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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.
  9,878 41 1
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.
  7,294 35 -
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.
  5,586 23 1
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.
  5,577 25 -
Computer vision syndrome among mobile phone users in Al-Ahsa, Kingdom of Saudi Arabia
Majed Al Subaie, Saif Al-Dossari, Mohamed Iheb Bougmiza
Oct-Dec 2017, 4(4):99-103
Background: The growing number of mobile phone users or video display terminals (VDTs) puts them at hazards of computer vision syndrome (CVS) resulting in ocular surface damage, eye strain, exhaustion, and muscular complaints as result of improper usage of VDTs. Objectives: To determine the prevalence of CVS and to get a baseline data about this syndrome among inhabitants of Al-Ahsa, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted for the duration of 1 month in Al Ahsa Saudi Arabia. Convenience sampling was used with a validated questionnaire to measure the CVS symptoms and to collect data. Consequently, Chi-square test was performed to observe the prevalence of CVS with its risk factors using SPSS version 22. Results: This study showed the prevalence of CVS among Al-Ahsa population to be 43.5% of the screened sample; this was significance results in the term of blurred vision (P = 0.002), dry eye (P = 0.011) and ocular discomfort (P = 0.013) among individuals suffer from CVS. Regarding extraocular complaint, there was a significant result seen in the presence of neck and shoulder pain (P = 0.008) and dizziness (P = 0.045) in individual developed CVS. Conclusion: The study found significant results in term of ocular and nonocular complaints among individuals who developed CVS from Al-Ahsa. Further longitudinal studies are required to study the effect of VDTs on ocular health.
  5,369 24 -
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.
  4,885 26 -
The effect of pterygium on corneal thickness, corneal curvature, tear volume, and intraocular pressure in a Sudanese Population
Rawia Tagelsir Eias Ali, Atif Babiker Mohamed Ali
Oct-Dec 2017, 4(4):109-113
Background: Pterygium is a triangular fold of bulbar conjunctiva usually found in the nasal side of the interpalpebral fissure. It consists from apex and base. Its apex advancing progressively toward the cornea. The exact cause of pterygium is not well understood, but long-term exposure to sunlight, especially ultraviolet rays, wind, and chronic eye irritation from dry and dusty conditions seems to play an important causal role. It looks like scar, but it is not. The growth might spread slowly during a life or stop after a certain point. In extreme cases, pterygium can cover pupil and cause vision problems. Aim: The aim of this study is to reveal the effect of pterygium on corneal thickness, corneal curvature, tear volume, and intraocular pressure (IOP). Materials and Methods: A total of 100 patients have primary pterygium in one eye (unilateral) compared to their healthy (control) eye. The study was conducted in Makkah Eye Complex in Alkalakla branch between April 2016 and November 2017. The criteria of admission included individuals who have no history of systemic/chronic or other eye diseases. The patients whose pterygium enters the cornea within 2.0–3.0 mm and visual acuity at least 0.50 decimal (6/12) were selected. The data included age and gender, while the clinical procedures included testing vision and visual acuity (Snellen's type), autorefraction and autokeratometry, ultrasound pachymetry, applanation tonometry, and break-up time tear assessment. Frequency distribution tables and t-test were used to present the data. Results: The results showed that the pterygium was more apparent among male (53%) than female (47%). Significant decrease on visual acuity (77%) and tear volume (86%) of the pterygium eye (P < 0.0001) was observed as compared to healthy eye (HE). The primary pterygium caused meridional steepness in corneal curvature (98%). With-the-rule corneal astigmatism was dominant (61%) among other types. Statistically, there were little decrease on central corneal thickness and nonsignificant effect in IOP between the two eyes. Conclusions: Pterygium can cause significant change in ocular functions compared to HEs according to study parameters. Ocular dryness complications and vision impairment due to corneal astigmatism should be considered to make correct diagnoses for eye symptomatology.
  4,683 14 -
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.
  4,635 29 3
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.
  4,418 23 -
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.
  4,358 25 -
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.
  4,303 22 -
Comparison of goldmann applanation tonometry measurements with and without fluorescein among adult sudanese glaucomatous and nonglaucomatous population 2018
Islam Elzein, Mahgoub Saleem
Oct-Dec 2017, 4(4):93-98
Background: Goldman applanation tonometry (GAT) is still the most accurate for measuring intraocular pressure (IOP). Usually, fluorescein eye drops are used in additional to topical anesthesia to gain the best visualization result. Objective: The main objective of the study is to compare the GAT values with and without fluorescein in adult Sudanese glaucomatous and nonglaucomatous population. Materials and Methods: In a cross-sectional hospital-based study, 400 patients were recruited from out patient's and glaucoma clinics at Makkah Eye Complex, Khartoum, in the period from December 2017 to January 2018. Different ages were classified into three groups, patients also classified into glaucoma (n = 200) and nonglaucoma (n = 200) patients, another classification according to gender. Then, IOP measurements with and without topical fluorescein were done by GAT. Results: Two hundred and sixteen (n = 216; 54%) were male and 184 (46%) were female, with an average age of 54.76 ± 24.5 years. Two hundred (50%) were glaucomatous, and the other 200 (50%) were nonglaucomatous. The average IOP with fluorescein was higher than without fluorescein by 13.1% (2.08 mmHg) and still was higher in comparison between non-Glaucomatous and glaucomatous with and without fluorescein up to 3. 41 mmHg (17.86%). Both results ± fluorescein and ± glaucoma were statistically significant (P = 0.000). There was a significant correlation between age and IOP values with fluorescein and between having glaucoma and IOP with fluorescein (P = 0.000), while there was nonsignificant correlation between sex and IOP measurements with fluorescein. Conclusion: There are statistically significant differences in IOP values by GAT either ± fluorescein or ± glaucoma. A significant correlation between age and IOP values either ± fluorescein or ± glaucoma were detected, but not to sex.
  3,850 28 -
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.
  3,847 19 -
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.
  3,810 35 -
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.
  3,724 27 -
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.
  3,717 26 -
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.
  3,702 24 -
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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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.
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Assessment of the effect of academic examination stress on binocular vision functions among secondary school-aged children
Amani Ahmed Elsiddig, Saif Hassan Alrasheed
Oct-Dec 2017, 4(4):114-119
Background: Binocular single vision involves the simultaneous use of both eyes with bifoveal fixation, and this process helps individuals to use their both eyes for reading, writing, and other near activities; the stress on this system could lead to ocular complaints and affect the near task for the school-aged children. Aim: The aim of this study was to assess the effect of academic examination stress on binocular vision functions among secondary school-aged children in Khartoum State of Sudan. Materials and Methods: This is an experimental study of 148 secondary school-aged children, selected randomly from Alfath Secondary School, and their ages ranged from 13 to 17 years with a mean age of 14.6 ± 1.13 years. Investigation was performed before and after the academic examinations in 2017. The clinical examinations include visual acuity measurements using Snellen vision testing chart, refraction using autorefractometer, dissociated near phoria by Maddox Wing, associated near phoria by Mallet Fixation Disparity Test, amplitude of accommodation and near point of convergence (NPC) measured by R.A.F rule, and near positive fusional vergence (PFV) and near negative fusional vergence by prism bar. All these investigations were done before 15 days of academic examinations and on the day after the students finished their academic examinations. Results: The findings indicated that most of the students (62.8%) before the academic examinations reported that they were free from any ocular complaints, whereas 37.2% had ocular symptoms. After stress due to examinations, the percentage of students who had ocular complaints increased to 71.6, whereas those free of ocular complaints decreased to 28.4. The mean of amplitude of accommodation before taken the examinations was 9.81 ± 2.16, and after the examination, the mean of amplitude of accommodation decreased to 8.77 ± 1.97 (P < 0.001). Nearly 54.7% of the participants had normal NPC before the academic examinations, and after the examinations, those who had normal NPC decreased to 46.4% (P < 0.001). Only 29% of the students had associated heterophoria before the stress of examinations, and after the examinations, the percentage of students with associated heterophoria increased to 56.5 (P < 0.001). Almost 40.5% of the students presented with normal PFV at near fixation, and after the stress, only 29.1% had normal PFV at near fixation. However, more than half of the students (59.5%) had weak PFV for near fixation before the examinations, and after the examination, they increased to 70.9% (P < 0.001). Conclusion: The academic examination stress had a major effect on binocular vision functions, result in decompensated heterophoria, as well as decline in amplitude of accommodation, and NPC. Thus, comprehensive eye examination including binocular vision function assessment should be made annual for school-aged children.
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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.
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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.
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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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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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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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