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Normal range values of ocular axial length in adult Sudanese population
Sahar Ibrahim Albashir, Mahgoub Saleem
July-December 2015, 3(2):31-38
Background: The axial length is one of the essential ocular biometric parameters which is to be done prior to any cataract surgery based on ultrasound. These ocular axial length (OAL) values can be influenced by sex, age, race, ethnicity, genetics, and refractive errors. Objectives: The aim of this study is to determine the normal ranges values of OAL in adult Sudanese population and to define the effects of age, gender, and tribal ethnicity on axial length. Materials and Methods: This is descriptive multi-center hospital-based study, carried out over a period of 6 months from January 2015 to June 2015. The study takes place in five study areas: Three in Khartoum and two in Omdorman. These centers are Khartoum Eye Hospital, Makkah Eye Complex, Alwalidain Eye Hospital, and Omdurman Military Hospital and Sudan Eye Center. The study population was recruited from patients presenting to the mentioned five Hospitals Biometric Departments or volunteers who accepted to be enrolled in the study. One thousand Sudanese adults participants (n = 1000), 507 female and 493 male, with ages ranging from 18 to 105 years were included. Patients with vitreoretinal diseases, intraocular surgery, recent trauma and staphyloma were excluded. All participants underwent systematic OAL measurements by A-scan ultrasonography. Effect of age, gender, and tribal ethnicity on OAL was analyzed. Results: The study showed that the average axial length was 23.09 mm ranging from 18.13 mm to 29.09 mm. It was longer in males (average 23.29), ranging from 20.31 mm to 28.48 mm and shorter in females (average 22.81), ranging from 18.31 mm to 29.09 mm. In the four main Sudanese tribes, the Nubian group had the longest axial length (23.23 mm), followed by the African group (23.15 mm), and then the Arab group (23.09 mm). Bejja group had the shortest axial length (22.85 mm). Conclusion: OAL in Sudanese adults was within the international standard but with a wider range (18.13–29.09 mm). Males' OAL was longer than the OAL of females. No significant age OAL variations, but the tribal ethnicity factor was clear, so tribal ethnicity had a major influence on Sudanese OAL.
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Pattern of eye diseases at tertiary eye hospital in Sudan (Makah Eye Hospital, Khartoum)
Khalil A lakho, Atif B Mohamed Ali
January-June 2015, 3(1):15-18
Purpose: The aim of the study was to determine the frequency and pattern of eye diseases among patients attending the eye clinics of Makah Eye Hospital, Khartoum, Sudan. Methods: A retrospective study involved all the new cases presenting to the outpatient department of the hospital over a 22-month period from January 2012 to October 2013. Patients were examined by optometrists/ophthalmologists through routine examination using the Snellen's chart, refraction, tonometry, slit-lamp examination of the anterior segment, and fundus examination. Results: A total of 64,529 patients were seen during this period with a male to female ratio of 1:1.1. The most common eye diseases were cataract, allergic conjunctivitis, infective conjunctivitis, refractive disorders, and glaucoma. Conclusion: The pattern of eye diseases observed in Makah Eye Hospital was similar to other reports from developing world and such study will be helpful in planning, management, and prevention of blindness.
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The effect of amblyopia on contrast sensitivity, color vision, and stereoacuity
Islam Altrifi Musa Suliman, Madiha Sid Ahmed Ali
April - June 2017, 4(2):54-57
Aim: This study aims to evaluate the contrast sensitivity, color vision, and stereoacuity in amblyopic eyes. Materials and Methods: A prospective, cross-sectional, hospital-based study includes 64 amblyopic patients (79 eyes), with age between 10 and 30 years, which represents the study sample. Thirty-six normal individuals of same age group were taken as a control group. The history of the patients was taken; vision, objective, and subjective refraction were performed. Pinhole was used to determine the amblyopia. Color vision, contrast sensitivity, and stereoacuity tests were done for both groups. Results: Anisometropic amblyopia represents 51.5% of cases. Significant decrease in contrast sensitivity was detected compared with the control group (P = 0.000). Color vision defect was found in 39.2% of amblyopic patients; 27.8% were tritanopes. Amblyopia affected stereoscopic vision in 48.5% of patients with mean 43.44 ± 95.17. Conclusion: Early detection of causes of amblyopia may prevent the bad Consequences.
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Assessment of biometry and keratometry in low and high degrees of myopia
Afra I Alsamani, Atif B Mohamed Ali
January-June 2015, 3(1):11-14
Purpose: To investigate the possible ocular biometric and keratometric changes in low and high degrees of simple myopia. Subjects of Methods: A sample of 60 myopic subjects their ages between 10 and 30 years recruited from the Makkah Eye Hospital in Khartoum. In this sample, 30 subjects with myopia < 3.00 D and other 30 subjects with myopia > 6.00 D. Auto keratometry and A-scan biometry were measured from two eyes of each subject. Results: Subjects with high myopia have longer axial length (AL) (P < 0.0001) compared to low myopic subjects. No significant difference found in front surface corneal power or type of corneal astigmatism between the two groups. Conclusion: Like previous studies myopia mainly develops with increases in AL of the eye rather than optical changes in cornea or lens.
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Rate of diabetic retinopathy among the diabetic patients with a best corrected visual acuity of 6/9 or better
Mahmoud Abdalla Salim, Rawya Abdelhadi Diab, Sarah Abdelmoneim Elshafie
July-December 2015, 3(2):50-52
Background: Diabetic retinopathy is one of the leading causes of blindness worldwide, broadly it is defined as a complication of diabetes that affects the retina; by damaging its blood vessels, which at first may be symptomless, though eventually can lead to serious and sight-threatening complications like hemorrhages, macular edema, and even blindness. Aim: The study aimed at detecting the presence of diabetic retinopathy in the diabetic patients having a best corrected visual acuity “BCVA” of 6/9 or better, attending Retina Clinic in Elsaiem Eye Hospital, to prove a hypothesis' that states: diabetic patients with a BCVA of 6/9 or better are unlikely to have a diabetic retinal complications, and if found they rarely need intervention. Results: Six hundred and eighteen eyes were included in the study; 59.2% of the eyes with BCVA 6/9, 75.6% of the eyes with BCVA of 6/6, and 86.2% of the eyes with BCVA 6/5 were found to have neither diabetic retinopathy nor maculopathy. Conclusion: As it can be stated out of the results; the better the visual acuity than 6/9 the lesser the prevalence of diabetic retinopathy, so visual acuity “among other factors” could be considered as one of the simple screening methods or predictors of the diabetic retinopathy that is of great importance in developing countries with minimal facilities and resource-poor settings.
  3,003 18 -
Study of the incidence, mechanism, various modes of presentation and factors responsible for the development of lens-induced glaucomas
Chandrasekhar Gujjula, Swapnil Kumar, U Varalakshmi, Mahaboob V Shaik
July-December 2015, 3(2):56-62
Objectives: The present study undertaken to study the factors responsible for the development of lens-induced glaucomas (LIGs), factors, and various modes of presentation in LIGs. Methodology: A minimum of 50 cases of LIG were selected based on simple random sampling, who attended the Department of Narayana Medical College Hospital and were diagnosed with LIG. Based on the clinical findings, etiological diagnosis of LIG was made. Results: Out of the 50 cases, 34 cases (68%) were diagnosed as phacomorphic glaucoma, 12 cases (24%) were of phacolytic glaucoma, two each (4%) were lens-particle glaucoma and glaucoma secondary to subluxation/dislocation of lens. Conclusion: There was no influence of sex, religion, or occupation on the incidence or occurrence of LIGs. Majority of the patients had good vision in the other eye as a result of which they neglected the affected eye till they developed LIG leading to pain during the time of presentation. Hence, it is important to advice the patients regarding the early surgical treatment of cataract before they develop complications.
  2,852 17 2
Ophthalmic disorder in patients with latent autoimmune diabetes in adult
Ahmed Bolad, Razan Abdelmageed, Abdelrahman Manofaly, Husham M Abdelrahim
July-December 2015, 3(2):53-55
It is well known that about 90% of all cases of diabetes mellitus (DM) are type 2, which is characteristic for adults aged above 40 years. Ten percent is represented by type 1 DM, typical for children and young. Adult's onset diabetes represent a heterogeneous mixture of type 1 and type 2 DM, often difficult to differentiate between, those patients may have actually latent autoimmune diabetes in adults (LADAs), where beta-cell destruction is less aggressive, leading to a slower development of insulin dependency. Studies indicated that antibodies against glutamic acid decarboxylase 65 (GAD 65) are good marker for diagnosis of autoimmune diabetes in adults who are not responding to oral hypoglycemic and may be at risk for getting complications namely increased risk of diabetic retinopathy. GAD 65 is mainly expressed in beta-cells of Langerhans but also in nonbeta-cells. GAD is an enzyme required for gama-aminobutyric acid (GABA) synthesis that acts as neurotransmitter in neurons of central nervous system and in pancreatic islets. GABA is probably involved in controlling the release of insulin from secretary granules.
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Sensitivity and specificity of nassar color test in early detection of diabetic macular edema
Moustafa Kamal Nassar, Mohamed YS Saif, Ahmed TS Saif, Passant S Saif
July-December 2015, 3(2):39-43
Purpose: To evaluate the sensitivity and specificity of Nassar color discrimination test in the presence of diabetic macular edema (DME) as a sensitive diagnostic tool for the detection of early functional changes. Design: A prospective, comparative case–control study. Setting: Multicenter study in the outpatient clinic of Beni Suef University, Fayoum University, and Misr University for Science and Technology. Methods: The study included 120 eyes with Type I diabetes recruited from the outpatient clinic. All patients were received ophthalmic exams and tested with Nassar color plate test, fluorescein fundus angiography (FFA), and optical coherence tomography (OCT). The main outcome measures are the presence of mild or moderate tritans indicating early DME changes that were documented in each group. Statistical Analysis Used: Student's t-test and ANOVA f-test were used for statistical analysis. P <0.05 were considered statistically significant. Results: The mean age of the patients was 41.15 ± 5.61 years (range 23–49 years) with the mean disease duration of 13.56 ± 2.59 years (range 10–20 years). All patient with dry macula (n = 60, 50%) were normal on Nassar color test while patients with DME showed normal (n = 6, 5%), mild tritan (n = 14, 11.66%), and moderate tritan (n = 40, 33.33%), respectively. Hence, the Nassar color test is 90% sensitive and 100% specific. Conclusions: The Nassar color plate is an affordable and effective for early detection of DME and recommended to be used in all primary ophthalmic examination especially in areas where no access to comprehensive ophthalmic exams such as OCT and FFA.
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Evaluation of ocular hypotensive effects of some drugs used in treatment of open angle glaucoma, at Alsaym Ophthalmic Hospital, Wad Medani, Sudan
MM Haitham, IM Tajeldin, Mamoun Mirghani Ahmed
July-December 2015, 3(2):44-49
Introduction: Glaucoma is a neurodegenerative disease. It is presented by a triad of elevated intraocular pressure (IOP), progressive optic nerve damage, and constriction of the peripheral visual field. Objectives: The aim of this study is to assess the ocular hypotensive effects of some drugs used in treatment of open angle glaucoma (OAG) at Alsaym Ophthalmic Hospital, Wad Medani, Sudan. Methodology: A cross-sectional hospital-based study was conducted at specialized ophthalmological health setting. Patients (n = 200) diagnosed with OAG and treated with different anti-glaucoma drugs were selected randomly to participate in this study. The ocular hypotensive effects of anti-glaucoma drugs were evaluated monthly for 4 successive months, by measuring the diurnal IOP for each patient, using tonometer. The obtained data were collected in especial data collection form and analyzed by IBM SPSS Inc. (IBM SPSS Statistics) Software;Group's Business Analytics Portfolio. Results: Monotherapy of timolol (eye drops 0.5% and 0.1% eye gel), betaxolol 0.5% eye drops produced significant reductions in the total mean of IOP, ranged between 4.4 and 6.1 mmHg, while travoprost 0.004% eye drops showed a remarkable reduction of 7.3 mmHg. Combinations of travoprost with timolol and and/or dorzolamide 2% resulted in significant IOP lowering effects, ranged from 8.9 to 12.7 mmHg. Mono or combined therapy with travoprost was found to be superior to other anti-glaucoma monotherapy. Conclusion: The obtained results showed that travoprost produced clinical significant and superior ocular hypotensive effects when used alone or in combination with timolol and/or dorzolamide. It is thus recommended to use prostaglandin analogues in treatment of OAG because they are the most effective agents in reducing the mean diurnal IOP.
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Normal ranges of interorbital anthropometric values in healthy sudanese children
Mai Osman Babiker, Mahgoub Saleem
April - June 2017, 4(2):43-48
Background: The knowledge of the normal ranges of interorbital anthropometric values among schoolchildren aged 6–15 years is very important because normal values of facial measurements, inner canthal distance (ICD), outer canthal distance (OCD), canthal index, and circumferential interorbital index are useful parameters in the evaluation and treatment of congenital or posttraumatic deformities of the cephalic and facial regions such as telecanthus, ocular hypotelorism, and craniosynostosis. Objective: To assess the normal ranges of interorbital anthropometric values in schoolchildren and to measure the interorbital distances and to define the effects of age and gender in Al-Shifa area, Khartoum State. Materials and Methods: Systematic interorbital anthropometric measurements were done in 980 schoolchildren aged 5–16 years. Measurements of far Interpupillary Distance (FIPD), Near Interpupillary Distance (NIPD), Outer Canthal Distance (OCD) and Inner Canthal Distance (ICD) were taken in all study population. Comparisons were made between their gender and age using the Chi-square test. Results: In total, 980 individuals were studied. Out of these, 675 (68.9%) individuals were boys and 305 (31.1%) were girls. The mean age of the study group was 9.47 ± 2.71 years; there was a statistically significant difference in all measurements (P < 0.05) according to the age of the children. There was a statistically significant difference in FIPD and NIPD measurements (P < 0.05) between the males and the females. Conclusion: Significant interorbital measurement differences were found between Sudanese children according to gender and age. The present study suggests that age and gender should be considered in Sudanese children in any orbital surgery. To individualize the treatment planning and diagnosis, it is important for the surgeons to have a knowledge of these local Sudanese interorbital norms.
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Recurrent sympathetic ophthalmitis
Mona Deshmukh, Chandan G Tiple
July-December 2015, 3(2):63-66
Sympathetic ophthalmitis (SO) is a rare, bilateral granulomatous uveitis occurring after perforating eye injury or ocular surgical procedure to one eye. The pathophysiology of this entity is not clearly understood, but an autoimmune hypersensitivity reaction against exposed ocular antigens in the injured eye is believed to be responsible for this disease. In this article, we present a patient with clinical diagnosis of SO with it recurrence.
  2,263 17 -
Standard documentation of paper-based medical records at four main hospitals in Khartoum state, Sudan, 2014–2015
ZS Fadl Elmula, Ahmed K Bolad
Jul-Sep 2017, 4(3):75-78
Background: Medical record management (MRM) has become a crucial part of every hospital or medical facility because MRM has all essential elements of an information system. Although the world of medicine seems to be changing and progressing with each day, one thing that has not changed is the need for good documentation. Aims: The aim of the study was to assess standard documentation of paper-based medical records in four main hospitals in Khartoum State, Sudan. Methods: This is an analytical, descriptive, hospital-based study recruited 400 paper-based medical records gathered equally from four main hospitals in Sudan; hospital A, hospital B, hospital C, and hospital D and they represented Khartoum, Khartoum North, and Omdurman cities. The study evaluated legibility, adequacy, accuracy, authenticity, and the use of abbreviations in paper-based medical records. Data were collected from record sheet using a pre-designed questionnaire, then analyzed using Statistical Package for the Social Sciences (version 21). Ethical clearance was obtained from Graduate College-Neelain University and provided for the study area (four hospitals), whose name was not mentioned for ethical considerations. Verbal consent was obtained from each hospital director and from Ministry of Health after explaining the purpose of the study. Results: Out of four hundred record files taken for the assessment from the four hospitals, mean of legibility was 36.8% for hospital (A, B, C, and D), mean of adequacy was 18.8%, mean of accuracy was 34.2%, mean of authenticity was 40.5% whereas using prohibited abbreviations was reported with a mean of 33.2%. All the four hospitals showed submoderate/poor level of practice regarding criteria of standard documentations (<50%), except legibility in hospital C (58%), accuracy, authenticity, and using abbreviations in hospital A (54%, 84%, and 97%, respectively). Discussion: Our findings showed that the overall mean of adequate records in the four hospitals was poor (34.3%). Except hospital C (58%), all the hospitals showed poor level of reporting eligible records (A: 39%, B: 31%, and D: 18%). These findings suggest that the four studied hospitals do not provide satisfying record files since they poorly lack the standard documentation required for proper records (eligibility, adequacy, accuracy, authenticity, and using prohibited abbreviations). This was found compatible with many other reported studies. Conclusion: Our findings have revealed that there is insufficiency in knowledge as well as there is poor practice among nurses in the studies' hospitals toward standard documentation of paper-based medical records, and this necessitates applying in-service training for nurses.
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Assessment of color vision in elderly patients: Pre- and post-cataract surgery
Hiba Mohammed Elhassan Ali Elawad, Ahmed Elsiddig Abd Elbagi Hamad, Mohammed Elhassan Ali Elawad
January-March 2017, 4(1):18-22
Aim: The aim is to assess color vision in Sudanese elderly patients' pre- and post-cataract surgery. Materials and Methods: Descriptive, cross-sectional, hospital-based study was conducted in in Makkah Eye Complex (a voluntary organization; a Tertiary Eye Care Center) in Khartoum Alryad. Elderly patients (200); their age varies from 60 to 95 (mean 67.91 and standard deviation ± 6.779) years with senile cataract were asked to participate in the study. Participation was entirely voluntary. Information was collected by means of interviews, questionnaire, and clinical examination. The data were analyzed using Predictive Analytic Software Statistics Version 18 (2010), a modified version of IBM SPSS Inc. PASW Statistics for Windows, Version 18.0; 2009. Chicago: SPSS Inc. All tests are of two sides (confidence interval of 99% level). Therefore, a P≤ 0.05 was taken to indicate the statistical significance for all analysis and spearman correlation (r) was used to identify association between variables. Results: In the presence of cataract, the results showed significant declines in visual acuity (>85% visually impaired). Failure to discriminate colors were recorded in right eye (RE) (56%) and left eye (LE) (60%). Improved visual functions as a result of cataract surgery included the following: Better optically corrected vision (71%) achieved satisfactory visual outcomes (logarithm of the minimum angle of resolution [LogMAR] >0.48) with average distance visual acuity (VA) of (0.36–0.46 Log MAR) and in increased ability to discriminate colors (90%) and 89% for RE and LE, respectively. Both pre- and post-operative results showed positive correlation for RE and LE and (P < 0.001) for Pearson Chi-square value were recorded for showing statistical significance for VA and color vision in the patients studied. Conclusions: VA and other retinal functions like color vision are restored by cataract extraction.
  2,244 15 -
Fungal keratitis
Honaida Elshiek, Roberto Pineda
January-June 2015, 3(1):3-5
Fungal keratitis is a very serious and potentially sight-threatening corneal infection that most commonly develops in patients after trauma or in those with a compromised corneal surface. Although it is relatively rare but due the extensive use of topical antibiotics and Steroids there have been a noticeable increase in fungal keratitis.
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Changing trends in pterygium management
Prabhakar Srinivasapuram Krishnacharya, Anuj Singhal, Pooja A Angadi, A Shamsiya Naaz, A Raghavender Reddy
January-March 2017, 4(1):4-7
Pterygia are progressive unilateral or bilateral ocular surface growths that develop within palpebral aperture area that leads to contour disruption with symptoms ranging from foreign body sensation to cosmetic blemish. Commonly, they appear during the active period of human life, generally between third and fourth decade. Fate of pterygium spans from progressive growth in its earlier stages that undergo diversity of changes such as inflammation, infection, and degeneration ultimately ending in regressive stage during the sixth to eighth decade of life. Pterygium recurrence is the main complication encountered by surgically treating it with or without adjuvant. Not uncommonly pterygium occurrence had been described during childhood that resolved by conservative treatment. Untreated pterygia might grow exuberantly with the invasion of corneal layers, which might result in significant visual loss due to visual axis obstruction and high astigmatism. Therefore, it is justifiable to treat pterygia at any clinical stage of presentation to prevent ocular morbidity and recurrences. Common misbelief in letting the pterygia until corneal encroachment develops should be made understandable to public by conducting awareness programs. Primary objectives of the present review article are to search for the most successful method in terms of nil to low recurrence rates by various modality of treatment and to arrive at promising surgical technique that provided maximum relief in terms of survival rates on the basis of follow-up duration. Secondary objectives are related to intra- and post-operative complications, which have an effect on the ocular surface and final visual gain or loss.
  2,049 18 -
Knowledge, attitudes, and practices on diabetic retinopathy among medical residents and general practitioners in Khartoum, Sudan
Fatima Elnagieb, Mahgoub Saleem
April - June 2017, 4(2):66-73
Background: Diabetic retinopathy (DR) is one of the major complications of diabetes mellitus (DM) and is the leading cause of blindness among working people. It constitutes 5% of the global causes of blindness. Knowledge, attitudes, and practices (KAPs) on DR among medical residents (MRs) and general practitioners (GPs) should be well assessed to insure a very good level of DR care. These groups are the most important primary health provider of the diabetic care network. Objectives: The aim is to assess the KAPs on DR among MRs and GPs in Sudan. Materials and Methods: Two hundred and twenty-five doctors, as the study population, were chosen from Khartoum state nonconsultant nonprivate working doctors, who are working in 22 general hospitals distributed across Khartoum state, between August and September 2016. All the selected study Personale were working in these hospitals, and they were exposed to diabetic patient's care which is available within the facilities of these hospitals. Specialist, consultants, and private doctors were excluded from the study. Data were collected through a well-designed self-administered questionnaire. The questionnaire was mainly included closed-ended questions with a few open-ended ones. It contains questions on demographic data, knowledge and awareness levels, practices toward screening DR, and questions on attitudes toward DR. At the end of the survey, the entire data were coded and entered into a Microsoft Excel spreadsheet in a personal computer. The responses were analyzed using Statistical Program for Social Sciences (SPSS) version 20 (Manufactured by IBM SPSS Inc., PASW Statistics for Windows, Version 20.0; 2009. Chicago: SPSS Inc., IL, USA). Results: Two hundred and twenty-five doctors; (GPs and MRs); were included in the current study. One hundred and thirty-seven (61%) of the responded participants were female and 88 (39%) were male. The mean age of the study group was 27.7 ± 8.0 years (range: 20–36 years). Two hundred and twenty-five questionnaires were distributed to all members, only 180 (93.75%) members completed the questionnaires. Fifty-eight (32%) has MBBS and 123 (68%) has MBBS + part one in medicine. Their years of medical practice was ranged from <1 year to >2 years. One hundred and sixty-one (92.5%) and 155 (89.0%) mentioned eye and kidney, respectively, as the organs affected by DM. One hundred and fifty-eight (90.8%) mentioned retina as the part of the eye that can be affected. One hundred and eighteen (68.0%) mentioned poor glucose control as the factor that influences the presence or severity of DR. Fifty-nine (34.0%) mentioned duration of DM. Fifty-six (32.4%) high blood pressure high and 13 (7.5%) lipid level is important for DR degree. One hundred and sixty-four (95.0%) respondents, mentioned retina as the part of the eye that should be examined first for changes for DR. Ninety-one percent noted that DM can cause eye complications; new vessel formations. Hemorrhages, retinal detachment… etc. Seventy-five percent have the attitude to examine the diabetics when only the vision is affected. Fifty-one percent strongly agreed to do eye examination in diabetic pregnant and to do fundoscopy for any diabetic patient. Thirty-seven percent strongly agree to check eyes when lipid is high. Most of the respondents, i.e., 99 (59%) strongly disagree that ophthalmology training in medical school was enough to detect patients with DR. Seventy-two (42%) do visual acuity for their diabetic patients and 50 (30%) examine the fundus (retina). One hundred and twenty-six (75%) disagree that eye examination is only required in diabetic patients when vision is affected. Conclusion: Participants generally had a poor knowledge on DR although they had good knowledge about relationship between DR and others end organs which can be affected by microvascular complication of diabetes mellitus and good practice in referral of diabetic patients 136(81%). Undergraduate ophthalmology training in medical school is not adequate.
  2,017 16 -
Any possible association between Behcet's disease and retinitis pigmentosa
AH Hassan, Hasan H Dirar, SM Ibrahim, TM Mudaw
January-June 2015, 3(1):19-23
Behçet's disease is a rare multisystem disease; it has many ocular features, and it is not known to be associated with dystrophic conditions such as retinitis pigmentosa (RP). This is a case report of a Sudanese patient with Behçet's disease with ocular features and RP. A 28-year-old female with nyctalopia, skin hyper-pigmentation, and oral and genital ulcers was diagnosed as RP with Behçet's disease. She received a high dose of steroids and Azathioprine. She developed bilateral cataract and glaucoma. Pathergy test is negative. The patient is fulfilling the diagnostic criteria of both RP and Behçet's diseases. Behçet's disease is a rare condition; it is not common among Sudanese patients, and it has not been known to co-exist with RP.
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Ophthalmology national normative database series (3): Normal ranges of interorbital anthropometric values in healthy sudanese adults
Hajir Siraj, Mahgoub Saleem
January-March 2017, 4(1):23-30
Background: The face is the most distinctive part of the human body. Of all areas on the face, the bilateral orbital regions which are located in the upper half of the face act as a strong influence in the perception of facial attractiveness, esthetic criteria, and “ideal” features of any certain nation. This fact increases the needs for interorbital anthropometry or interocular distances (IODs) which refers to the measurements of the human far interpupillary distance (FIPD), near interpupillary distance (NIPD), outer canthal distance (OCD), and inner canthal distance (ICD) among individuals of different age, sex, and ethnicity. Objective: To assess the normal ranges of interorbital anthropometric values among adult healthy Sudanese population and to define the effects of age, gender, and tribal ethnicity on interorbital anthropometry. Materials and Methods: Systematic interorbital anthropometric measurements were done in 920 Sudanese adults aged 20–85 years. Parameters included were FIPD, NIPD, OCD, and ICD across age, sex, and tribal ethnic perspective of the study subjects. Comparisons were made between their gender, age, and tribal ethnicity using the Chi-square test. Results: The study included 565 female (61.4%) and 355 male (38.6%) subjects with mean age of 48 ± 20 (range 20–85) years. Significant age, gender, and ethnical dimorphism were noted in the following parameters. OCD (male: 92.23 mm; female: 90.79 mm), FIPD (male: 63.20 mm; female: 61.57 mm), NIPD (male: 59.34 mm; female: 57.73 mm), and ICD (male: 34.30 mm; female: 33.00 mm). Conclusion: Significant interorbital measurement differences were found between Sudanese males and females in different age and ethnic groups. The present study suggests that age, gender, and ethnicity should be considered in Sudanese esthetic criteria and “ideal” features in any cosmetic or reconstructive orbital surgery. To individualize the treatment planning and diagnosis, it is important for the surgeons to have knowledge of these local Sudanese interorbital norms.
  1,958 24 -
Prevalence and causes of blindness and visual impairment in population aged 50 years and over in North Kordofan State, Sudan
Kamal Hashim Binnawi, Awad Hassan Mohamed, Balgis AlkhairAlshafae, Zainab Abdalla, Mazin Alsanosi, Hoyda Alnoor, Khalil Ibrahim, Alsawi Yusif
January-June 2015, 3(1):6-10
Objectives: To estimate the prevalence and causes of blindness and other degrees of vision impairment in people aged 50 years and older in North Kordofan state, Sudan, using the Rapid Assessment for Avoidable Blindness methodology. Design: Cross-sectional, population-based survey. Participants: Forty-three clusters of 50 people aged 50 years and older were selected by probability proportionate to size sampling of clusters. Households within clusters were selected through compact segment sampling. A total of 2167 eligible persons were selected, of whom 2032 (93.8%) persons were examined. Materials and Methods: Participants underwent a comprehensive ophthalmic examination in their houses by trained ophthalmic teams, including measurement of visual acuity (VA) with a tumbling-E chart and the diagnosis of the principal cause of visual impairment. Results: The prevalence of bilateral blindness (presenting VA < 3/60) was 8.37% (95% confidence interval [CI]: ±1.60), the prevalence of severe visual impairment (VA < 6/60–3/60) was 2.71% (95% CI: ±0.59) and the prevalence of bilateral visual impairment (VA < 6/18–6/60) was 9.06% (95% CI: ±1.76) in the sample. Definite avoidable causes of blindness (i.e., cataract, refractive error, trachoma and corneal scarring) were responsible for 76.5% of bilateral blindness. Cataract was the major cause of blindness (60.6%), followed by Glaucoma (20%). Conclusions: The prevalence of blindness in people aged 50 years and older in North Kordofan state was higher than that expected for Sudan. The main cause of blindness was Cataract, followed by Glaucoma. More than 75% of blindness was due to avoidable causes.
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Comparison of retinal nerve fiber layer thickness in relation to optic nerve head size and average retinal nerve fiber layer thickness using optical coherence tomography in glaucomatous optic neuropathy
Janitha Plackal Ayyappan, Faraz Khurshid
Jul-Sep 2017, 4(3):82-88
Context: This study is conducted to determine the correlation between retinal nerve fiber layer (RNFL) thickness and optic nerve head (ONH) size in normal and glaucomatous subjects by optical coherence tomography (OCT). Objective: The objective of this study is to compare the thickness of RNFL in relation to ONH size and average retinal nerve fiber thickness in glaucomatous optic neuropathy using OCT. Subjects and Methods: A prospective study was carried out on one hundred and fifty eyes of 75 patients with 39 normal and 36 glaucoma patients aged between 20 and 60 years. Results: Stratus OCT, values were correlated with the data obtained by ONHs analysis. The values of RNFL thickness showed a high correlation with the ONH size. The RNFLA values were also positively correlated with the *2.27 value. Mean RNFL in glaucoma patients is 72.20 ± 18.79 (standard deviation [SD]) and in *2.27 is 63.57 ± 17.3 (SD) (calculated Z value is 2.58 and P ≤ 0.004) and is highly significant at 4% level in glaucoma patients. Besides correlation coefficient of RNFLA*2.27 in glaucoma patients found positive correspondence with the correlation coefficient 0.867. In normal subject, mean RNFL is 92.16 ± 9.80 and in *2.27, 85.16 ± 10.21 (calculated Z value is 4.34 and P ≤ 0.007) and significant at 3% level in normal subjects. A negative correlation was seen with the value of correlation coefficient − 0.21. Conclusions: RNFL thickness *2.27 measurement has high correlation with each other as obtained by Stratus OCT; moreover, it decreased significantly with an increase in optic disc size. Statistical Analysis Used: To test the difference between two means, Z-test was used. “Z” distribution with population variance not known at that point of time because no normative-based population data were available for Indian population to find out the correlation between two variance correlation coefficient at that point of time.
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The effect of spherical refractive error on tear volume
Reem Hassan Abd Almajeed, Mohammed Elhassan Elawad
Oct-Dec 2017, 4(4):104-108
Background: Dry eye disease (DED) is the most common multifactorial annoying ocular surface disorder, of various ocular symptoms, ranging from eye discomfort, dryness, itching, irritation, and foreign body sensation up to noticeable visual disturbance. Eventually ends with reducing quality of life. Optical refractive quality might deteriorate in these DED individuals, especially in hot-dry-windy climates like in Sudan. Aim: This study aims to determine the influence of spherical refractive errors (REs) on the tear volume and DED. Materials and Methods: In a comparative cross-sectional hospital-based study 90 (n = 90) participants were included; all were free from any ocular or systemic diseases and not using contact lenses. They were of equal numbers of hypermetropes and myopes of mixed gender; males and females, with their ages range between (18-28) years. The mean ages in both groups of RE states were 21.97 ± 2.35 and 22.55 ± 3.29 hypermetropes and myopes, respectively. The study was performed at Makkah Eye complex (MEC), Khartoum, Sudan, from May to July 2015; where the participants were recruited from the general refraction clinics at MEC. All individuals were subjected to the full eye examination. The Schirmer's test was used for all the participants. SPSS statistical analysis program was used to analyze the data. Results: Dry eye was found in 26.6% on hypermetropic patients and 1.1% myopic patients. In this study, the spherical REs showed a significant difference between males (16.6%) and females (12%) P = 0.001. Conclusion: REs may be considered to be one of the risk factors to cause dry eye condition. Correcting RE may reduce the risk factor of dry eye, and that may reduce its prevalence.
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Posterior dropped crystalline lens by a car battery explosion ocular trauma
Mahgoub Saleem
July-December 2015, 3(2):67-69
To report a case of right posterior dropped crystalline lens by a car battery explosion ocular trauma, in which the diagnosis was missed on initial ocular B-scan ultrasonography. Ocular injuries can be severe enough to compromise the vision, temporarily or permanently, depending on the type and mode of trauma itself; besides the urgency and competency of their managements. They often happen due to cars, sport, bombings, work, or war-related accidents. They can be penetrating or nonpenetrating injuries due to sharp or blunt impact causes; both can damage the structures at the front or at the back of the eye, with deferent degrees of severity. The prompt and competent emergency actions are the ophthalmic surgeons' challenges to save the vision. One of the not-uncommon eye traumas is due to the car battery explosions, which can lead to crystalline lens anterior or posterior dislocation. This case study will report the presentation and management of a posterior dropped crystalline lens by a car battery explosion, in which the diagnosis was missed on initial ocular B-scan ultrasonography.
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The impact of delay in diabetic patient's referral for diabetic retinopathy screening on the level of retinopathy detected in adult Sudanese diabetic Sudanese patients
Mahgoub Saleem
April - June 2017, 4(2):49-53
Background: Diabetic retinopathy (DR) is the most common complications of diabetes mellitus (DM) which needs early detection. Delay in referral of patients with significant DR by physicians to the concerned ophthalmologist may compromise visual outcome since early treatment is associated with a 50% reduction in the risk of visual loss. Objective: The aim of this study is to assess the relationship between delays in diabetic patient's referral for DR screening after diagnosis of DM and the level of the DR detected at Sudan. Materials and Methods: A 2-year prospective cross-sectional study was conducted on 240 patients with type I and II, newly referred patients in the period from January 2013 to February 2015. The estimated time lapse between this first DR screening and the onset of DM was recorded as “delay period” in diabetic patient's referral for DR screening, which was compared with the level of DR and the level of visual loss at the time of the first visits. Results: In a 2-year study (2013–2015), 240 were newly referred diabetic patients, 225 type 2 DM (93.75%), and 15 (6.25%) type I DM. DM duration was 17.6 years (2–40 years); 202 with poor control. Eighty-nine were hypertensive with a mean duration of 3.7 years. About 83.3% were referred by general ophthalmologists, 10.4% by physicians, 4.2% by optometrists, and 2.1% by their own will. Nearly 85% referred for their visual disturbances and 15% for self-referral. Two hundred and eleven patients (87.09%) had one form of DR; while only 29 patients did not apparent DR. Low-risk DR recorded in 174 (72.5%), high risk in 66 (27.5), and diabetic macular edema (DME) in 94 (39.2%). The average delay was 14.8 years; 15.5 years for men and 14.04 years for women. The average percentage of visual loss in the low-risk group was 16.7% (visual score of 83.3%). While the visual loss in the high risk was 69.3% (visual score of 30.7%). DME reported 36.6% visual loss and 63.4% visual score. The mean visual loss in all diabetic study population was 40.9% with the total visual score of 59% which equivalent to 6/40 at the moderate low vision range of the World Health Organization. Conclusion: There was a strong correlation between the levels of DR detected and the percentage of visual loss. The “no apparent DR group” recorded the minimal detection of visual loss.
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Basic assessment of corneal collagen cross-linking in Sudanese sample
Albadry Khlifa Siddig Abdellah, Atif Babiker Mohamed Ali
April - June 2017, 4(2):62-65
Background: Collagen Corneal Cross-Linking (CXL) is a surgical technique that combines ultraviolet light and riboflavin eye drops as a one of the modern therapies for keratoconus. Objectives: This retrospective study aimed to assess the visual outcome, corneal curvature, corneal thickness, and refractive status after CXL. Methods: The records of 25 patients did CXL during May 2012 to May 2014 at Makkah Eye Hospital were reviewed. The recorded data included uncorrected and best-corrected visual acuity (Nidek Chart Projector CP 670 Japan), central corneal thickness and average K-readings (ATLAS 9000, Corneal Topography System, Germany), and refraction (Nidek Auto Refractometer, AR310A Japan); all these measurements were taken at baseline before CXL and after 1 year post-CXL. Results: The age range of this group was 12–26 years of whom 60% females and 40% males. A little improvement of vision was achieved from a presenting mean 6/30 to CXL mean 6/20 at P = 0.024. No significant difference was observed in corneal central thickness preoperative mean 447.72 ± 27.52 μm) and postoperative (mean 448.83 ± 22.35 μm). K-readings showed only limited changes in the form of astigmatism and not in the degree of astigmatic error (mean 2.80 ± 1.327 D) preoperative and (mean 3.08 ± 1.717 D) postoperative. A moderate spherical refractive error (noncorneal) was persisting (mean 2.79 ± 2.09 D preoperative and 2.66 ± 2.10 D postoperative). Conclusions: CXL assumes controlling of corneal ectasia and regarded as one of effective procedures in improving the vision, particularly when combined with optical correction.
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Ophthalmology national normative database series (2): Gonioscopic character of the normal anterior chamber angle in sudanese adults
Manal Fadlallah, Mahgoub Saleem
January-March 2017, 4(1):8-17
Background: The anterior chamber angle (ACA) is the anatomical angle bounded by the iris root and the peripheral corneal vault that comprises the aqueous outflow drains, namely the trabecular meshwork (TM) and the Schlemm's canal. The assessment of the ACA is used to classify glaucoma into open or narrow angle glaucoma's. Objective: The aim of this study is to determine the normal range values of the gonioscopic character of the ACA in adult Sudanese population and to define the effects of age, gender, and tribal ethnicity on these values. Materials and Methods: Three hundred ninety-eight eyes (n = 396); of 198 adults volunteers Sudanese healthy workers, from two factories in Khartoum, North district, were enrolled in this study; over a period of 3 months from January 1, 2009 to March 30, 2009. One hundred and sixty males 38 were females; aged ranged from 18 to 50 years. All participants underwent systematic static and dynamic gonioscopy by Posner Gonio lens in conjunction with Haag- Streit slit lamp. Then, the ACAs were graded according to Shaffer grading and classification system. The effect of age, gender and tribal ethnicity on ACA was analyzed. Then, the overall grading and TM Pigmentation analysis were done with special grading criteria specifically designed for this study (Manal–Saleem ACA Overall Grading System and Saleem-Manal TM Pigmentation Grading System). Results: In total, 198 (n = 198) Sudanese adults were recruited for the study with the mean age of the study group was 43 ± 16 years (range: 18–50 years). About 80.8% of males and 19.2% of females. 77.8% have open ACA and 19.2% narrow ACA, 0.5% closed ACA, and 2.5% with Creeping ACA. Open ACA is more in males (81.3%) than female (63.2%) while narrow ACA is more in female (34.2%) than male (15.6%). Closed and creeping ACA are similar in the two sexes. The effects of tribal ethnicity was not so profound as both the Arabs (84.1%) and Africans (87.5%) origin groups were showing minor differences in the high rate of open-angle (3.4% more in the African's) and narrow ACA (2.9% more in Arab's) apart from the Bejja groups, who recorded 100% narrow ACA while the Nubian groups of Far North recorded a lower percentage of the open ACA (78.6%) and higher of narrow ACA (17.9%). Narrow ACA was proved to be more with older age (25% as compared 10–12.5%). The TM Pigmentation in the younger age groups was found to be of lightly pigmented in 66.7% and heavily pigmented in 33.3%. A result which was affected by tribal ethnicity; 54.9% of Arab origin groups have lightly pigmented TM while 92.0% of African origin groups presented with heavily pigmented TM. In general, pigmentation was shown to be more heavily in the inferior quadrant rather than superior and horizontal quadrants. Conclusion: There is a higher rate of open ACA (77.8%) in Sudanese Adults with low rate (19.2%) of narrow ACA, followed by an even more lower rate of creeping ACA 2.5% and scarcely closed ACAs (0.5%). The average Sudanese ACA TM pigmentation is 35.4% being of light pigmentation and 64.6% of heavy pigmentation with highly significant tribal, age, and Quadrantic variations (P = 0.000).
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