Odarosa M Uhumwangho

Retinal vein occlusion in Benin City, Nigeria

Background: Retinal vein occlusion (RVO) is the most common occlusive retinal vascular disorder and results in varying degrees of visual loss. Aim: To determine the pattern of presentation, risk factors, and treatment outcomes in a group of patients with RVO seen in a tertiary hospital in Nigeria. Materials and Methods: Medical records of patients who presented to the University of Benin Teaching Hospital, Benin City, Nigeria in whom a diagnosis of RVO was made over a 5 years period were reviewed. Data obtained were analyzed with the GraphPad Instat Software, Inc. version V2.05a program, San Diego, Califonia and a P < 0.05 considered significant. Results: There were 20 patients made of 14 (70.0%) males and 6 (30.0%) females with a mean age of 62.7 ± 10.4 years. There were 15 (68.2%) eyes with central RVO, 3 (13.6%) eyes with branch RVO, and 4 (18.2%) eyes with hemi RVO. Bilateral involvement occurred in 2 (10.0%) patients. Risk factors included hypertension 14 (70.0%), diabetes mellitus 9 (45.0%), and glaucoma 5 (22.7%). Multiple risk factors were present in 14 (70.0%) patients. Complications included macula edema 15 (68.2%), retinal neovascularization 5 (22.7%), neovascular glaucoma 3 (13.6%), and vitreous hemorrhage 2 (9.1%). Eyes which had definitive treatment with intravitreal antivascular endothelial growth factors and laser photocoagulation for macula edema and retinal neovascularization, respectively, had better visual acuity compared to eyes which did not receive these treatment, P = 0.002. Conclusion: The incidence and visual loss that occurs from RVO can be reduced by modifying known risk factors and early institution of appropriate therapy for complications that occur.

Syndrome of myelinated retinal nerve fibres, myopia, amblyopia and strabismus in a Nigerian.

Myelinated retinal nerve fibres (MRNF) are rare congenital anomalies. They may present in a syndrome characterised by ipsilateral myelinated retinal nerve fibres, myopia and amblyopia. We report a case of this rare condition with unilateral extensive MRNF, axial myopia, amblyopia and strabismus in a Nigerian girl.

Current trends in treatment outcomes of orbital cellulitis in a tertiary hospital in Southern Nigeria

Background: Orbital cellulitis refers to the inflammation or infection of the soft tissues of the orbit located behind the orbital septum. Aim: To determine the current trends in the outcomes following the management of orbital cellulitis in a tertiary hospital in Southern Nigeria. Patients and Methods: A retrospective review of medical records of patients with orbital cellulitis from January 2008 to December 2014 was conducted. The age, sex, duration of symptoms, predisposing factors, clinical findings, laboratory/radiological investigations, treatment provided, complications, and follow-up were recorded. Results were analyzed with SPSS Version 21 program. Results: Forty-two patients were seen made of 17 (40.5%) males and 25 (59.5%) females with a mean age of 18.2 ± 18.7 years of which children <16 years constituted 24 (57.1%) of cases. Orbital cellulitis was a unilateral occurrence in 38 (90.5%) patients. Trauma and sinusitis were the common predisposing causes in 20 (47.6%) and 6 (14.3%) patients, respectively. The most common complaint was eye swelling 36 (52.9%). Most patients had visual acuities of >6/18 at presentation, 38 (82.6%) and at discharge, 39 (84.8%). The mean duration of presenting complaints was 15.5 ± 31.6 days. Patients who presented early were less likely to develop complications, P = 0.003. The most common complication was exposure keratopathy in 8 (44.4%) eyes. The only surgical intervention performed was incision and drainage of abscess in 3 (7.1%) eyes. No patient came for follow-up. Conclusion: Prompt institution of effective antibiotics and management of complications that may arise improves prognosis of orbital cellulitis.

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

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

Endophthalmitis in a tertiary center in Nigeria

Background: Endophthalmitis is a sight-threatening condition due to inflammation of intraocular structures usually from infectious organisms. The study aims to identify the pattern of presentation of endophthalmitis in a tertiary center in Nigeria. Materials and Methods: A retrospective observational study of cases with a diagnosis of endophthalmitis. Results: Twenty-six eyes of 26 patients were found comprising, 20 (76.9%) males and 6 (23.1%) females. The mean age of the patients was 32.4 ± 24.5 years (range 2-68 years) of which 11 (42.3%) were ≤ 16 years (P < 0.005). There were 14 (53.8%) right eyes and 12 (46.2%) left eyes involved. The most common etiology was post traumatic infection in 16 (61.5%) cases of which 11 (68.8%) occurred in children ≤ 16 years. Complications of cataract surgery was the only surgically related etiology in 7 (26.9) cases. Endogenous endophthalmitis is a rare occurrence. Conclusion: Supervised play in children, strict adherence to asepsis protocol in surgeries, prompt diagnosis with well-equipped ancillary investigations and appropriate early intervention will help limit the incidence of endophthalmitis and improve outcomes.

Central serous chorioretinopathy in Benin City, Nigeria

BACKGROUND Central serous chorioretinopathy (CSCR) is a retinal cause of visual loss. The aim of this report is to describe the pattern of presentation of CSCR in patients presenting to a tertiary hospital in Nigeria within a specified period. MATERIALS AND METHODS The case folders of all patients in which a diagnosis of central serous retinopathy (CSR) was made from January 1, 2012 to December 31, 2014 were retrieved, data extracted and reviewed. RESULTS There were a total of five patients within the study period made of four males and one female. There were two cases of bilateral CSCR and three cases of unilateral CSCR. There was a positive history of underlying anxiety or stress related conditions in all the patients. One patient with bilateral CSCR was on systemic prednisolone for arthritis. Confirmatory investigations were performed in all patients. Four patients had fundus fluorescein angiography which showed smoke stack and ink blot patterns in two patients, respectively. Two patients had optical coherence tomography showing macular neurosensory detachment, with one having associated pigment epithelial detachment. Vision improved in all patients with conservative management, reduction in anxiety/stress related activities and steroid use discontinuation in the patient with chronic steroid use. CONCLUSION CSR has a favorable outcome with appropriate intervention.

Retinal abnormalities in patients with cerebrovascular accident

Background: Cerebrovascular accident (CVA) or stroke is a leading cause of morbidity and mortality worldwide. The aim of the study is to document the retinal abnormalities in patients with CVA seen in a tertiary hospital. Materials and Methods: The retina of patients aged ≥18 years with CVA occurring within 1 year managed in a tertiary hospital were examined from October to December 2013 and the findings recorded. Patients with prior history of ocular trauma and unconscious stroke patients were excluded. Data were analyzed with Statistical Package for the Social Sciences (SPSS) version 20 and P < 0.05 was taken as significant. Results: A total of 85 patients comprising 61 (71.8%) males and 24 (28.2%) females were seen. The mean age was 66.1 ± 11.0 years (range: 43-88 years), out of which 57 (67.1%) were ≥60 years. There were 67 (78.8%) and 18 (21.2%) cases of ischemic and hemorrhagic stroke, respectively. Hypertension was the most common predisposing factor of stroke in 95.3% of the patients. Abnormalities in the retina background included hemorrhages in 18 (10.6%) eyes, hard exudates and cotton wool spots in 13 (7.8%) and 4 (2.4%) eyes respectively. Retinal vascular abnormalities were documented in 55 (32.4%) eyes. There were more abnormalities in the retina vasculature of patients with hypertension, diabetes mellitus (DM), and hyperlipidemia than in patients without these conditions (P < 0.50). There were also more abnormalities in the background retina of the diabetics when compared to the nondiabetics (P = 0.02). Conclusion: Regular ophthalmic evaluation of patients with predisposing risk factors for CVA with early detection of ocular manifestations/complications of the disease could help modify treatment to prevent or limit more untoward and debilitating effects such as stroke.

Traumatic hyphema in Benin City, Nigeria

Background: Hyphaema is a common sequalae following trauma. Th aim of this study was to determine the demographics, pattern, complications and visual outcome in patients managed with traumatic hyphema. Materials and Methods: A retrospective review of all cases of traumatic hyphema seen from July 1, 2008 to June 30, 2013. Data analyzed included biodata, duration of injury prior to presentation, grading of hyphema and activity during injury, visual acuity, intraocular pressure, associated injuries and complications. Results: A total of 45 eyes in 45 patients with traumatic hyphema were reviewed. The mean age of the patients was 27.3 ± 18.6 years with 44.4% occurring in the age group 0-20 years. The male:female ratio was 6.5:1. About 40.0% of patients presented within 24 h of the injury and 51.1% with Grade 1 hyphema. Injury occurred mostly during play and at work in 17.8% each. The initial visual acuity was worse than 6/60 in 82.0% but decreased to 60.0% following treatment while visual acuity of 6/18 or better increased from 6.7% at initial presentation to 31.1% following treatment. Lid and corneal injuries were the most common associated injuries in 20.0% each, while secondary glaucoma was the most common complication of hyphema in 22.2%. Conclusion: Traumatic hyphema is a common occurrence in children and young adults during play and at work. Early presentation, associated injuries, complications and management affects visual outcome.

Endogenous endophthalmitis with mixed infection

Endogenous endophthalmitis is a rare but serious metastatic ocular inflammation which occurs from hematogenous spread of infection that has crossed the blood ocular barrier. It has no age or sex predilection and is a sight-threatening condition with multifactorial etiology.It usually occurs in the setting of a relative immunosuppressive state from an underlying medical condition. The management of a case of endogenous endophthalmitis presenting to a tertiary centeris discussed. Visual outcomes are often poor, regardless of the choices in management. The presence of co-morbid diseases usually results in late presentation, a delay in diagnosis and treatment.There is still no clear consensus regarding the correct approach especially with regards to early surgical intervention.