BACKGROUND: In the current era of highly active antiretroviral therapy (HAART), when disorders like immunological recovery uveitis (IRU) have evolved, an updated evaluation of credible data on the extent and forms of ocular symptoms of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) in an HIV-endemic setting is required. The aim was to ascertain the association between the ocular symptoms of HIV/AIDS and the CD4+ count and viral load at the Federal Medical Center in Lokoja, Kogi State, Nigeria, to provide suggestions for better ocular care for adult HIV-positive patients. MATERIAL AND METHODS: The study was a cross-sectional hospital-based study of HIV-positive 310 patients on HAART in Lokoja, Nigeria. Random sampling was used systematically to recruit patients. Data was gathered using interviewer-administered questionnaires. The chosen patients were also assessed. Version 21 of the Statistical Package for Social Sciences (SPSS) was used to analyse the data. Tables displaying frequency and percentages were created using the participant demographics, the frequency and pattern of ocular symptoms, CD4+, and the viral load. Chi-square was used to assess the relationship between the CD4+ count, viral load, and ocular symptoms of HIV. A p-value of < 0.05 was used to define statistical significance at a 95% confidence interval. RESULTS: Interviews and examinations were conducted with 310 subjects, of whom 249 (80.3%) were female and 61 (19.7%) were male. In this investigation, the hospital prevalence of HIV-related ocular manifestations (HROM) was 5.2%. The association between HIV/AIDS ocular manifestations and CD4+ cell count was not statistically significant. However, there was a statistically significant difference in the mean viral load (VL) between individuals with some ocular manifestations and those without (p-value of < 0.05). CONCLUSION: The statistically significant correlation between the viral load and the ocular symptoms of HIV/AIDS suggests that a high viral load is a predictor of HROM but not of CD4+ cell count. Periodically monitoring viral load and promoting ocular exams for all HIV-positive individuals are recommended.

Mitogen-activated extracellular signal-regulated kinase (MEK) inhibitor-associated retinopathy (MEKAR) is observed in oncological patients undergoing MEK inhibitor therapy, such as binimetinib and encorafenib. It is characterized by self-limiting accumulation of the subretinal fluid. MEKAR typically presents bilaterally, involving the fovea, and reveals characteristic optical coherence tomography (OCT) features compared to central serous chorioretinopathy (CSR), which may clinically resemble. Recent studies highlight that MEKAR often resolves without discontinuing the inhibitors. We report a case of a 55-year-old female with metastatic melanoma who developed MEKAR a few hours after administering binimetinib and encorafenib treatment. Progress in the development of oncological diseases’ pharmacological treatment, and consequently increased use of MEK inhibitors, should raise awareness among ophthalmologists regarding the management of patients with MEKAR and the importance of collaboration with oncologists.

Basal cell carcinoma (BCC) stands as one of the most prevalent malignant epithelial skin tumors worldwide, and it is characterized by diverse clinical forms with locally destructive growth and a high recurrence rate. Usually, this type of cancer is more common in individuals over the age of 60. Therefore, the current study discusses contemporary approaches to treating basal cell carcinoma, highlighting the advantages and disadvantages of potential therapeutic options.

The inner canthus is the site of aggressive basal cell carcinomas. The management of these tumors requires knowledge of the basic principles of reconstruction in reconstructive surgery. Surgical resection with exhaustive control of the excision margins should be performed. Even when the tumor is small, the need for healthy margins often results in a moderate to a large palpebral defect that cannot be repaired with direct sutures. The goal of reconstruction is to achieve a mobile eyelid, good corneal protection, and a good aesthetic result with acceptable donor site sequelae. In this manuscript, we describe a case of basal cell carcinoma of the medial canthus that underwent resection followed by reconstruction with a glabellar flap.

Background: The purpose of this study was to describe anatomical and visual outcomes after scleral buckling, pars plana vitrectomy, and the use of silicone oil as a tamponade in the management of retinal detachment associated with giant retinal tears (GRT). Material and methods: A retrospective descriptive chart review was conducted for cases with an initial presentation of rhegmatogenous retinal detachments associated with GRT. Patients underwent surgical management by a single surgeon and had follow-ups at least 12 months. Results: We included 32 eyes of 32 patients. All eyes underwent 23G pars plana vitrectomy with scleral buckling and silicone oil as tamponade. Lensectomy was performed for all phakic eyes. Mean pre-operative best-corrected visual acuity (BCVA) was 20/800, and post-operative was 20/40 (20/20-LP). The mean follow-up was 18 months. Fourteen eyes (45%) had grade C proliferative vitreoretinopathy, and five eyes (16%) had GRT more than 180º. The primary reattachment rate was 93%, and the overall final anatomical success rate was 100%. Transient intraocular pressure (IOP) elevation was found in 6 (19%), and after silicone oil removal surgery, no patient required antihypertensive management. Conclusion: High rates of anatomical success support the management of GRT-associated retinal detachment with scleral buckling, lensectomy, par plana vitrectomy, and the use of silicone oil as tamponade. Removal of silicone oil helps to avoid complications secondary to its emulsification, such as glaucoma and band keratopathy.

Background: The objective of this study was to identify the orbital and periorbital anthropometric variations and determine the effects of age and gender on these variables. From January 2020 to July 2020, we conducted a hospital-based, descriptive, observational study. Material and methods: Three hundred and eighty individuals of age15 years and above were included in the study. Exophthalmometric value (EV) and outer inter-canthal distance (OICD) were measured [mm] on Hertel’s exophthalmometer. Inner inter-canthal distance (ICD), inter-pupillary distance (IPD) [mm], palpebral fissure width (PFW), palpebral fissure height (PFH), marginal reflex distance 1 (MRD1), marginal reflex distance 2 (MRD2), lid crease height (LC), pre-tarsal show (PTS) and levator function (LF) were recorded using a millimeter ruler scale. Data were analyzed using a Microsoft Excel sheet. Results: Out of 380 subjects, there were 222 females and 158 males. Mean EV was 15.86 mm, OICD — 105.57 mm, ICD — 31.7 mm, IPD — 59.55 mm, PFW — 29.7 mm, PFH — 10.04 mm, MRD1 — 4.21 mm, MRD2 — 5.87 mm, LC — 8.31 mm, PTS — 4.24 mm and LF —14.66 mm. Significant sexual dimorphism was noted in five parameters; EV, ICD, IPD, PFH and MRD2 were significantly higher in males versus females. PFH was decreased while PTS was increased in individuals of more than 40 years. Conclusion: There is a significant difference between males and females in some variables, and no difference was detected in others. Age did not significantly affect a majority of the variables.

Background: The aim of the study was to assess the power use and efficacy of Nd:YAG laser iridotomy in the management of primary angle closure (PAC). Material and methods: A prospective cross-sectional analysis was done in 146 eyes of 81 cases who underwent neodymium: yttrium-aluminum-garnet laser iridotomy. There were 42 patients with chronic primary angle closure glaucoma (PACG), 46 with acute and subacute PAC, and 11 with PACS (suspects). After initial intraocular pressure (IOP) controlling, all patients were treated with Nd:YAG laser iridotomy. Before and after the laser therapy, IOP, laser parameters, mean power use, and complications, if any, were noted. Results: The average total power used was 78.56 ± 8.1 mJ per eye. The anatomy of angle structures improved by one or two of Shaffer’s grades. Controlled IOP was noted in 71% (17) of patients with PACG (chronic) and 93% (43) of patients with PAC (acute and subacute). The average total power used was 78.568.1 mJ per eye. Junior residents used more power than senior residents (88.5 62.5 mJ vs. 63.55 ± 5.8 mJ, p = 0.011). Complications included elevated IOP in 38.27% (31/81), aqueous flare/debris in 34.56% (24/81), iris bleeding in 18.51% (15/81), corneal burns in 4.93% (4/81), and lens damage in 3.71% (3/81). Laser peripheral iridotomy (LPI) was repeated in 48.14% of cases (39/81), with junior residents having a higher rate of repeat LPI than senior residents (p = 0.02). Complication rates differed between residents who performed the procedure (p = 0.16). In PACS subjects, 63.6% had a history of repeated LPI, followed by 58.33% in PACG and 39.1% in PAC cases. At follow-up, 3% of PAC eyes had glaucomatous optic neuropathy. Conclusion: Laser iridotomy in managing early PACG reduces IOP and improves patient acuity. Nd:YAG laser iridotomy is effective in widening the drainage angle and lowering elevated IOP in patients with PAC.

Background: This study aimed to measure the changes in choroid thickness using Swept-Source Optical Coherence Tomography (SS-OCT) after treatment of posterior uveitis along with changes in fundus auto-fluorescence pattern. Material and methods: This prospective observational cohort study was conducted from December 2018 to May 2020, in which 32 eyes of 20 patients presenting in the out-patient department with a clinical diagnosis of posterior uveitis were enrolled. Best-corrected visual acuity (BCVA) by Snellen chart, intraocular pressure (IOP) Measurement using a non-contact tonometer, choroidal thickness by SS-OCT, and fundus imaging by Fundus Autofluorescence was done. All tests were done at baseline, first follow-up of 2 ± 1 weeks and the second follow-up of 6 ± 2 weeks. Data was compiled and analyzed. Results: The mean age of patients was 31 ± 6.9 years with M:F of 3:1. During the second follow-up, with the healing of the lesions, there was a significant reduction in the choroidal thickness at all levels by SS-OCT (p < 0.05), with significant improvement in BCVA (0.05 vs. 0.14 vs. 0.31, p < 0.05). IOP increased significantly at the first follow-up to 17.31 from baseline (16.25) (p = 0.032). However, the rise at the second follow-up was not significant (17.03 vs. 16.25 at baseline, p = 0.15). On fundus autofluorescence, normal autofluorescence and hypofluorescence increased at the second follow-up of 6 weeks (p < 0.0001) Conclusion: SS-OCT showed a significant decrease in the choroidal thickness at all levels during the follow-ups. The healing of the posterior uveitis lesions and fundus autofluorescence became normal simultaneously.

Background: The aim of this prospective study was to compare the success rate of external dacryocystorhinostomy (DCR) with and without suturing the posterior mucosal flaps. Material and methods: One hundred patients who underwent external DCR surgery were included in this study. They were divided into group A and group B, with 50 patients in each group. In group A, patients who underwent an external DCR with only anterior flaps sutured and removal of posterior flaps were included. In group B, patients who underwent an external DCR with both anterior and posterior flaps sutured were included. All patients came for a follow-up visit at one week, one month, three months, and at six months. The success rate was evaluated by symptomatic relief from epiphora and patency on syringing performed at the follow-up six months after DCR. To evaluate differences in both groups, a Chi-square test was used. A p-value less than 0.05 was considered statistically significant. Results: The success rate was 98% in group A, and 84% in group B. Our results show the success rate was higher in group A where anterior flaps were sutured, and posterior flaps were excised. The difference was statistically significant (p-value < 0.05) Conclusions: This study shows that DCR surgery with anterior flaps anastomosis and excision of posterior flaps has a higher success rate than anterior and posterior flaps anastomosis.

Background: The purpose of this study was to quantify the inter-eye difference in corneal sensations in patients with infectious corneal ulcers using the Cochet-Bonnet esthesiometer (CBE). Material and methods: Patients with unilateral corneal ulcers of at least 1.5 mm of the clear cornea in all quadrants meeting the study criteria were identified and enrolled. The clinical features with their etiologies were noted. The corneal sensations were measured with CBE in all four quadrants. Patients were further sub-categorized based on the surface area and the “time to heal” of the ulcers for further correlation and analysis. Results: This was a cross-sectional study conducted at a tertiary care center. The study included 35 patients, with the majority (30 patients, 85.7%) diagnosed with fungal etiology. The average corneal sensations in the ulcer and the normal eyes were 52.29 mm and 57.36 mm, respectively. The inter-eye differences were 3.93 mm (p = 0.06) and 6.55 mm (p = 0.04) among patients with an average surface area of ≤ 10 mm 2 and > 10 mm 2 , respectively. Patients who took up to 30 days and > 30 days to heal had inter-eye differences in a sensation of 0.71 mm (p = 0.04) and 6.14 mm (p = 0.05), respectively. Conclusions: The mean corneal sensations in all quadrants were less significant in the infectious ulcer eyes than normal eyes. Infectious ulcers with a surface area of > 10 mm2 had greater inter-eye differences in their corneal sensitivities. Patients who took a longer "time to heal" of > 30 days showed a significant and greater inter-eye difference in their corneal sensitivities.