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Dennis Nkanga,1 Olukorede Adenuga,2 Ogugua Okonkwo,3 Wilson Ovienria,4 Affiong Ibanga,1 Chineze Agweye,1 Idris Oyekunle,3 Toyin Akanbi3 On behalf of The Collaborative Retina Research Network1University of Calabar Teaching Hospital, Calabar, Nigeria; 2Jos University Teaching Hospital, Jos, Nigeria; 3Eye Foundation Hospital, Lagos, Nigeria; 4Irrua Specialist Hospital, Edo, NigeriaCorrespondence: Ogugua OkonkwoEye Foundation Hospital, 27 Isaac John Street, GRA. Ikeja, Lagos, NigeriaTel +234 8035027308Email o_okonkwo@yahoo.comPurpose: To determine the burden of retinal diseases and the degree of visual impairment associated with each disease, amongst Nigerians.Patients and Methods: This was a hospital-based multicenter, prospective, cross-sectional, non-comparative study conducted from January to December 2018. Data was obtained from consecutive patients with a retinal diagnosis presenting at the general ophthalmic and specialty retina clinics in four hospitals (three public, and one private teaching eye department) in Nigeria. Biodata, visual acuity and refraction, intraocular pressure, findings on dilated retinal examination, diagnosis and systemic diseases were noted. Degree of monocular and bilateral visual loss associated with each diagnosed retinal disease was summarized and p value was calculated using chi-square test. P < 0.05 was considered significant.Results: Eight hundred seventy-six of 8614 patients had a retinal diagnosis; establishing a hospital-based retinal disease prevalence of 9.8%. Male:female ratio was 1.1:1. The mean age of study patients was 49.97 (standard deviation 17.64 years). Mean symptom duration was 21.63 months (standard deviation 41.94). The mean intraocular pressure was 13.87 mmHg. Forty-three different retinal diseases were diagnosed. The most common was retinal complications of diabetes, i.e., diabetic retinopathy (DR) alone, diabetic macular edema (DME) alone and a combination of DR and DME, which accounted for 13.7%, 5.6% and 9.3%, respectively (contributed 28.6% of the entire diagnosis). This was followed by retinal detachment (RD), in 219 eyes (15.4%), dry age-related macular degeneration (AMD) in 124 eyes (8.7%). Nearly half of the eyes were blind or severely visually impaired. Blindness occurred in 34.1% of eyes; severe visual impairment in 8.2% of eyes and 29.7% had normal vision. There were 469 patients who had systemic diseases. The common systemic diseases were hypertension in 169 patients (19.3% of the total number of patients), hypertension and diabetes in 156 patients (18%), and diabetes alone in 98 patients (11.1%). Sickle cell disease was present in 1.5%.Conclusion: There is need to invest in infrastructure, local training and development of systems for early detection and treatment of several retinal diseases in sub-Saharan Africa; DR and DME having the largest burden. Collaborative physician care and management of hypertension and diabetes could significantly reduce the burden of DR and DME.Keywords: vitreoretinal diseases, sub-Saharan Africa, diabetic retinopathy, macular edema, retinal detachment

Ogugua Ndubuisi Okonkwo,1 Chineze Thelma Agweye,2 Toyin Akanbi1 1Department of Ophthalmology, Eye Foundation Hospital and Eye Foundation Retina Institute, Ikeja, Lagos, Nigeria; 2Department of Ophthalmology, University of Calabar and University of Calabar Teaching Hospital, Cross River, NigeriaCorrespondence: Ogugua Ndubuisi Okonkwo, Eye Foundation Retina Institute, 27, Isaac John Street, GRA, Ikeja, Lagos, Nigeria, Tel +234 803 502 7308, Email o_okonkwo@yahoo.comAbstract: Nonarteritic central retinal artery occlusion (NA-CRAO) is a variant of acute ischemic stroke (AIS) and is a cause of sudden severe loss of vision. There are guidelines by the American Heart Association and the American Stroke Association for the care of CRAO patients. This review explores the basis of retinal neuroprotection for CRAO and its potential for improving the outcome of NA-CRAO. Recently, there have been significant advances in research into the use of neuroprotection to treat retinal diseases, including retinal detachment, age-related macular degeneration, and inherited retinal diseases. Also, neuroprotective research in AIS has been extensive, and newer drugs tested, including Uric acid, Nerinetide, and Otaplimastat, with promising results. Progress in cerebral neuroprotection after AIS offers hope for retinal neuroprotection after CRAO; and a possibility of extrapolating research findings from AIS into CRAO. Combining neuroprotection and thrombolysis can extend the therapeutic window for NA-CRAO treatment and potentially improve outcomes. Experimented neuroprotection for CRAO includes Angiopoietin (Comp Ang1), KUS 121, Gene therapy (XIAP), and hypothermia. Efforts in the field of neuroprotection for NA-CRAO should focus on better imaging to delineate the penumbra after an acute episode of NA-CRAO (using a combination of high-definition optical coherence angiography and electrophysiology). Also, research should explore details of pathophysiologic mechanisms involved in NA-CRAO, allowing for further neuroprotective intervention, and closing the gap between preclinical and clinical neuroprotection.Keywords: neuroprotection, non-arteritic central retinal artery occlusion, thrombolysis, acute ischemic stroke

Ogugua N Okonkwo,1,2 Toyin Akanbi,2 Chineze T Agweye3 1Eye Foundation Retina Institute, Lagos, Nigeria; 2Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria; 3Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, NigeriaCorrespondence: Ogugua N Okonkwo, Eye Foundation Retina Institute, Lagos, Nigeria, Tel +234 803 502 7308, Email o_okonkwo@yahoo.comPurpose: To report incidence, clinical presentation, and treatment outcome of full-thickness macular hole (FTMHs) diagnosed post pars plana vitrectomy.Methods: We retrospectively reviewed the demographics, best-corrected visual acuity (BCVA), indication for the primary vitrectomy, time to diagnose the secondary FTMH, optical coherence tomographic (OCT) appearance, and treatment outcome of FTMHs, occurring after vitrectomy performed between January 2019 and December 2020.Results: Six of 523 vitrectomized eyes developed FTMHs, an incidence of 1.1%. There were five females and one male, mean age of 56.5 years (range 37– 85). The indication for primary vitrectomy was rhegmatogenous retinal detachment (RRD) in three eyes, one eye each for sub internal limiting membrane hemorrhage from a ruptured macroaneurysm, vitreous hemorrhage from polypoidal choroidal vasculopathy (PCV), and pre-insertion of Ahmed glaucoma drainage device (GDD). FTMHs occurred within one week to three months after vitrectomy (time from primary vitrectomy to the identification of the secondary MH was a mean of 1.03 months). Mean BCVA in all six MH eyes was log MAR 0.9 (Snellen: 6/54). Anatomical closure was achieved after one surgery in three eyes, two surgeries in 1 eye, after photodynamic therapy (PDT) in the PCV eye, and one patient declined surgery. The mean BCVA in the four surgically closed MH eyes improved marginally from log MAR 0.82 (Snellen: 6/38) to log MAR 0.72 (Snellen: 6/30), mean follow-up 7.6 months.Conclusion: Post-vitrectomy FTMH is rare, and RRD was the commonest indication for initial vitrectomy. We observed that all secondary MHs were closed successfully using the inverted internal limiting membrane (ILM) flap technique with limited improvement in vision. The visual outcome of these secondary MHs trails behind that of idiopathic MHs.Keywords: full thickness macular hole, vitrectomy, complications of vitrectomy, epiretinal membrane, optical coherence tomogram, inverted internal limiting membrane flap

Ogugua Ndubuisi Okonkwo,1,2 Dennis Sibanda,3 Toyin Akanbi,2 Adekunle Olubola Hassan1,2 1Department of Ophthalmology, Eye Foundation Retina Institute, Lagos, Lagos State, Nigeria; 2Ophthalmology Clinics, Eye Foundation Hospital, Apo, Abuja, Nigeria; 3Department of Ophthalmology, The Eye Zone, Harare, ZimbabweCorrespondence: Ogugua Ndubuisi OkonkwoEye Foundation Retina Institute, 27 Isaac John Street, GRA, Ikeja, Lagos, NigeriaTel +234 8035027308Email o_okonkwo@yahoo.comPurpose: To report the natural history of a large bubble of perfluorocarbon liquid (PFCL) in a parafoveal subretinal position which was monitored using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). The bubble of PFCL was removed when it migrated to the subfoveal position; outcome after removal is also reported.Observation: A 62-year-old male, after repair of a giant retinal tear (GRT) detachment, regained Snellen acuity of 6/18 from preoperative vision of CF at 1 meter. A large bubble of subretinal PFCL was in the superior parafoveal area. For 18 months, the PFCL bubble was monitored using OCT and OCTA until it migrated into the subfoveal position after 22 months, coinciding with a decrease in vision to 6/36. Surgical removal of subfoveal PFCL was performed. This involved detachment of the foveomacular, epiretinal membrane (ERM) peel (complicated by iatrogenic macular hole (MH) formation), intravitreal injection of PFCL to displace subretinal PFCL to the periphery, creation of an inverted internal limiting membrane (ILM) flap to repair the MH and air exchange. Postoperative vision remained 6/36. His postoperative OCT showed significant loss of subfoveal outer retina. On OCTA, the superficial and deep vascular plexi and choriocapillaris appeared to be intact after the removal of the subfoveal PFCL.Conclusion and Importance: This report suggests that a large superior parafoveal bubble of PFCL may take as much as 18 months to migrate to the subfoveal position. Before this time, vision does not appear to be affected, though macular edema is present. Therefore, removal of the PFCL can be delayed until a convenient time for surgeon and patient. A large bubble of parafoveal PFCL ought to be removed before migrating to a subfoveal position and vision loss, since its removal will reduce the risk of outer retina loss.Keywords: perfluorocarbon liquid, sub-retinal, complications, vitreoretinal surgery, retinal detachment, giant retinal tear