Open Access Case Series

Initial Diagnostic Dilemma with 3 Neuro-Ophthalmic Cases Seen at University of Port Harcourt Teaching Hospital, Nigeria

Chinyere. N. Pedro-Egbe, Chibuike. S. Ejimadu, Alfred. A. Onua, Abieyuwa. K. Adediji, Ogochukwu. A. Sibeudu

Ophthalmology Research: An International Journal, Page 1-6
DOI: 10.9734/OR/2018/46255

Aim: The aim is to present three patients with neuro-ophthalmic symptoms and signs who initially presented a diagnostic dilemma. Two later turned out to be retroviral positive.

Presentation of Cases: CASE 1 was a 35 yo female nurse assistant who first presented with a-one month history of deep-seated pain in the right eye, right side of face and headache with sudden onset diminished vision in the right eye. She was initially diagnosed with optic neuritis but this was followed 7 months later with panuveitis and bullous RD. Patient was not hypertensive or diabetic and was retroviral (RV) negative. Even though she presented a diagnostic dilemma, a tentative diagnosis of recurrent idiopathic neuro-retinitis is entertained on account of the clinical features and normal investigations. CASE 2 was a 32yo female who presented on account of sudden onset binocular horizontal diplopia of 2 weeks duration. She later developed dizziness and paraesthesia of the left side of her body and examination revealed bilateral torsional nystagmus. The patient was HIV positive with a CD4+=39 cells/μl. The third Case was a 17yo student initially diagnosed with Bell’s palsy but later developed transient visual loss. He was found to be HIV positive with a CD4+= 768 cells/μl.

Conclusion: These 3 cases bring to the fore the importance of entertaining a high index of suspicion in managing unusual cases that present to the ophthalmologist; and in all cases to rule-out HIV/AIDS since it has its highest prevalence in sub-Saharan Africa. That way, early intervention can be instituted and this would ultimately reduce morbidity and mortality from the disease.

Open Access Original Research Article

Optical Coherence Tomography Findings of Diabetic Maculopathy in Egypt

Gehad Mahmoud Abdeen, Gamal Radwan, Mohamed Elagouz, Mahmoud Mohamed Farouk

Ophthalmology Research: An International Journal, Page 1-7
DOI: 10.9734/OR/2018/45805

Aim of the Work: To evaluate the diagnostic function of Optical Coherence Tomography (OCT) in diabetic maculopathy and the most significant and common OCT findings.

Patients and Methods: This study was a prospective, non-comparative, non-interventional, case series, carried out between November 2015 to March 2017 and included 500 eyes of 287 diabetic patients with diabetic maculopathy. Their retinas were assessed and classified according to OCT findings of retinal thickness, retinal morphology, retinal topography, macular traction, and foveal photoreceptor status.

Results: OCT classification of the cases according to their retinal thickness showed that 18.8% of the cases had no macular edema, 21.8% had early subclinical macular edema and 59.4% had established macular edema. Regarding retinal morphology, OCT showed that 62.8% of the cases had simple non cystoids macular edema, 31.6% had early cystoid macular edema and 5.6% had serous macular detachment. 89.8% of the cases had no macular traction, 7.6% had questionable macular traction and 2.8% had definite macular traction. The retinal outer layers integrity showed that 94.4% of cases had intact inner segment/outer segment line (IS/OS) and external limiting membrane (ELM) and 5.6% had IS/OS and ELM with disrupted integrity

Conclusion: Our study concluded that OCT provided variable data about the thickness, morphology, topography, specific changes in the outer retina and the presence of VMT (vitreo-macular traction) in cases of DME (diabetic macular edema). Among patients at Sohag Governorate, Simple non cystoid macular edema was the most common finding with little incidence of VMT and affection of the outer retina.

Open Access Original Research Article

Trend Analysis of Various Ocular Surgeries Performed at University of Port Harcourt Teaching Hospital (UPTH), Nigeria Over a Ten-year Period

Chibuike Sydney Ejimadu, Chinyere N. Pedro-Egbe

Ophthalmology Research: An International Journal, Page 1-6
DOI: 10.9734/OR/2018/47004

Aim: To identify the pattern of ocular surgeries performed at UPTH and determine any significant changes in trends of these surgeries over a ten-year period - 2005 to 2016.

Methods: It was a hospital-based retrospective study over a ten-year period. Data were extracted from the ocular surgery register and inputted into an excel-spread sheet. Data analyzed with United States Centers for Disease Control and Prevention (CDC) Epi-Info version 7 software to determine significant differences in trends of the various eye surgeries.  A p-value < 0.05 was considered statistically significant.

Results: A total of 1,039 major and 1,322 minor ocular surgeries were done in a ten-year period. Most of the major cases (198) were done in 2012 while the least number of the major cases (27) were done in 2016. Significant variations in trends within this period occurred with cataract extraction, corneal repair, evisceration/enucleation and trabeculectomy (p<0.0001 respectively). Most of the minor cases (271) were done in 2008 while the least number (83) was done in 2011 with significant trend occurring with pterygium excision (p<0.001) and conjunctival mass excision (p<0.009). The most common major ocular surgery was cataract extraction (744) while the most common minor surgery was pterygium excision (597).

Conclusion: Ocular surgical load in UPTH is comparable to other parts of the country. There was a significant variation in the trend of cataract surgery, corneal repair, evisceration/enucleation, trabeculectomy, pterygium excision and conjunctival mass excision. These may have been affected by incessant breaks in services as a result of both local and national strike actions by health workers. In addition, patients’ ignorance or refusal to accept some of the procedures offered may have also contributed to the trend seen. Enlightenment and regular service delivery are keys to improving ocular surgical uptake.

Open Access Original Research Article

The Analysis of Intra-retinal Layers with Automatic Optical Coherence Tomography Segmentation in Healthy Subjects

Osman Ahmet Polat, Ali Kurt, Raşit Kılıç, Özkan Kocamış

Ophthalmology Research: An International Journal, Page 1-13
DOI: 10.9734/or/2018/v9i430092

Aims: To give normative databases of each retinal layers on OCT images in the healthy Caucasian population in Turkey and investigate the relevance of the data with factors such as age, gender, axial length and refraction.

Study Design: Prospective, cross sectional, descriptive study.

Place and Duration of Study: Department of Ophthalmology, Faculty of Medicine, Kirsehir Ahi Evran University, Kirsehir/TURKEY. Between September 2017 and March 2018.

Methodology: 133 participants underwent full ophthalmologic examination and spectral domain OCT imaging (Spectralis, Heidelberg Engineering, Germany). After the automatic segmentation, central 1 mm and 1-3 mm superior, inferior, nasal and temporal thicknesses of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retina pigment epithelium (RPE), inner retinal layers (IRL), outer retinal layers (ORL) and total retina thickness (TRT) analyzed with respect to age, gender, axial length and refraction (spherical equivalent).

Results: Central 1 mm INL, ONL, ORL, IRL and TRT and four quadrants of pericentral 1-3 mm thicknesses of RPE had positive correlation with the age. All the sections of total retina, RNFL, GCL, IPL, INL, ONL and IRL thicknesses were significantly thicker in males compared to females. The thicknesses of all RNFL sections and central 1 mm circle thicknesses of TRT, IPL, INL, OPL, RPE and IRL had positive correlation with the axial length.

Conclusion: A normative database for thicknesses of intra-retinal layers in Turkish population was presented in the study and significant impacts of the age, gender and axial length were presented.

Open Access Original Research Article

Assessment of Bacterial Profile of Ocular Infections among Subjects Undergoing Ivermectin Therapy in Onchocerciasis Endemic Area in Nigeria

Okeke-Nwolisa, Benedictta Chinweoke, Enweani, Ifeoma Bessie, Oshim, Ifeanyi Onyema, Urama, Evelyn Ukamaka, Olise, Augustina Nkechi, Odeyemi, Oluwayemisi, Uzozie, Chukwudi Charles

Ophthalmology Research: An International Journal, Page 1-9
DOI: 10.9734/or/2018/v9i430094

Bacteria are the major contributor of ocular infections worldwide. This can damage the structures of the eye with possible blindness and visual impairments, if left untreated. This study was undertaken   to determine bacterial agents of conjunctivitis among individuals from onchocerciasis endemic area in Anambra State, Nigeria. This was a cross-sectional study involving ninety-two (92) randomly recruited  test  subjects  undergoing ivermectin therapy aged between 11-80 years with signs and symptoms of  onchocerciasis infection and bacterial conjunctivitis at Isu-Anaocha community in  Anambra state between October and November, 2016. Ninety-two (92) apparently healthy subjects without signs and symptoms of onchocerciasis and bacterial conjunctivitis with normal vision, within the age of 11-80 years from the same community were used as control subjects, making a total of 184 participants. Visual acuity test was conducted on the participants using Snellen’s alphabet chart and illiterate E   chart.  Phenotypic   and antibiotic susceptibility tests of these isolates were   carried out according to  Kirby - Bauer disc diffusion method guidelines. In the test group, 22 out of 92 conjunctival samples yielded bacterial growth, giving percentage prevalence of 23.9%, with age group 41-50 years having the highest frequency 7(31.8%) among individuals co-infected with onchocerciasis infection whereas 72 out of 92 conjunctival samples in the control group yielded bacterial growth giving percentage prevalence of 78.3%, with age group 41-50 years having the highest frequency 35(37.2%) among individuals that had  no signs and symptoms of onchocerciasis infection. The predominant bacteria isolated was Staphylococcus   aureus 8(36%) in the test group and 20 (28%) in the control group, giving a total of 28 (30%). Other bacterial isolates were Streptococcus pneumoniae 17 (18%), Staph. epidermidis 15 (16%), Escherichia coli 13(14%), Pseudomonas aeruginosa 12(13%) and Salmonella spp. 9(9%). Antibiotic susceptibility testing showed that Gentamicin and fluoroquinolones are most active against Gram positive bacteria in conjunctivitis while Augmentin was found to be the most active against Gram negative organisms, therefore, recommended as first line drug. Visual acuity (VA) test done on the test group showed that 52 (57%) persons had   normal vision, 20 (22%) had mild visual impairment, 15 (16%) had moderate visual impairment, 5(5%) had severe visual impairment but none was blind. All forms of visual impairment are not wholly attributable to bacterial conjunctivitis as some could be due to ageing and uncorrected refractive errors.