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Objective: To determine the frequency, demography, aetiology and mechanisms of ocular injuries associated with childhood traumatic cataract in Nigeria., Methods: A retrospective multicentre study conducted across ten child eye health tertiary facilities in Nigeria between January 2017 and December 2021. Clinic records of all children aged 0-17 years who had been diagnosed with cataract at the various participating centres were reviewed. Information collected include: biodata, mechanism of injury; laterality, place of injury; object responsible; person responsible; duration before presentation and surgical intervention., Results: A total of 636 out of 1656 children (38.4%) had traumatic cataracts during the study period. Their mean age was 109.4 ± 45.2 months with a male-to-female ratio of 2:1. Most injuries were unilateral, two (0.3%) children had bilateral involvement. Only 78 (15.3%) children presented within 4 weeks of the injury. Closed globe injuries were responsible for the traumatic cataract in 475 (74.7%) children, while open globe injuries were more likely to present within 24 h (P < 0.001). The commonest objects of injury were cane, sticks, plant, wood and play materials. Self-inflicted injuries occurred in about 82 (13%) children while 407 (64.0%) were caused by close relatives and contacts. The location where trauma occurred was home in 375 (59.8%) and school in 107 (16.8%) children., Conclusion: This multicentre study demonstrates that more than one-third of all childhood cataracts in Nigeria are trauma-related and majority are due to closed globe injuries. Public health interventions to reduce the occurrence of ocular trauma and to encourage early presentation after trauma are advocated., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: The purpose of this study is to compare the quality of life (QoL) of medically treated versus surgically treated primary open-angle glaucoma (POAG) patients attending Lagos University Teaching Hospital, Lagos, Nigeria., Methods: The study was a hospital-based, comparative cross-sectional study. Consecutive consenting POAG participants who met the inclusion criteria were recruited until the sample size was achieved. QoL of all participants was assessed using the glaucoma QoL-15 and National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) questionnaires. Analysis was done using the IBM statistical package for the social sciences version 25.0., Results: The study involved 81 participants who were only on medical treatment for POAG and 81 age- and sex-matched POAG participants who had trabeculectomy surgery. Surgically treated participants had a lower mean intraocular pressure 11.68 mmHg when compared to the medically treated participants 14.82 mmHg. Medically treated participants however had a better overall mean glaucoma QoL using the glaucoma QoL-15 (medical 34.36 ± 10.4, surgical 39.11 ± 13.9 P = 0.015) and NEI-VFQ-25 questionnaires (medical 68.32 ± 15.0, surgical 62.44 ± 18.8 P = 0.029). Controlling for the severity of glaucoma using the glaucoma QoL-15 questionnaire, medically treated participants had a better QoL only among participants with severe POAG (medical 49.13 ± 5.9, surgical 54.06 ± 4.6 P = 0.003). While using the NEI-VFQ-25 questionnaire, medically treated participants had a significantly better QoL only among participants with moderate (medical 74.70 ± 6.6, surgical 67.07 ± 15.6 P = 0.012) and severe POAG (medical 54.52 ± 6.3, surgical 45.51 ± 10.0 P = 0.004)., Conclusion: The study demonstrated that although participants that had trabeculectomy had a lower mean intraocular pressure, their overall mean QoL was reduced compared to the medically treated participants., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Middle East African Journal of Ophthalmology.)

Purpose: To determine the status of sub-specialization among Nigerian ophthalmologists as well as their dispositions and barriers against sub-specialization with a view to providing valuable information for the purpose of human resources for eye care planning thereby providing useful insight into the future of ophthalmic practice in Nigeria., Methods: This was a web-based, cross-sectional study conducted among ophthalmologists in Nigeria. An online questionnaire was distributed through e-mails using Qualtrics software (Qualtrics, Provo, UT, USA). Information concerning socio-demographic characteristics, type of practice, location of practice, years of practice, status and disposition to sub-specialization as well as barriers to sub-specialization were obtained through the questionnaire., Results: Two hundred and four Nigerian ophthalmologists participated in the study out of which 118 (57.8%) were females. One hundred and ten (54.0%) respondents had undergone sub-specialty training. The sub-specialties with the highest number of patronage was Paediatric Ophthalmology and Strabismus (14.2%). Respondents who had practised for more than 7 years were three times more likely to have undergone sub-specialty training compared to respondents who had practised for 7 years and below [odds ratio (OR) = 3.01, 95% confidence interval (CI) = 1.33-6.83, p = 0.01]. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice were non-availability/inadequate trained specialist and inadequate equipment., Conclusion: Nigerian ophthalmologists are well disposed to sub-specialization although the extent of sub-specialization among them was a little above average. The main barriers to the availability and uptake of sub-specialty services as well as the challenges of sub-specialty services at the centres with established sub-specialty practice in this study were non-availability/inadequate trained specialist and inadequate equipment., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the technique of eye drop instillation and its determinants among patients with primary open angle glaucoma (POAG) attending a Nigerian tertiary hospital., Methods: This study was a cross-sectional observational study conducted among 130 participants. Systematic sampling technique was used. Inclusion criteria were the presence of POAG, in individuals ≥ 18 years, and self-instilling their ocular hypotensive medications for at least 6 months. Demographic data and clinical characteristics were obtained using an interviewer-administered questionnaire and clinical examination. All participants underwent eye drop instillation of sterile water. Administration techniques were observed and graded using a comprehensive grading scheme. Patients with poor techniques were educated. Determinants of poor eye drop administration technique were also explored., Results: One hundred and thirty patients with POAG were studied. The mean age was 57.13 ± 13.20 years, and 63% percent of the participants had poor eye drop administration technique. On multivariate analysis, previous eye drop instillation education significantly influenced eye drop instillation technique (p = 0.02; OR = 3.230; 95% CI = 1.173-8.896). Among the participants, 47 (36%) touched the globe, 128 (98.5%) did not wash their hands, and 126 (97%) did not occlude the punctum. Sequel to the training, mean score of subjects improved from 2.8 ± 1.1 to 4.1 ± 1.3 (p value < 0.001)., Conclusion: This study demonstrated that a high proportion of POAG patients had poor eye drop instillation technique despite long-term self-use of topical medication. Thus, this aspect of therapy deserves periodic scrutiny by the clinician., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: The travel distance from home to a treatment centre, which may impact the stage at diagnosis, has not been investigated for retinoblastoma, the most common childhood eye cancer. We aimed to investigate the travel burden and its impact on clinical presentation in a large sample of patients with retinoblastoma from Africa and Europe., Methods: A cross-sectional analysis including 518 treatment-naïve patients with retinoblastoma residing in 40 European countries and 1024 treatment-naïve patients with retinoblastoma residing in 43 African countries., Results: Capture rate was 42.2% of expected patients from Africa and 108.8% from Europe. African patients were older (95% CI -12.4 to -5.4, p<0.001), had fewer cases of familial retinoblastoma (95% CI 2.0 to 5.3, p<0.001) and presented with more advanced disease (95% CI 6.0 to 9.8, p<0.001); 43.4% and 15.4% of Africans had extraocular retinoblastoma and distant metastasis at the time of diagnosis, respectively, compared to 2.9% and 1.0% of the Europeans. To reach a retinoblastoma centre, European patients travelled 421.8 km compared to Africans who travelled 185.7 km (p<0.001). On regression analysis, lower-national income level, African residence and older age (p<0.001), but not travel distance (p=0.19), were risk factors for advanced disease., Conclusions: Fewer than half the expected number of patients with retinoblastoma presented to African referral centres in 2017, suggesting poor awareness or other barriers to access. Despite the relatively shorter distance travelled by African patients, they presented with later-stage disease. Health education about retinoblastoma is needed for carers and health workers in Africa in order to increase capture rate and promote early referral., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria., Design: Descriptive case study., Setting: Neonatal intensive care units in Nigeria., Participants: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria)., Methods and Analysis: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision., Results: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems., Conclusion: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To determine the prevalence and causes of visual impairment in hearing-impaired students in Lagos, Nigeria and to assess their level of ophthalmic care utilization., Methods: Descriptive cross sectional study carried out in a primary school for hearing impaired students in Lagos, Nigeria. Socio-demographic characteristics, medical and ocular history were obtained. Ocular examination comprised of distance and near visual acuity assessment; cover tests; anterior segment examination and direct fundoscopy. Visually impaired students had cycloplegic refraction, dilated fundoscopy and subjective refraction. In-depth interviews were carried out for parents of students requiring referral for further eye care., Results: One hundred and nine students participated in the study. The prevalence of visual impairment was 19%. The causes of visual impairment were refractive error (11%), amblyopia (6%), cataract (1%) and macular scarring (1%). A lower mean age (p = 0.020) and ocular misalignment (p = 0.037) were associated with visual impairment on multivariate analysis. The spectacle correction coverage was 11% and only 8% of the students had prior ophthalmic care utilization. Ignorance of ocular morbidity and perceived inaccessibility of eye care were cited by parents/guardians as reasons for poor utilization of eye-care services., Conclusion: A high prevalence of visual impairment was found among the hearing impaired students; uncorrected refractive error and refractive amblyopia were the most prevalent causes. The level of prior ophthalmic service utilization was found to be low. It was recommended that ophthalmic services especially refractive services should be made available in schools for the hearing impaired., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: To compare the prevalences of diabetic retinopathy in diabetes mellitus patients, with and without primary open-angle glaucoma, with a view to determine if glaucoma is a risk factor for the development of diabetic retinopathy., Methods: Cross-sectional, comparative study consisting of 86 diabetic patients with glaucoma matched with 86 diabetic patients without glaucoma. The two groups were matched by age, sex and duration of diabetes mellitus. Demographic data were obtained via patient medical records and self-administered questionnaires. Participants underwent a standardized examination protocol including blood pressure measurement and ocular examination. Main outcome measure was the presence of diabetic retinopathy., Results: Two hundred and ninety-two eyes (144 glaucomatous eyes and 148 non-glaucomatous eyes) of 172 participants with diabetes mellitus were assessed. The prevalence of diabetic retinopathy among 86 participants with glaucoma comorbidity was 23.6%, while the prevalence among 86 non-glaucomatous participants was 33.8% (p = 0.06). After the regression analysis, controlling for systemic and ocular risk factors for diabetic retinopathy, the odds of developing diabetic retinopathy were significantly higher in the glaucomatous eyes compared with eyes without glaucoma (OR: 2.75; p = 0.03; 95% CI: 1.10-6.87)., Conclusion: This study demonstrated that glaucomatous diabetic eyes were almost three times more likely to develop diabetic retinopathy compared to non-glaucomatous diabetic eyes. Prospective studies may be required to establish a risk-cause relationship. Ocular perfusion pressure control should be considered in patients with diabetes mellitus and glaucoma.

Purpose: To determine the relationship between corneal sensitivity and diabetic retinopathy among diabetics attending Lagos University Teaching Hospital, compared to their age-sex-matched non-diabetics, with a view to proposing its use as a screening tool for diabetic retinopathy., Methods: The study was a hospital-based comparative cross-sectional study among diabetics aged 25-65 years and their age-sex-matched non-diabetics at Lagos University Teaching Hospital, Lagos, Nigeria. Interviewer-based questionnaire was administered. Corneal sensitivity was assessed with Cochet-Bonnet aesthesiometer. Dilated fundoscopy examination was carried out using slit-lamp bio-microscope with 78D lens and binocular indirect ophthalmoscope., Results: A total of 120 diabetics and 120 age- and sex-matched non-diabetics were enrolled into the study. Among the diabetics, the mean corneal sensitivity was 52.6 ± 6.9 mm, which was statistically lower than among non-diabetics - 58.2 ± 3.0 mm (p-value < 0.05). Twenty-one percent of the diabetic respondents had diabetic retinopathy. The mean cornea sensitivity was statistically lower among diabetics who had developed diabetic retinopathy compared to those with no diabetic retinopathy (48.9 ± 7.3 vs. 55.3 ± 5.4, p < 0.05). The sensitivity and specificity of the aesthesiometer for proliferative diabetic retinopathy at 55 mm cut-off were 100% and 58%, respectively., Conclusion: Cornea sensitivity was significantly lower among diabetics with retinopathy compared to those without retinopathy. Also, the degree of cornea sensation loss among diabetics reduced significantly with severity of diabetic retinopathy. Larger validity studies need to be conducted to further assess the use of corneal aesthesiometer as a screening tool for diabetic retinopathy among non-ophthalmologists and other cadres of health workers.

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale., Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis., Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017., Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis., Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- and middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68])., Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs.

Context: Proper use of protective eyewear (PEW) is important in the prevention of occupational eye injury., Aim: The aim of this study was to determine the ocular morbidity and utilisation of PEW among carpenters in Mushin Local Government, Lagos, with a view to promoting ocular health and safety in the workplace., Subject and Methods: This was a cross-sectional study of one hundred and fourteen (114) carpenters that were enrolled into the study. Interviewer-administered questionnaires were used to collect information on socio-demographics, work-related ocular history, awareness and utilisation of, as well as barriers to utilisation of PEW. Ophthalmic examination was done. In-depth interviews were also carried out to probe the barriers to utilisation of PEW. Quantitative responses were analysed using the IBM SPSS software, and content data analysis was performed for qualitative responses., Results: The prevalence of reported work-related eye injury and complaints were 30.7% and 32.5%, respectively. The prevalence of ocular morbidity among the respondents was 74.6%. Seventy-seven respondents (67.5%) were aware of PEW; only 21.1% owned PEW, whereas the utilisation level was 26.3%. In-depth interviews revealed ignorance, forgetfulness, and unfamiliarity as the key barriers to PEW use. The odds of using PEW were about three-fold with previous eye injury at work and history of eye complaint., Conclusions: This study demonstrates a significant prevalence of ocular morbidity and poor utilisation of PEW among carpenters in Mushin, Lagos. There was a significant relationship between previous eye injury or complaint and PEW use. Thus, there is a need to create awareness among carpenters and develop occupational safety policies to improve the use of PEW., Competing Interests: None

Background: Maternal and child health workers (MCHWs) are often the first point of contact with pregnant women, children, and caregivers. Therefore, they can play a significant role in early detection of causes of childhood blindness, facilitate prompt referral to specialized centers and provide health education to caregivers for preventive eye care., Methods: This is a pre-test, post-test, single group, quasi-experimental study to evaluate the outcome of training MCHWs on common blinding childhood diseases. All MCHWs in Ifo Local Government Area were selected to participate in the study. Pre-training, qualitative data was obtained from two focus group discussions while quantitative data was obtained using a self-administered questionnaire. Three months post-training, quantitative data was obtained using the same self-administered questionnaire as was used pre-training. Total and percentage scores on the pre- and post-tests were calculated for each participant. A score of ≥70% was regarded as sufficient while < 70% score was regarded as insufficient. McNemar's test was used to determine differences in proportions between pre- and post-training quantitative measurements., Results: Of the 65 MCHWs in the Local Government Area, 61 participated in the study giving a response rate of 93.8%. The age range of study participants was from 28 to 57 years with a mean age of 41 ± 8.3 years. The male: female ratio was 1:7.7. During the focus group discussions, measles was the most commonly mentioned cause of childhood blindness however, participants showed more knowledge of the signs and symptoms of new-born conjunctivitis. Based on a sufficient knowledge score of ≥70%, only one participant (1.6%) demonstrated sufficient knowledge on quantitative survey pre-training. Post-training, there was a statistically significant increase (20, 32.8%) in the proportion of participants with sufficient knowledge (McNemar's test p = .000)., Conclusions: This study demonstrated that the training of MCHWs on common childhood blinding diseases (such as congenital cataract and congenital glaucoma) had the potential to improve knowledge regarding prevention, prompt recognition and early referral of common treatable potentially blinding diseases.

Background: Circulatory abnormalities of retrobulbar vessels are increasingly being linked to the aetiopathogenesis of primary open angle glaucoma. These abnormalities can be assessed with a colour Doppler Imaging of retrobulbar vessels., Aims and Objectives: To compare the Doppler ultrasound patterns of central retinal artery and ophthalmic artery in new patients with primary open angle glaucoma (POAG) diagnosis with those of non-glaucomatous group., Design of the Study: A hospital-based, comparative, cross-sectional study., Setting: Department of Ophthalmology (Guinness Eye Centre) and Department of Radiology, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria., Materials and Methods: End diastolic velocity (EDV), Peak systolic velocity (PSV) and resistivity index (RI) were measured in the central retinal artery (CRA) and ophthalmic artery (OA) of both eyes of newly diagnosed POAG patients. The CDI values of newly diagnosed POAG patients were compared with age-gender matched non-glaucomatous group. The Doppler values of the better and worse eye of patients with asymmetrical POAG were also compared., Results: One hundred subjects (200 eyes) comprising of 50 POAG patients and 50 non-glaucomatous healthy subjects were recruited for this study. The male to female ratio was 1:1.1(24 males and 26 females) for POAG patients and 1:1 (25 males and 25 females) for non-glaucomatous subjects. The CRA and OA in both eyes of POAG patients had a significantly lower mean EDV and PSV compared with those of non-glaucomatous group (p< 0.001). The CRA and OA in both eyes of POAG patients had a significantly higher mean RI compared with those of non-glaucomatous group (p< 0.001). A significant positive Pearson correlation was seen between the IOP and the RI in the CRA and OA in both eyes. Also, statistically significant negative Pearson correlations were seen between the IOP and the PSV and EDV in the OA and CRA in both eyes., Conclusion: This study demonstrated a significant reduction in EDV and PSV as well as an increase in RI of the CRA and OA in both eyes among POAG patients compared to the non-glaucomatous group., (© 2010 - 2018 JWACS-JCOAC. ALL RIGHTS RESERVED.)

Aim: The aim of this study was to determine the pattern of childhood visual impairment and blindness (VI and BL) among students attending schools for the visually impaired in Lagos State, with a view to providing information on avoidable causes as well as emerging trends that would be useful to policy-makers for the planning and implementation of strategies for the control of avoidable childhood BL in Lagos State., Subjects and Methods: The study was conducted among students enrolled in two schools for the visually impaired in Lagos State who developed VI/BL before the age of 16 years. Participants and their parents/guardians were interviewed to obtain medical history. Ocular and systemic examinations were also performed. Information was recorded using a modified World Health Organization/Prevention of BL Eye Examination Record for Children with BL and Low Vision and analysed using the Statistical Package for the Social Sciences version 23.0. Z-test determined differences in the proportions of the causes of VI/BL between this study and an earlier study., Results: A total of 116 students were enrolled in this study of which 65 (56.0%) were males. Avoidable causes accounted for 58.5% of VI/BL. Preventable causes predominated with measles (15; 12.9%) accounting for the largest proportion. Surgical complications (16; 13.8%) were the largest cause of VI/BL. A statistically significant decrease (P = 0.004; 95% confidence interval = 0.09-0.50) in the proportion of avoidable BL between a previous study carried out in Lagos State and this study was found. Hereditary cataract and cortical VI were the findings of this study not recorded in the previous study., Conclusion: Avoidable causes of childhood VI/BL still predominate among students in the schools for the visually impaired in Lagos State; however, there is a statistically significant decrease., Competing Interests: There are no conflicts of interest

Vogt-Koyanagi-Harada's (VKH) disease has been reported to be rare in sub-Saharan Africa. Two Nigerians with the disease are presented in this report. The first patient, a 32-year-old pregnant Nigerian woman presented with a 1-month history of bilateral blurring of vision, persistent headache, and alopecia. Presenting visual acuity was 1 m counting fingers in both eyes. Examination revealed vitiligo and poliosis with bilateral panuveitis as well as bilateral exudative retinal detachment. A clinical assessment of complete VKH disease was made. The patient commenced systemic and topical steroids that resulted in remarkable recovery of vision and control of inflammation. The second patient, a 56-year-old Nigerian woman presented with severe headache, tinnitus, and visual loss in both eyes of 2 weeks duration. There was associated redness of both eyes and photophobia. Examination showed visual acuity of Hand motion (HM) and counting fingers at 1 meter (CF). in the right and left eye, respectively, with bilateral panuveitis and bilateral exudative retinal detachment. Subsequent follow-up showed poliosis, vitiligo, and sunsetting fundus appearance. The patient improved with systemic and topical corticosteroids. Developing a high index of suspicion is necessary in diagnosing VKH disease, even in sub-Saharan Africa. Prompt institution of appropriate treatment prevents blindness., Competing Interests: The authors report no conflicts of interest in this work.

Objective: The objective of this study was to determine the prevalence and pattern of amblyopia in primary school pupils in Kosofe town of Lagos State with a view to providing baseline data that may facilitate the establishment of routine school eye screening programs in primary schools in Lagos State., Materials and Methods: A descriptive, cross-sectional study was conducted among pupils from public and private primary schools in Kosofe town. The pupils underwent visual acuity assessment with the HOTV charts, detailed ocular examinations and cycloplegic refractions. Data obtained were analysed using the Statistical Package for Social Sciences version 20.0., Results: A total of 1702 pupils participated in the study, out of which 899 (52.8%) were males. The age range was 4-16 years with 1630 (95.8%) pupils within the ages of 4 and 10. Amblyopia was detected in 24 (1.4%) of the screened pupils (95% confidence interval = 0.610-0.914). There was no significant sex predilection (P = 0.367) or age trend (P = 0.158) in this study although amblyopia occurred more in boys (54.2%). Refractive amblyopia (58.4%) was the most common type of amblyopia out of which anisometropic amblyopia accounted for 78.6%. Unilateral amblyopia was observed in 87.5% of the amblyopic pupils, and the left eye was more commonly affected than the right eye. All the types of amblyopia were more common within the age group of 4-10 years and in public school children (P = 0.039 and P = 0.015, respectively)., Conclusion: The prevalence of amblyopia in this study was low and it falls within the general prevalence range for amblyopia in Nigeria.

Background: Presbyopia is an age-related loss of lens accommodation resulting in difficulty in performing near task with attendant effect on the quality of life., Objective: The objective of the study was to determine the prevalence of presbyopia and presbyopic spectacle correction coverage among public school teachers in Ifo township, with a view to providing a baseline information that could be useful for advocacy and planning appropriate intervention., Study Design: The study was a descriptive, cross-sectional study., Materials and Methods: Six hundred public school teachers aged 30 years and above were examined in 25 clusters using a multistage random sampling technique with probability proportional to size. Questionnaire was used to obtain information on demographic data, sources of spectacle and barriers to spectacle use. All participants underwent a standardised protocol including visual acuity assessment (distance and near acuity), anterior and posterior segment examinations and refraction., Results: Six hundred teachers were examined with an age range of 30-61 years. The mean age was 44.7 ± 7.5 years and the male to female ratio was 1:2.2. The prevalence of presbyopia was 81.3% and 38.5% of the presbyopic teachers did not have presbyopic correction. However, the average age of onset of presbyopia was earlier in females 33 years compared to 36 years observed in males, although not statistically significant (P = 0.88). The presbyopic correction coverage was 61.5%. One hundred and eighty-six (62%) presbyopic teachers obtained their spectacle from opticians, and the main barriers to the use of near vision spectacle were lack of awareness (23.7%) and cost (13.7%)., Conclusion: This study demonstrated a high prevalence of presbyopia among public school teachers in Ifo town, South-West Nigeria, but less presbyopic spectacle correction coverage.

Background: Destructive eye surgeries are terminal treatment modalities for some ophthalmic conditions with psychological, emotional and cosmetic implications, especially for the patients and their relatives., Objective: The aim of this study was to determine the frequency and indications for destructive eye surgeries at an Eye Centre of a Nigerian Tertiary Hospital with a view to identifying the preventable indications for which appropriate preventive measures could be recommended., Patients and Methods: A retrospective, descriptive study of all patients who underwent evisceration, enucleation or exenteration at the Guinness Eye Centre, Lagos University Teaching Hospital from January 2003 to December 2012 was performed. Their outpatient, ward and theatre records were retrieved and reviewed. Information obtained included age, sex, eye affected, duration of symptoms before presentation, visual acuity of affected eye at diagnosis, indication for surgery and type of destructive surgery., Results: A total of 186 eyes of 185 patients were surgically removed constituting 4.8% of a total of 3866 surgeries performed during the period of study. Children below 16 years accounted for 33.5% of the cases while 30.3% were in their first decade of life. Overall, the most common indication for destructive eye surgery was trauma (36.2%) followed by tumour (27.6%) and ocular infection (18.4%). However, tumour (73.2%) was the most common indication in the first decade of life with retinoblastoma accounting for 92.7% of these., Conclusion: Ocular trauma, tumour and infection were the most common indications for destructive eye surgery in this centre.

Small incision cataract surgery (SICS) offers the benefits of a phacoemulsification (phaco) surgery without the attendant high cost, but it is not without certain risk such as nucleus drop into the vitreous as seen in phaco. A retrospective study of SICS and associated factors leading to nucleus drop during surgery, challenges of management and the visual outcomes. Of 793 eye surgeries performed during the study 586 were SICSs. Nucleus drop during SICS occurred in 0.68% of patients. Can-opener technique of capsulotomy, use of dispersive viscoelastic, diabetes mellitus, lack of anterior vitrectomy machine and poor access to immediate posterior vitrectomy were important problems in the management of the cases of nucleus drop in this study. The visual outcomes were poor in all the cases of nucleus drop. Careful patient selection for SICS and the use of continuous curvilinear capsulorhexis are advocated. An interior vitrectomy machine should be available to all cataract surgeons. It is good professional practice to be acquainted with the available vitreo-retina surgeons for urgent assistance in cases of nucleus drop.

Objective: To determine the pattern of presentation of uveitis at the Guinness Eye Centre of the Lagos University Teaching Hospital, Lagos, Nigeria., Materials and Methods: The case files of all patients with the diagnosis of uveitis who presented at the center from January 2006 to December 2010 were reviewed. Data on age, sex, ethnicity, symptoms, duration of symptoms before presentation, eye affected, anatomical type of uveitis and clinical type of uveitis were extracted onto a form for analysis., Results: A total of 68 cases of uveitis were reviewed. There were 38(60.3%) males and 25 (39.7%) females. The range was from 12 to 90 years. The peak incidence occurred within the age range 21-40 years inclusive. Anterior uveitis and posterior uveitis occurred in 34(54.0%) and 17(27%) patients respectively. While reduction in vision was reported as a symptom by 54(85.7%) patients, only 41(65.1%) patients presented within 4 weeks of onset of symptoms., Conclusion: Anterior uveitis was the most common clinical type in this study. The highest incidence of uveitis occurred in the third and fourth decades of life.

Aim: To determine changes in post-cataract surgery central corneal thickness (CCT) at Lagos University Teaching Hospital by assessing the time it takes for the cornea to return to its preoperative thickness value., Methods: This study is a prospective, hospital-based open within-patient controlled study with the unoperated eye controlling for the operated one., Results: Two hundred patients with 400 eyes were analyzed, with bilateral mature cataract in 47.0%. All the patients had manual small incision cataract surgery with posterior chamber intraocular lens implant. There is an increase in mean baseline CCT from 520.6±20.3 μm by 76.9 μm (597.9±30.4 μm) 24 hours after cataract surgery followed by relative reduction in the mean CCT to 555.2±24.7 μm and 525.1±19.7 μm at 2 weeks and 12 weeks, respectively. Increase in mean CCT in the unoperated and contralateral eyes were recorded in this study., Conclusion: There was a transient increase in corneal thickness following cataract surgery with subsequent decrease to preoperative thickness by 12th and fourth week in the operated and unoperated eyes, respectively. Corneal manipulations during cataract surgery must be minimal to reduce visual rehabilitation time to barest minimum. Postoperative refraction will be better at eighth week to 12th week considering the time it takes for the CCT to return to its stable preoperative values.

Background: Screening and early treatment of retinopathy of prematurity (ROP) is important to reduce visual impairment in at risk infants., Aim: To determine the frequency and risk factors associated with ROP in preterm infants in Lagos University Teaching Hospital., Methods: This was a prospective cohort study of preterm infants with gestational age (GA) less than 32 weeks and birthweight 1500 g or less conducted from November 2011 to May 2014. The infants' eyes were examined using an indirect ophthalmoscope at 4-6 weeks of life or at 34 weeks post-conceptual age. Examinations were repeated weekly until regression or progression to a high risk pre-threshold disease. Staging was according to the revised International Classification for ROP and treatment criteria were as defined by the Early Treatment for ROP study. The GA, birth weight (BW), use of oxygen, presence of respiratory distress syndrome and other risk factors were recorded and tested for significance., Results: Twelve (15%) of the 80 infants examined had any ROP and six (7.5%) had treatable ROP. The mean (SD) GA and BW for infants with ROP were both lower than for those without ROP; 28.2 (1.7) weeks vs 29.1 (1.6) weeks and 1124 (212) g vs 1251 (274) g for GA and BW, respectively. Risk factors such as supplemental oxygen, sepsis, respiratory distress and anaemia were not significantly associated with ROP., Conclusion: The frequency of ROP and treatable ROP was high; it is therefore recommended that routine care of preterm infants should include screening for ROP and that affordable treatment facilities should be provided in public hospitals.