye examinations included visual acuity assessment, external ocular examination using a pen torch, and fundal examination using a direct ophthalmoscope. Data were analyzed using IBM SPSS version 26. Results: Out of 460 students screened 94% were under 18 years (mean age of 14.2 ± 2.3 years) and 50.4% were female. The most prevalent ocular conditions were allergic conjunctivitis 176(38.3%), bacterial conjunctivitis 59(12.8%), and refractive error 18(3.9%). Fundus abnormalities included suspicious discs 23(5%), glaucomatous changes- 3(0.7%). Referral uptake was 57.4%. Conclusion: A significant burden of preventable ocular disorders exists among secondary school students in Yola North, with allergic conjunctivitis being the most prevalent condition and referral uptake for specialist care is suboptimal.
Factors associated with uptake of second eye cataract surgery amongst patients attending University College Hospital, Ibadan, Nigeria
Purpose: To identify the factors affecting the uptake of second eye cataract surgery in patients with bilateral visually significant cataract with a view to making appropriate recommendations for improved uptake. Methods: This was a cross-sectional and hospital-based study, carried out at the Eye clinic of the University College Hospital (UCH), Ibadan, Nigeria. A total of 427 patients with bilateral age-related cataract, that had undergone cataract surgery in at least one eye, were recruited and administered a questionnaire to identify factors associated with uptake of second eye cataract surgery (SECS), as well as the barriers to uptake. Data was analyzed using IBM-SPSS version 25 and summary statistics are presented using frequency tables, means and rates. Chi–square test was used to test for associations between qualitative variables while Student’s T-test was used for quantitative variables. Results: Only 124 (29.0%) underwent SECS within 2 years of the first eye cataract surgery (FECS) with an average interval of 12 ±7.4 months. Factors associated with uptake of SECS include having formal education (p=0.004) and counseling patients on the benefits of SECS and risk of hypermaturity- related complications (p<0.001). While the barriers include insufficient income (p<0.001) and telling patients the cataract is not mature (p=0.003). Conclusion: Formal education and counselling patients on the benefits of SECS may improve the uptake of SECS while informing patients that “Cataract is not mature” may discourage uptake of SECS and should be avoided by ophthalmic professionals after FECS.
Ocular manifestations of connective tissue diseases in patients attending clinics in Aminu Kano Teaching Hospital, Northwestern Nigeria
Purpose: The study determined the ocular manifestations of connective tissue diseases in Nigerian patients. Methods: A single-centre cross-sectional study conducted at Aminu Kano Teaching Hospital, Kano, northwestern Nigeria. Study participants were patients aged 18years and above who had already been diagnosed with connective tissue diseases (CTDs). Participants were interviewed and examined; and data was collected using a semi-structured questionnaire. Data obtained was analysed using IBM SPSS version 22, Armonk, NY. Results: A total of 140 patients were recruited and examined. Of these, 123 (87.9%) were females, and 17 (12.1%) were males (M:F =1:7 ), with mean age of 37.1±13.9 years. Majority of them (86.4%) had ocular manifestations. The commonest type of CTDs with ocular manifestation was rheumatoid arthritis (43.8%), followed by systemic lupus erythematosus (28.5%) and systemic sclerosis (6.6%). Among the patients with ocular manifestations, 70 (57.9%), presented with dry eye disease, 17 (14.0%) had cataract, 10 (8.3%) had episcleritis and 7 (5.8%) had keratitis. Dry eye syndrome (55%), cataract (13.3%) and episcleritis (5.0%) were found to be more frequent in patients with rheumatoid arthritis. There was a statistically significant association between the presence of CTD-related ocular manifestations and female gender (p<0.001). Conclusion: Dry eye syndrome, episcleritis, keratitis and cataract were frequent ocular manifestations of CTDs. Periodic ophthalmic examination is important for patients with CTDs.
Effectiveness of a short message reminder on compliance to follow-up after cataract surgery in an outreach setting in Zamfara State, Nigeria: a randomized controlled trial
BACKGROUND Cataract outreach programs aim to deliver cataract surgical services to individuals with cataracts in their communities.1 Poor follow-up compliance has been one of the major drawbacks of outreach surgery.2 Various interventions were found to improve follow-up compliance.3 The aim of this study was to assess whether a short message service (SMS) reminder would improve compliance with post-operative follow-up and to determine the visual outcome of cataract surgery in patients operated on in an outreach setting. METHODS The study was a randomized controlled trial, registered with the Pan African clinical trials registry (RCT-PACTR20231075160700). Ethical clearance was obtained from the Research and Ethics Committee of the National Eye Centre Kaduna and administrative permission was also obtained from the authorities of the Ministry of Health Zamfara State. Written informed consent was obtained from each patient. A total of 125 patients with cataract were recruited. Block randomization was conducted, and randomization codes were generated using Research Randomizer computer software (www.randomiser.org). Sixty-two participants were randomly allocated to the SMS intervention group and 63 participants to the control group. Automated SMS reminders were sent using a Bulk SMS software platform on each follow-up visit. A semi-structured interviewer-administered questionnaire was administered. The data collected included socio-demographic information, follow up visit at day one, weeks one, six and twelve after surgery respectively; pre-operative and post-operative follow up examination findings including visual acuity, anterior segment and fundal examination of all the patients on the scheduled follow up visit. RESULTS The age range of participants was between 30 and 87 years, with a mean of 63.00±8.99 years. The sociodemographic characteristics of study participants in the 2 groups were similar (Table 1). Seventy-three (58.4%) of the patients owned a mobile phone, and 52 (41.6%) lived with phone owners; there was no significant difference in phone ownership status between the control and study groups (p > 0.05). All the participants turned up for follow-up on day one and week one. But there was a decline in attendance at the subsequent visits at six and twelve weeks. There was no statistically significant difference with respect to follow-up compliance between the groups (Table 2). Among the participants, 22(35.5%) attended the 12 week follow-up in the intervention and 15(23.8%) in the control groups respectively. There was no statistically significant difference in follow-up between the intervention and control groups (p > 0.05). DISCUSSION Socio-demographic distribution between the study groups was similar; this enables more reliable comparison of outcomes. Access to mobile phones was similar, indicating that SMS interventions were practical and well-suited for this setting. The decline in follow-up highlights the challenges of maintaining long-term follow-up in an outreach setting. Combining SMS reminders and additional incentives has been shown to improve follow-up.3 All the participants that completed the study achieved good visual acuity. CONCLUSION The study evaluated whether an SMS reminder would increase follow-up compliance following cataract surgery in an outreach setting. The intervention group’s compliance was slightly higher; but the difference was not statistically significant. This suggests that SMS reminders alone may not be sufficient to ensure long-term follow-up.
Modelling the Factors Associated with Ophthalmic Health Seeking Behaviour and Health Service Utilization among Patients Attending National Eye Centre, Kaduna
BACKGROUND Health is a fundamental human right, with the highest attainable health standards considered a critical global social goal. Poor health significantly impacts households economically, exacerbating poverty, increasing debt, and reducing essential consumption due to productivity losses and out-of-pocket (OOP) healthcare expenses.1,2 Inflation, an economic phenomenon affecting various sectors, including healthcare, influences healthcare utilization patterns.3 In recent years, inflation has surged, affecting healthcare prices and overall health spending. Health‑seeking behaviour is the activity undertaken by individuals who perceive to have a health problem for the purpose of finding an appropriate remedy. Visual impairment is a significant public health concern globally, affecting at least 2.2 billion people.4 The utilization of eye care services is influenced by their availability, affordability, and accessibility.5,6 This study aims to model the factors associated with ophthalmic health-seeking behaviour and health service utilization among patients attending the National Eye Centre, Kaduna (NECK). METHODS The study was a hospital-based, cross-sectional study carried out at NECK. Ethical approval was obtained from the National Eye Centre’s research and ethics committee and informed consent obtained from study participants. Participants were patients aged 18 years and older attending the hospital. A sample size of 186 was determined, and systematic random sampling was employed to select the study participants. Data was collected using a semi structured, interviewer-administered questionnaire. The data included socio-demographic information, economic factors: health insurance status, transportation costs, and out-of-pocket expenses; knowledge about common eye conditions, awareness of available eye care services, and sources of information; health seeking behaviour: frequency of eye check-ups, reasons for seeking or not seeking care, and history of previous eye conditions; service utilization: type of services utilized, waiting time, satisfaction with services, and barriers to accessing care. RESULTS The mean age was 36.5±15.8 years, and the male-to-female ratio was 1:1.45. Eighteen (9.7%) participants had no formal education. Reasons for delay in seeking eye care included financial constraints (33.9%), lack of time (12.5%), distance (23.2%), fear (2.7%) and lack of awareness (22.3%). The participants’ monthly income varied, majority earned between N20,000-N50,000 per month, Only 20 (10.8%) earned above N100,000.00 in a month (Figure 1). Only 50 (26.9%) had insurance. Age, occupation and marital status were statistically significantly associated with health-seeking behaviour and service utilization (Table 1). Majority (84.0%) of the participants had knowledge on the importance of eye check but only 28.0% went for check-up regularly, 37.6% went occasionally and 34.4% went rarely or had never gone. Financial constraints, lack of time, distance, fear and lack of awareness are the contributory factors. DISCUSSION Younger individuals were less likely to seek eye check-ups. This age-related trend is consistent with previous literature.7 The study suggests that women are less proactive in seeking healthcare services than men. Additionally, marital status and occupation were significant factors. The study also found that only about a quarter of the participants had insurance, which is a critical factor in accessing healthcare services. Knowledge alone is not enough to ensure optimal health-seeking behaviour. This discrepancy between knowledge and behaviour highlights the influence of barriers. CONCLUSION Majority of the study participants had a relatively high level of knowledge about eye health, although significant barriers that hindered optimal health-seeking behaviour and service utilization were noticed. Socio-demographic factors played a significant role in shaping individuals' engagement with eye care services.
Surgically induced astigmatism following manual small incision cataract surgery versus phacoemulsification in age-related cataract: a comparative analysis
BACKGROUND Cataract surgery is among the most common and successful procedures globally.1,2 While phacoemulsification is the more advanced method, manual small incision cataract surgery (MSICS) remains prevalent in developing countries due to its affordability, shorter duration, and comparable visual outcomes.3-5 There is limited comparative data from Nigeria on corneal astigmatism and refractive stability between MSICS and phacoemulsification. This study aims to compare these outcomes between the two techniques. MATERIALS AND METHODS The study was a prospective hospital-based, comparative study of consecutive patients with age-related cataracts, randomized into 2 groups by randomly assigning letters A and B in a ratio of 1:1 to undergo MSICS (group A) or phacoemulsification (group B) using the superior approach, comparing the surgically induced corneal astigmatism (SIA) between the two techniques. SIA was calculated through vector analysis using the Warren Hill SIA calculator and the Holladay SIA method while stable corneal astigmatism was defined as average keratometry readings (average K in dioptres) within ± 0.50D6 and axis within 30 degrees of the last follow-up.7 The results were compared between the two groups, with a p-value of less than 0.05 indicating statistical significance. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research Ethical Committee (HREC) and written informed consent was obtained from the patients. RESULTS A total of 214 eyes were studied, with 107 in each surgical group. Age and gender distribution were similar (p=0.153 and 0.218) as seen in Table 1. Preoperative against-the-rule (ATR) astigmatism was more common in the phacoemulsification group (66.4%) than in the MSICS group (47.7%). By month 3, ATR astigmatism increased to 76.6% in the MSICS group compared to 49.5% in the phacoemulsification group. As shown in Table 2, the mean SIA in the MSICS group at months 1, 2 and 3 was 1.94D x 19.3o, 1.83D x 18.2o and 1.72D x 20.2o, respectively, while in the phacoemulsification group, the mean SIA was 0.92D x 17.7o, 1.01D x 16.4o and 1.00D x 15.8o at months 1, 2 and 3, respectively. SIA differed significantly between the two groups at all postoperative time points (p<0.001). Final best corrected visual acuity was similar at month 3, with 95.3% of MSICS and 98.1% of phacoemulsification patients achieving 6/12 or better (p=0.324). By the first postoperative month, 96 eyes (89.7%) in the MSICS group and 89 eyes (83.2%) in the phacoemulsification group had achieved stable corneal astigmatism. By the second month, stability was observed in 95 eyes (88.8%) of the MSICS group and 106 eyes (99.1%) of the phacoemulsification group (Figure 1). DISCUSSION This study found that postoperative ATR increased significantly among MSICS patients compared to phacoemulsification, a finding in line with earlier studies8,9 and likely due to larger incisions, wound construction, and cauterization in MSICS. Surgically induced astigmatism (SIA) was consistently higher in MSICS at all follow-up points, in line with previous evidence by Waghmare et al9, and Nair et al.10 Although more of the MSICS eyes stabilized by 1 month compared to phacoemulsification eyes, nearly all phacoemulsification eyes stabilized by the second month. Both procedures produced excellent visual outcomes, with over 96% of MSICS and 98% of phacoemulsification patients achieving 6/12 or better by three months. Nonetheless, phacoemulsification provided slightly better unaided visual acuity, reducing the likelihood of dependence on corrective lenses. CONCLUSION Phacoemulsification resulted in lower and more stable SIA. However, both techniques provided excellent final visual outcomes. While Phacoemulsification is more desirable, MSICS is relevant in resource-limited settings.
Simple Limbal Epithelial Transplantation (SLET) for chemical injury: a case report from National Eye Centre, Kaduna
Chemical injury to the eye is a sight-threatening emergency that can result in limbal stem cell deficiency (LSCD), which may lead to persistent epithelial abnormalities, corneal opacity and eventual vision loss. Simple Limbal Epithelial Transplantation (SLET) has evolved as a successful, one-stage, minimally invasive surgical approach for restoring the ocular surface in LSCD. We report the case of a 21-year-old male who suffered a serious alkali burn to his left eye after being accidentally exposed to herbicide. Despite initial treatment with extensive irrigation, topical nonsteroidal anti-inflammatory drugs and antibiotics, the patient acquired chronic epithelial abnormalities and corneal conjunctivalization. Following a diagnosis of unilateral LSCD, autologous SLET was conducted using about 2 × 2 mm limbal sample from the contralateral healthy eye, spread over an amniotic membrane put on the corneal surface with bandage contact lens. Topical antibiotics, corticosteroids and preservative-free lubricants were administered postoperatively. The patient was observed for the first three months. Within three weeks, the ocular surface had stabilized and epithelialized completely. There was no recurrent conjunctivalization or irritation. Best-corrected visual acuity had improved from counting fingers to 6/12 as at the first year post-SLET. This case demonstrates the safety, ease of use and efficacy of SLET in recovering corneal epithelial integrity and visual function in young individuals with unilateral LSCD following chemical injury. Early referral and adequate surgical intervention are critical for the best results.
Changes in tear film indices following manual small incision cataract surgery for age-related cataract in Northern Nigeria
INTRODUCTION The tear film is the interface between the ocular surface epithelium and the environment.1 Mucin, aqueous, and lipid make up its three layers.1 Cataract is the leading cause of blindness in the world, and Manual small incision cataract surgery (MSICS) is efficient in developing countries such as Nigeria due to its cost-effectiveness. 2 There is a high prevalence of OSD in the ageing population in Nigeria, with a high proportion of cataract patients suffering from the disease, some of whom will eventually undergo a cataract surgical procedure.3 Cataract surgeries have widely been seen to adversely affect the tear film status in the early postoperative period, leading to the development of dry eye. 4, 5 Studies showed that it could exacerbate or induce symptoms of dry eye disease postoperatively, at least for the first two months.4-7 Increased inflammatory mediators, surface irregularity at the site of the incision and/or light from the operating microscope can play a role in the initiation or exacerbation of OSD postoperatively.4,8 -11 This study seeks to evaluate changes in tear film indices using Tear break up time, Schirmer’s test I, and Tear meniscus height before and after MSICS in patients with age-related cataract. METHODS A hospital-based prospective observational study. Consenting patients with age-related cataract aged 40 years and above attending ECWA Eye Hospital, Kano, during the study duration and who met the inclusion criteria were recruited. Tear break-up time, Schirmer’s test-1, Tear meniscus height were measured preoperatively, on day 1, at week 4 and at week12 postoperatively. Ocular surface index score was assessed preoperatively, at 4 weeks and at 12weeks. All patients underwent MSICS under peribulbar anaesthesia by experienced surgeons using a standard technique. IBM-SPSS version 26 was used for data analysis. Ethical approval was obtained from the institution, and informed consent was obtained from the patients. P-value <0.05 was considered statistically significant. RESULTS A total of 124 patients were recruited, 6 were lost to follow-up while 118 completed the study. There were more males (78%) than 26 females (22%) with a Male: Female ratio of 3.5:1. The mean age was 63±8.39 years. Tear break up time (TBUT) reduced significantly on day 1, with a gradual improvement observed by 12 weeks (Table 1). Schimer’s test-1 and TMH declined significantly at 1 month, with gradual recovery observed by 12 weeks (Table 2). DISCUSSION The study observed short term variations in tear film indices following MSICS with the most pronounced effects at day 1 and 4 weeks after surgery. Gradual recovery occurred by 12 weeks but was yet to reach baseline, this is consistent with previous studies.6,13 The reduction in TBUT and TMH is likely due to surgical trauma, conjunctiva manipulation and postoperative use of preserved topical medications. This is comparable to the findings of earlier authors.6,13-17 At 12 weeks postoperatively, TBUT detected dry eye in 27.1% of the patients, OSDI score found 15.3% to have dry eye. This study observed high prevalence of dry eye disease (DED) using OSDI score in participants preoperatively (95.8%). The presence of blurred and poor vision as scoring points in OSDI questionnaire may be contributory to higher prevalence in this study since they are also the major symptoms of cataract. However, the mean OSDI score significantly reduced over time post-operatively, because after surgery vision got improved and this might have contributed to improved OSDI score. Even though the blurring of vision was transient preoperatively, it was significant enough to affect the overall OSDI score. Schimer’s test -1 detected dry eye in 26.3% of the participants and TMH observed 18.6% at 12 weeks postoperatively. A statistically significant reduction in the mean values of all assessed tear film indices was observed at postoperative period with p- values of < 0.001. The clinical implication is that patients may experience early postoperative dry eye symptoms, which can be mitigated by artificial tears, adequate preoperative assessment and counselling. CONCLUSION The study showed statistically significant reduction in tear film indices assessed postoperatively when compared with preoperative values and demonstrates the need for counselling and evaluation for DED to improve postoperative satisfaction and care.
Introduction: Evisceration is the removal of intraocular contents while preserving the scleral shell and attachments, enabling a more natural coupling between the orbital implant and prosthesis. As the balance between necessity and preference shifts, it is essential to identify when evisceration is the appropriate procedure to prevent unnecessary tissue removal. This review examines evisceration in contemporary practice, with emphasis on when it becomes a necessity rather than a choice. Methods: A structured narrative review of the literature on indications, contraindications, surgical techniques, orbital implants, complications, and postoperative rehabilitation regarding evisceration was conducted, searching PubMed, Scopus, and Google Scholar from database inception to 31 May 2025. Findings: Evisceration is primarily indicated or necessary in eyes that are irreversibly blind and painful due to chronic disease or infection. The potential for residual infection within the scleral envelope, the theoretical risk of occult intraocular malignancy, severe scleral thinning, or rupture extending posteriorly may preclude evisceration in selected cases. Factors such as the underlying pathology, the patient's systemic condition, and the desired aesthetic outcome play an integral role in decision-making. The introduction of the scleral wall modifications has enhanced implant sizing, orbital volume restoration, and symmetry. Thus, establishing evisceration as a reconstructive operation capable of achieving good cosmetic and functional outcomes in severely traumatised, phthisical, or anterior staphylomatous eyes. Conclusion: Evisceration is not only a less invasive alternative to enucleation, but also a reconstructive procedure with specific indications. Careful case selection, ethical counselling, optimal surgical technique, and postoperative rehabilitation remain central to successful patient outcomes.
From beautiful nails to sore eyes: a case of ocular super glue injury in Abuja
INTRODUCTION Commercial cyanoacrylate glue (super glue) has gained popularity among young ladies due to its high adhesive ability when used to hold stick-on artificial nails.1–3 Artificial nail fixing accounts for 3.8% of cases of ocular super glue injury.4 Previous cases of ocular super-glue instillation have been reported in Nigeria, in two patients who mistook it for their ophthalmic eye ointment.5,6 Burning sensation and inability to open the eyelids are common symptoms. Ocular findings may include: inadvertent tarsorrhaphy, eyelash loss, bruises along the eyelid margins, conjunctival hyperemia, chemosis, and corneal epithelial defects.5–8 Ocular super glue instillation can be prevented by the use of protective eyewear during use, proper handling and a change in packaging to avoid accidental instillation in place of an eye ointment.1,5 We present a case of ocular super glue injury. CASE REPORT Miss A.E., a 25-year-old lady presented to the hospital’s emergency department on account of inability to open the left eye for 2 hours after super glue accidentally squirted into her left eye while trying to fix nail extensions. She also had tearing, mild eye pain and foreign body sensation in the left eye. Prior attempts to open the eye after irrigation proved abortive. Examination of the left eye showed dried glue residue on the eyelids and eyelashes, chemical tarsorrhaphy involving more than two-thirds of the eyelids, and mild lid margin hyperemia (Figure 1). The right eye was essentially normal. Copious irrigation with 1 litre of normal saline was done, amethocaine eye drops were instilled, and KY-jelly mixed with 0.1mls of lidocaine was applied over the eyelid margin and lashes. Gentle manipulation was done using KY-jelly lubricated cotton buds to open the lids. On further examination, visual acuity was 6/12 on the right and 6/9 on the left. Slit lamp examination showed glue crusts on the ocular surface, which were removed under topical anaesthesia, and corneal abrasions mildly staining with fluorescein (Figure 2). She was placed on tetracycline ointment and nepafenac eye drops.She was commenced on steroid ointment after 48 hours, and this was used for 10days. An artificial tear gel was used for another 2 weeks. At 6 weeks post-injury, visual acuity was 6/6 BE, and she also had a refraction with BCVA of 6/5 in both eyes. The patient’s informed consent was obtained for the clinical photographs and this case report. DISCUSSION Cosmetic-related cyanoacrylate glue injuries following nail and eyelash fixing are becoming popular. 2,4,9 Improper handling is a common risk factor in adults.7 Like the index case, other studies have reported chemical tarsorrhaphy and corneal abrasions after these injuries.2,5-7,9 Although thorough irrigation is advised by cyanoacrylate glue manufacturers, the rapid polymerization when in contact with fluid makes this poorly effective. Thorough ocular lubrication, lash trimming, and surgical separation have been used in other studies. 2,5-7,9 Our report describes an effective and low-cost method of managing cyanoacrylate glue-induced chemical tarsorrhaphy by gentle manipulation using a lubricant mixed with a local anaesthetic agent. CONCLUSION Accidental splash of superglue into the eyes can occur during nail fixing, and protective eye wear is advised to prevent this. Management consists of copious lubrication, gentle eye opening under topical anaesthesia, and topical steroid/antibiotic ointments. Prompt management results in complete recovery and good visual prognosis.
Pattern of presentation and risk factors of dry eye disease among glaucoma patients on topical medications in Ahmadu Bello University Teaching Hospital, Zaria
INTRODUCTION Glaucoma is the second leading cause of blindness in the world. Globally, 36 million are blind1, and of these, 4.5 million (12%) are blind from glaucoma.2 There is strong evidence suggesting that glaucoma medications may contribute to ocular surface disease (OSD) and the development of dry eye disease (DED).3,4 METHODS This was a hospital-based descriptive, cross-sectional study of 181 adult glaucoma patients seen at the Eye Clinic of Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Ethical approval for the study was obtained from the Ethics and Research Committee of the Hospital and informed consent was obtained from the participants. For the purpose of this study, the diagnosis of dry eye disease was based on the Dry Eye WorkShop Diagnostic Methodology5 as follows: presence of a positive Ocular Surface Disease Index( score of ≥ 13)6 together with either an abnormal Schirmer’s 1 test (reading of less than 10mm wetting in 5 minutes)7 or an abnormal Tear Break Up Time (an appearance of the first randomly distributed dry spot in less than 10 seconds).7 Chi-square test and binary logistic regression were used to check for the association of risk factors with DED and statistical significance was set at 95% confidence interval (P≤0.05). RESULTS A total of 181 participants were studied with a mean age of 54±15.7 years. There were 115 (63.5%) females with a female-to-male ratio of 1.74:1. The prevalence of dry eye disease was found to be 40.9%. Grittiness (51%) and blurring (54%) of vision were the most common presenting symptoms (Table 1). Older age, female gender, longer duration of drug administration and mean deviation were found to be statistically significantly associated with a diagnosis of DED (Table 2). DISCUSSION The commonest presenting symptoms of dry eye disease in this study were blurred vision (54 %) and grittiness (51%). This differs from the study by Sarimiye et al8 that reported stinging (38%) and burning (25%) as predominant complaints. While Pisella et al9 in a multicenter study of 4107 patients in France documented ‘discomfort’ as the most common symptom. There was higher propensity of dry eye disease among those 60-79 years (Odds ratio 4.9) and 80 years and older (Odds ratio: 10) compared to those below 40 years in this study. This finding was corroborated by Fetchner et el4 in their study. Gender also had a significant association with DED. This is consistent with other studies.10,11Duration of treatment of glaucoma with topical antiglaucoma medications was significantly associated with DED and this is corroborated by other studies.12,13 CONCLUSION Dry eye disease is a common association of topical antiglaucoma medications; it predominantly presents with blurred vision and grittiness. Identified risk factors include: Older age, female gender, increased duration of drug use and severity of glaucoma. The assessment and treatment of dry eye disease should be integrated in the management of glaucoma to ensure total ocular care of these patients. The screening for dry eye disease should be periodic to ensure early diagnosis and treatment.
INTRODUCTION Retinoblastoma is the commonest childhood ocular malignancy, accounting for about 2.5 to 4 % of all paediatric malignancies.1,2 The disease is a life-threatening cancer though good survival rates have been reported especially in advanced countries, where detection is early with good care.3 The challenges of management in low- and middle-income countries are late presentation and paucity of trained manpower for cancer care.3 However, cases of recurrence have been recorded despite optimal care.2,3 The purpose of this case report is to highlight the need for vigilance, lifelong follow up and optimal care, with a high index of suspicion for recurrence. CASE PRESENTATION A 10-year-old boy, born in Zaria, Nigeria, first presented on 12/08/2016 after his mother noticed a whitish speck in his right Eye (RE) at 18 months of age. Examination revealed a healthy-looking child with stable vital signs. Visual acuity was uncentral, unsteady and unmaintained fixation on the right eye and central, steady and maintained fixation on the left eye. There was a whitish mass filling the whole of the vitreous of the RE. Examination under anesthesia (EUA) done on 30/08/2016 showed tumour in the left eye (LE). A diagnosis of bilateral retinoblastoma: RE group E and LE group C was made. His parents were subsequently counselled on their child’s condition. He had right eye (RE) Enucleation with orbital implant. Histology report revealed nuclei hyperchromasia with scanty cytoplasm, and necrotic fleurettes, pathognomonic of Retinoblastoma. The tumor involved the optic nerve stump. He received 15 cycles of high-dose chemotherapy [HDC] (Vincristine, etoposide and carboplatin), at monthly intervals, plus 3 cycles of transpupillary thermotherapy (TTT) in the left eye. EUA done on 11/04/2017 revealed no evidence of disease. He had 6 more cycles of HDC in view of optic nerve involvement. EUA done on 11/01/2018 showed tumour tumour-free status with visual acuity of 6/6 in the LE. He subsequently underwent 6-monthly EUA until late 2021 and continued follow-up in another facility throughout 2022. He presented on 20/02/2023 with complains of deterioration of vision in LE. His visual acuity was 6/18, with a hypopyon like deposit in the anterior chamber (Figure 1). EUA confirmed a tumour recurrence in the LE. He was reviewed by the Oncologist who recommended administration of 2nd line drugs. He subsequently had 3 doses of intracameral and intravitreal Topotecan, 1 mg. The tumor in the anterior chamber (AC) disappeared after two doses. He subsequently developed cataract for which he had lens washout with foldable intraocular lens (IOL) implant. His current V/A in the LE is 6/36. The most recent magnetic resonance imaging (MRI) done revealed no intracranial involvement. The oncologist plan is to continue with chemotherapy, and also discussed with the national Retinoblastoma Network (RB- NET)who advised on counselling parents for enucleation of the remaining only eye (Figure 2). DISCUSSION Reese4 published the first study on RB recurrence in 1948, and estimated an orbital recurrence rate of 72 %. A review of RB recurrence done in 2019 noted that recurrence is usually intraocular with rates ranging from 6 to 45 percent5. In another study, the estimated rate of recurrence was 46% at 3 years and 50% at 5 years.2 Despite the use of many treatment options that salvage the globe and life of children, recurrence rates have been on the increase,2 especially where late presentation, anterior chamber involvement and intracranial spread has occurred.4 Most recurrences occur within 3 years of treatment, though late recurrence that occurred after more than 10 years has been reported4. Following systemic chemoreduction, which was the first-line treatment for this patient, it is estimated that the rate of development of new retinal tumors range from 24 to 44 %.4 For the index patient, recurrence was noticed 6 years after initial diagnosis. It is worthy to note that most studies stated diagnosis and treatment were delayed in about one third of patients 4 which is a common problem in developing countries like Nigeria, mainly because paucity of trained personnel e.g. paediatric ophthalmologists. Patients have to travel across different geopolitical zones to access paediatric cancer care. However, in this index case who presented quite early to one of the best tertiary eye care centers and had the best optimal treatment possible, recurrence still occurred. This underscores the need for strict vigilance and maintaining high index of suspicion for recurrence, so that the correct plan of treatment can be continued with regards to second line and adjuvant treatment. Regular and lifelong follow up of the patient is required to prevent recurrent RB. CONCLUSION Retinoblastoma care and treatment remain a challenge in developing countries. Cases of recurrence have been recorded years after successful treatment as in this index patient. Follow-up should be for life despite successful treatment.