Ophthalmology Research: An International Journal

Infectious Keratitis in Sub-Saharan Africa: Microbiological Issues, Delayed Diagnosis and the Role of Patient Education

Amadou Bouba Traoré Hassane — 2026-02-26

Introduction: Infectious keratitis (IK) is a major cause of preventable corneal blindness, disproportionately affecting populations in sub-Saharan Africa (SSA). The visual prognosis is often clouded by complex challenges, including a specific microbiological profile, frequent diagnostic delays, and gaps in overall patient management. This narrative review aims to synthesise current knowledge on microbiological issues, factors contributing to delayed diagnosis, and the potential role of patient therapeutic education (PTE) in improving clinical outcomes for IK in SSA.

Methods: A narrative review of the literature was conducted by consulting the PubMed and Google Scholar databases and institutional archives (HAL, DUMAS). Keywords included ‘infectious keratitis,’ ‘corneal ulcer,’ ‘sub-Saharan Africa,’ ‘fungal keratitis,’ ‘delayed diagnosis,’ and ‘patient therapeutic education.’ Relevant articles published up to January 2026, dealing with the epidemiology, aetiology, diagnosis and management of IK in SSA, were included.

Results: The literature confirms that SSA has a high incidence of IK, with a marked predominance of fungal keratitis (FK), often linked to agricultural trauma. Bacterial pathogens, particularly *Pseudomonas aeruginosa* and *Staphylococcus aureus*, also remain prevalent. Delayed diagnosis is a major multifactorial problem, fuelled by socio-economic and geographical barriers, the use of self-medication and traditional medicines, and limited diagnostic capabilities (lack of access to corneal scraping and culture). Although recognised as a potential lever for improving compliance and prevention, ETP remains largely unstructured and undocumented in the region.

Conclusion: Infectious keratitis in sub-Saharan Africa is a major public health problem, characterised by high incidence, a microbiological profile dominated by post-traumatic fungal and bacterial infections, and devastating visual consequences. This narrative review of the literature has highlighted the interconnected factors that explain the severity of this condition in the region. Delayed consultation, fuelled by geographical, economic and socio-cultural barriers, as well as the frequent use of dangerous traditional eye medicines, is the main determinant of poor prognosis.

Sustained-Release Ophthalmic Drug Delivery Systems: An Updated Review of Innovations, Current Trends and Future Prospects

Chinna Reddy Palem — 2026-03-06

Background & Scope: Ocular drug delivery is inherently limited by anatomical and physiological barriers such as rapid tear turnover, blinking, nasolacrimal drainage, and restricted corneal permeability. These protective mechanisms substantially reduce drug residence time and bioavailability following topical administration, particularly with conventional eye drops, necessitating frequent dosing and compromising patient adherence. Sustained-release (SR) ophthalmic systems have emerged as a strategic approach to overcome these limitations by enabling prolonged drug retention and controlled therapeutic exposure.

Methodology: This review systematically evaluates recent advancements in SR ocular drug delivery technologies. Both formulation-driven and device-based platforms are examined, including in situ gelling systems, polymeric and lipid nanoparticles, liposomes / Niosomes, ocular inserts and films, implants, and microneedle-assisted delivery systems. Emerging technologies and innovations, including 3D printing, smart contact lenses, gene therapy and biologics, as well as bioadhesive and mucoadhesive systems, were discussed. Key aspects such as formulation design principles, drug release kinetics, translational considerations, and progression from preclinical studies to clinical application are critically analyzed.

Results & Discussion: Emerging SR platforms demonstrate improved precorneal retention, sustained therapeutic concentrations, and enhanced patient compliance compared with conventional formulations. Advances in material science and microfabrication have enabled precise control over drug release profiles and targeting efficiency. However, challenges persist, including sterility assurance, long-term safety, scalability, regulatory complexity, and manufacturing feasibility, which influence successful clinical translation.

Conclusion: Sustained-release ophthalmic delivery systems represent a transformative advancement in ocular therapeutics, offering the potential to address longstanding bioavailability constraints and unmet clinical needs. Continued integration of innovative materials, device engineering, and regulatory alignment will be essential to accelerate commercialization and optimize patient outcomes in ocular disease management.

Ophthalmic Assessment in Isolated Orbital Fractures: Identifying Patients at Risk

M. R. Haranadha Reddy — 2026-03-28

Isolated orbital fractures are frequently approached as injuries of facial skeleton and orbital volume, yet their most consequential morbidity often lies in concurrent ocular and optic nerve injury. Although many patients have only minor adnexal or conjunctival findings, a clinically important minority harbour vision-threatening pathology that requires urgent ophthalmic intervention. The central challenge in acute care is therefore not simply to confirm the fracture, but to distinguish the patient who can be safely observed from the patient whose examination or imaging suggests occult severe injury. This review synthesises contemporary evidence on the ophthalmic assessment of isolated orbital fractures, with particular attention to predictors of substantial ocular injury, the strengths and limitations of bedside examination, and the integration of clinical and radiological findings into risk stratification. A narrative review was conducted using PubMed, Web of Science, Scopus, and Google Scholar. Searches were conducted since January 2006, with emphasis on studies from 2015 onward and inclusion of a small number of earlier landmark articles where they remained influential in current practice. The literature consistently identifies reduced visual acuity, abnormal pupillary responses, afferent pupillary defect, primary-gaze diplopia, ocular pain, conjunctival haemorrhage or chemosis, inability to open the injured eye, retrobulbar haemorrhage, and selected fracture patterns as features that should elevate concern. At the same time, recent protocol-based studies suggest that routine urgent ophthalmology consultation for every isolated orbital fracture may not be necessary when a patient is truly asymptomatic and carefully screened. The review argues for a structured, ophthalmically informed assessment pathway that begins with visual function and pupillary examination, incorporates targeted motility and anterior segment assessment, interprets computed tomography in a risk-based manner, and recognises specific contexts in which symptom-based triage is unreliable. Such an approach can improve patient safety, preserve visual outcomes, and reduce unnecessary emergency consultation without missing time-critical pathology.

Evaluation of Preoperative Anxiety among Patients Undergoing Elective Ophthalmic Surgeries at KCMC

Mzee Yusuf Gawany — 2026-02-19

Aims: To evaluate the proportions and assess factors associated with pre-operative anxiety among patients undergoing elective eye surgeries at KCMC.

Study Design: This was a hospital based cross-sectional study.

Place and Duration of Study: Department of Ophthalmology at Kilimanjaro Christian Medical Center, Tanzania, between November 2024 and May 2025.

Methodology: A total of 220 participants scheduled for ophthalmic surgery were enrolled into the study. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was used to detect preoperative anxiety along with a data collection sheet for surgical and patient information. The overall prevalence of pre-operative anxiety was determined using a binary variable derived from patients who scored above 10 on the total APAIS score. Bivariate analysis comparing categorized variables and multivariate analysis were performed.

Results: The proportion of high preoperative anxiety was 26.4% (95% CI: 20.7–32.4%). Surgery-related anxiety (31.8%; mean score 4.44 ± 2.22) was more prevalent than anesthesia-related anxiety (23.2%; mean score 3.87 ± 2.25). Younger age(P = 0.15), high information desire (P < 0.001), and diagnostic surgical indication(P = 0.001). were independently associated with high preoperative anxiety.

Conclusion: A substantial proportion of ophthalmic patients at KCMC experience high preoperative anxiety, predominantly driven by surgery-related concerns. Targeted preoperative counseling and patient-centered information delivery may reduce anxiety levels.

Epidemiology, Clinical Profile and Factors Associated with Poor Visual Outcome among Children with Closed Globe Injury in Northern Tanzania (2020-2024)

Gideone Elisa Mghamba — 2026-02-27

Background and Aim: Ocular trauma refers to injuries of the eye, its surrounding structures, or the orbit. It is a significant but often underrecognized cause of visual impairment and blindness, as it usually affects only one eye and is underreported in epidemiological studies. To assess, clinical profile, visual outcome, complications and factors associated with poor visual outcome among pediatric patients with closed-globe injuries in northern zone Tanzania.

Study Design: A hospital-based retrospective cohort study.

Place and Duration of Study: A 5 years study, conducted at Kilimanjaro Christian Medical Centre from January 2020 to December 2024.

Methodology: A total of 324 patients (332 eyes) aged 16years and below attending pediatric eye clinic at Kilimanjaro Christian Medical Centre (KCMC) hospital were enrolled. The final best corrected visual acuity (BCVA) was measured at the end of follow-up period, which was 3 months. A detailed medical history and ocular examination including visual acuity, slit-lamp biomicroscope and fundus examination, was obtained. Data analysis was done using Statistical Package for Social Sciences (SPSS) version 25.

Results: The prevalence of closed globe injury among total ocular trauma cases were (33.7%), the mean age at presentation was 7 ± 4 years, male were 2.4 times involved than female. Majority of injury occur in children aged 5-9 years (45.8%). The highest proportion of injuries occur in street (34.9%) followed closed by home (30.1%). The most common mechanism of injury were child play (41.3%) and majority of injury caused by blunt object (40.4%) followed by vegetative matter (30.7%). Closed globe contusion were 216(65.1%) mostly involving zone I and cornea tissue frequently involved (51.7%).

BCVA >6/60 at 3 months were better in 70.5%.Poor initial VA(AOR = 7.05, p = 0.008), vitreous hemorrhage and Retina hemorrhage(AOR = 0.11, p = 0.009) and (AOR = 0.05, p = 0.027) respectively, Zone II injury (AOR = 5.22, p = 0.001), Zone III injury(AOR = 24.94, p < 0.0001),POTS 1(AOR = 117.46, p = 0.002),POTS 2(AOR = 14.43, p = 0.030), were associated with poor final visual outcome

Conclusion: A significant proportion of closed globe injury occurred mostly during child play in school aged male. More than two third attained best corrected visual acuity better than 6/60 at 3month follow up. Poor initial visual acuity, vitreous hemorrhage, retinal hemorrhage, zone II injury, zone III injury, POTS 1and POTS 2 were significantly associated with poor final visual outcome

Surgical Outcomes and Complications Following Silicone Oil Removal in Retinal Detachment Surgery at KCMC Eye Department, Northern Tanzania (2020-2023)

Urvashi Solanki — 2026-02-27

Background and Aims: Retinal detachment (RD) is the separation of the neurosensory retina from the retinal pigment epithelium, causing subretinal fluid buildup. Pars plana vitrectomy (PPV) with silicone oil tamponade is commonly used to treat retinal detachment. The aim of the study was to evaluate the anatomical and functional outcomes and to identify the postoperative complications following silicone oil removal in retinal detachment surgery.

Study Design: Retrospective cohort study.

Place and Duration of Study: Eye department in KCMC hospital in Northern Tanzania, from January 2020 to December 2023.

Methodology: A total of 231 eyes with a documented six-month follow-up after silicone oil removal were included. Data were collected using a structured data collection form. Good visual outcome was categorized as visual acuity ≤ 1 LogMAR, and anatomical success was defined as retinal reattachment after oil removal. Statistical analysis was performed using SPSS version 25. Associations between clinical variables and outcomes were assessed using the Chi-square test, univariate and multivariable analysis, with a p-value ≤0.05 considered statistically significant.

Results: Anatomical success was achieved in 66.7% and functional success in 42% of eyes. Multivariable analysis showed that retinal re-detachment significantly reduced the likelihood of a good visual outcome (ARR: 0.33, 95% CI: 0.20- 0.54, p< 0.001), whereas good baseline visual acuity (≤1 LogMAR) increased the likelihood (ARR: 1.71, 95% CI: 1.31- 2.23, p<0.001). Preoperative proliferative vitreoretinopathy increased the risk of re-detachment (ARR: 1.57, 95% CI: 0.99- 2.46, p = 0.05), while myopia was associated with a 68% reduced risk (ARR: 0.32, 95% CI: 0.11- 0.94, p = 0.04). The most common postoperative complications comprised of retinal re- detachment (33.3%), cystoid macular edema (14.8%), epiretinal membrane formation (12.1%), ocular hypertension (10.4%), keratopathy (7.5%), and hypotony (7.5%).

Conclusion: A good baseline visual acuity and retinal attachment after oil removal were strongly associated with a favorable visual outcome. Proliferative vitreoretinopathy was a major risk factor for postoperative retinal re-detachment, while myopia was linked to a lower risk. The apparent protective effect in myopic eyes may have been attributed to the use of prophylactic panretinal photocoagulation, which could have reduced the risk of retinal re-detachment.

Incidence and Factors Associated with Ocular Hypertension after Intravitreal Triamcinolone Injection among Macula Oedema Patients Attending KCMC (2024-2025)

Karist Nkondo Anthony — 2026-03-06

Background: Intravitreal triamcinolone acetonide (IVTA) is an effective cor ticosteroid used in managing retinal conditions such as cystoid macular edema (CME), diabetic macular edema (DME), and retinal vein occlusion (RVO). Despite its therapeutic benefits, IVTA is known to cause ocular hypertension (OHT), which can lead to irreversible glaucomatous damage if not adequately monitored, posing a particular challenge in resource-limited settings.

Objectives: To determine the incidence, pattern, and associated risk factors of ocular hypertension following intravitreal triamcinolone injection among patients with macular edema attending the Ophthalmology Department at Kilimanjaro Christian Medical Centre (KCMC) between 2024 and 2025.

Methods: A prospective cohort study was conducted involving 110 adult patients diagnosed with macular edema and treated with a standardized 4 mg dose of IVTA. Intraocular pressure (IOP) was measured at baseline, immediately post-injection, and at 2-week and 6-week follow-up visits using an Icare tonometer. OHT was defined as IOP > 21 mmHg or an increase ≥5 mmHg or 20% from baseline. Statistical analysis was performed using SPSS 25, with multivariate regression applied to identify independent predictors of OHT.

Results: The incidence of ocular hypertension was 35%. Mean IOP rose significantly from 14.59 mmHg at baseline to 28.42 mmHg immediately post-injection, decreasing to 17.75 mmHg at 2 weeks and 17.05 mmHg at 6 weeks (p < 0.001). Retinal vein occlusion was the strongest independent predictor of OHT (ARR = 3.23; 95% CI: 1.10–9.54; p = 0.033).

Conclusion: IVTA is associated with a high incidence of transient and sustained OHT. Early and routine IOP monitoring, especially in RVO patients, is crucial to prevent glaucomatous complications, particularly in low-resource settings.

Epibulbar Dermoid Cyst in Goldenhar Syndrome: A Case Report and Review of Management

Hind Safi — 2026-02-26

Background and Aims: Goldenhar syndrome is a rare condition that causes a defect in the development of structures derived from the first and second branchial arches, manifesting with a wide range of symptoms, including ocular, auricular, and vertebral abnormalities.

The objective of this case presentation is to disseminate knowledge about Goldenhar syndrome, to promote timely diagnosis and surgical intervention in order to improve functional and cosmetic outcomes in these patients.

Case Report: We report the case of a four-year-old girl whose parents complained primarily of a growth on her left eye, present since birth and which, according to them, had progressively increased in size over the years. On examination, we observed a large, rounded mass straddling the temporal limbus of the left eye, with a few fine hair follicles, consistent with a limbal dermoid cyst. The lesion was further characterized by B-mode ultrasound, which revealed a mass with a hyperechoic anterior wall and a hypoechoic core, resting on the cornea without invasion of Descemet's membrane or the anterior chamber. An oculo orbital Magnetic Resonance Imaging was also performed, showing a well-defined prelimbic lesion in the left eye, measuring 8.5 x 4.8 x 14 mm, hyperintense on T1- and T2 sequences, without enhancement after contrast injection. The evaluation of systemic malformations revealed the bilateral presence of multiple preauricular appendages. The overall clinical presentation was consistent with an epibulbar dermoid cyst within the context of Goldenhar syndrome. Regarding the management of the dermoid cyst, we opted for complete excision, combined with a multilayer amniotic membrane graft secured with 7-0 Vicryl to cover the wound. Histopathological examination confirmed the dermoid nature of the cyst. The patient then benefited from regular follow-up, with very satisfactory postoperative results and good healing.

Conclusion: Goldenhar syndrome is a rare congenital disorder with highly variable clinical manifestations. Epibulbar dermoid cysts are the characteristic ocular manifestation, and their treatment aims for a dual objective: preserving visual function and improving cosmetic appearance. Management can range from a conservative approach with optical correction and simple monitoring to more invasive surgical excision, combined with various techniques for reconstructing the resulting defect.