Prevalence and clinical profile of glaucoma patients in rural Nigeria—A hospital based study

Purpose To determine the prevalence and clinical presentation of participants with glaucoma attending a public eye care facility in Nigeria. Method Hospital based retrospective study of glaucoma participants aged 50 years and above seen over a 5-year period. Descriptive statistics summarized the demographic, clinical characteristics and treatment of the participants and determined the association of variables with gender and age. Prevalence of the glaucoma by type, and their 95% confidence intervals (CI) were also calculated. Result Of the 5482 case files that were reviewed, 995 (18.15%, 95% Cl 17.15–19.19%) had glaucoma particularly primary open angle glaucoma (11.55%, 95%CI 10.73–12.42%) and were mostly females (564, 56.7%) aged 69 ± 12 years (range, 50–103 years). In contrast to other glaucoma types, the prevalence of primary angle closure glaucoma (3.68, 95%CI 3.22–4.22) increased by 15% over 5 years. The mean intraocular pressure ranged from 15–50 mmHg but higher in females than males (27.8 ± 6.1mmHg versus 26.6 ± 6.0 mmHg, P <0.05) who had comparable VA (0.58 ± 0.4 Log MAR) and cup-disc ratios (P >0.05). On presentation, the glaucoma hemi field test (GHFT) was outside the normal limits in 45.5% and 54.5% of males and females, respectively. The type of visual field defect was associated with glaucoma type (P = 0.047). Arcuate scotoma was most common (35.5%) across glaucoma types, paracentral scotoma more common in Secondary glaucoma while Seidel scotoma was highest in NTG (19.3%). Beta-blocker was the mainstay of management (42.2%) but more likely to be prescribed to males while more females received carbonic anhydrase inhibitors. Conclusions The high prevalence of glaucoma in older people remains a public health problem in Nigeria. The fact that about half of the participants presented with visual field defect suggests there is a need for public health messages to emphasize on early glaucoma screening, detection and management.

A Case Study of Eyelid Edema Post Craniotomy

Objectives: This study considered the effectiveness of Korean medicine for the treatment of eyelid edema post craniotomy.Methods: The patient was diagnosed with Taeumin-one of the four constitution types in Korean medicine-and treated with herbal medicines: Cheongsimyeunja-tang, Chungpyesagan-tang, and Hwangryunhaedok-tang pharmacoacupuncture treatment. The severity of eyelid edema was assessed using Kara and Gokalan’s scale, daily imaging of the patient’s eyelids, and the ratio of the length of the left eye to that of the right.Results: Following treatment, the Kara and Gokalan score decreased from 3 to 0. The changes in the ratios were 29% and 50%, respectively. The visual field defect due to edema in the left eye was also repaired.Conclusion: This study suggests that Korean medical treatment could be an effective option for treating eyelid edema following craniotomy.

Nonarteritic Anterior Ischemic Optic Neuropathy following COVID-19 Vaccination: Consequence or Coincidence

To report a patient with nonarteritic anterior ischemic optic neuropathy (NA-AION) occurring soon after the COVID-19 vaccination. A 55-year-old woman presented with a 4-day history of inferior visual field disturbance in the right eye 7 days after receiving the first dose of Pfizer-BioNTech COVID-19 vaccine. Examination revealed a best-corrected visual acuity of 20/20 in both eyes. A relative afferent pupillary defect was observed in the right eye. Fundoscopy revealed diffuse optic disc swelling in the right eye, which was prominent above the optic disc. Goldmann visual field testing identified an inferior altitudinal visual field defect with I/2 isopter in the right eye. Although typical complete inferior visual field defect was not detected, a diagnosis of NA-AION was made. The patient was followed without any treatment. During the 2-month follow-up period, the optic disc swelling was gradually improved, and visual acuity was maintained 20/20; however, the optic disc looked diffusely pale in the right eye. Although it is uncertain whether the development of NA-AION after COVID-19 vaccination was consequential or coincidental, we speculate that the close temporal relationship with COVID-19 vaccination suggests the possibility of vasculopathy on the microvascular network of optic nerve head as background of inflammatory or immune-mediated element to the timing of the onset of NA-AION. The aim of this case report is to present this biological plausibility and to elucidate potential ophthalmological complications.

Evaluation of blood vessel network formation and visual field defect in optic disc melanocytoma

AimTo investigate the association between visual field defects and blood vessel network (BVN) formation in optic disc melanocytomas (ODMs) using optical coherence tomography angiography (OCTA).MethodsSingle-centre, retrospective case series of 32 eyes of 32 patients with ODM, in which eyes were divided into two groups based on complete and incomplete BVN formations.ResultsOCTA revealed incomplete BVN formation in 16 of 32 ODMs. The location of BVN absence corresponded to the location of hypofluorescence from fluorescein angiography (FA) in 12 (75%) and to the location of visual field defect in 13 (81%) ODMs in the incomplete BVN group. Perimetric indices were significantly worse in the incomplete BVN group than in the complete BVN group. Linear regression of mean deviation (MD) and Visual Field Index (VFI) on the area of BVN absence were statistically significant (p=0.01 and p=0.003, respectively), whereas linear regressions of MD and VFI on the tumour area were not statistically significant (both p=0.09) in the incomplete BVN group.ConclusionThe location of BVN absence within ODMs corresponded to the location of visual field defect and the location of FA hypofluorescence. Visual field defect was more severe in the incomplete BVN group than in the complete BVN group. Visual field defect was more significantly associated with the area of BVN absence than the tumour area.