Background: Understanding the clinical profile of keratoconus is important in the diagnosis and management of the disease. Aim: This study aimed to investigate the clinical characteristics of keratoconus patients in Sudan with respect to age and gender. Materials and Methods: Clinical records of keratoconus patients were retrospectively reviewed in a period between April and June 2015. Records were collected from Makkah Eye Complex, Alwaledain Eye Charity Hospital and Sudan Eye Center, Khartoum City. Parameters investigated included patient's demography, keratometric readings, visual acuity, and manifest refraction. Classification of keratoconus was based on Amsler-Krumeich grading system. Results: A total of 208 patients' record was found diagnosed with keratoconus. The mean age of subjects was 21.43 ± 8.91 years. Around 78% of subjects were found with bilateral keratoconus. Analysis showed that keratoconus is more common in males (55.8%) than in females (44.2%) and manifest in young age (late teenage and early 20s). Age was not correlated with disease severity (P > 0.05). No significant difference was found between both genders in term of age, visual acuities, and severity of keratoconus (P > 0.05). Conclusion: Clinical profile of Sudanese keratoconus patients looks similar to that reported earlier worldwide.

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Objectives: To determine the magnitude and causes of avoidable blindness in 50 years and older population of Amran and Lahj governorates, Yemen. Materials and Methods: Using the RAAB manual, 78 clusters were randomly selected, 50 people aged of 50 ≥50 years were examined in each cluster. Visual acuity (VA) was measured with a tumbling "E" chart. Ophthalmologists examined people with <6/18 in either eye. A software program for RAAB was used for data collection and analysis. Results: In Amran and Lahj, 1789 (91.8%) and 1836 (94.3%) people were examined, respectively. The prevalence of blindness (VA < 3/60 in better eye, with available correction) in Amran was 9.33%, while in Lahj it was 10.84%. The principal cause of blindness was unoperated cataract in both governorates. The three main barriers to cataract surgery were unaware of treatment, destiny /God's will and cannot afford in both Amran and Lahj governorates. Conclusion: The prevalence of blindness, severe visual impairment and visual impairment in people aged ≥50 years in Amran and Lahj governorates were relatively higher than WHO's estimate in the sub region and the principal cause of blindness was untreated cataract in both governorates.

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Aim: To determine the prevalence of horizontal strabismus, the relationship between the family's socioeconomic factors and their attitude towards the child's eye health, its types, and to determine the attitude and compliance of the patients and their parents towards it among basic school children in Khartoum city between July and December 2010. Materials and Methods: A cross-sectional survey was conducted in Khartoum city among basic school children by questionnaire and eye examination. Sampling was with systematic random sampling for schools, probability proportional to size for children number in each school and systematic random sampling for children after obtaining a written consent from the ministry of basic education and parents. Results: 768 children were interviewed using questionnaire with a response rate of 100%. The questionnaires were analyzed using SPSS version 19 giving prevalence of horizontal squint of 2.8%, significant association between the father's educational level, socioeconomic status and their attitude towards eyes' health. Esotropia is the predominant type with a 2.2% and a slightly acceptable compliance towards regular eye follow up. Conclusion: Most of families didn't show good compliance towards the eye health unless they had a problem but almost all of them had the desire to know more.

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Objective: To determine the clinical indications for destructive eye surgeries (DES) in Sokoto, North-Western Nigeria. Materials and Methods: A retrospective hospital-based study involving the review of the medical records of all patients that had DES in Usmanu Danfodiyo University Teaching Hospital and Specialist Hospital, Sokoto from January 2010 to December 2014. The age, sex, occupation, indications for surgery, and type of surgery done were recorded. Results: A total of 41 patients had DES during the study period. The mean age of the patients was 34.4 ± 17.7 years. The most frequent indication for DES was malignant neoplasms 41.4% (n = 17) followed by ocular infections 24.4% (n = 10) and trauma 24.4% (n = 10). Evisceration (n = 22) was the most common DES procedure. Conclusion: There is a need for educating the population on the dangers of late presentation, and since trauma and intraocular infections are largely preventable, public health education on safety measures is advocated.

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Only few cases of Eptopic cilia have been reported in literature. Anterior ectopic cilia cause no apparent ocular symptoms and can be surgically excised for cosmetic improvement. We report a case of a 28-year-old male with anterior ectopic cilia in association with hypermetropic anisometropic amblyopia. Only 15 cases of anterior ectopic cilia have been reported in literature. Few of them were associated with some conditions such as choristoma, aberrant lacrimal glands, atopic eczema, nail–patella syndrome, and hypochromic nevus. To the best of our knowledge, this is the first reported case of anterior ectopic cilia associated with hypermetropic anisometropic amblyopia. No underlying common causative disorder became evident. The observed association was considered as coincidental.

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Goldenhar syndrome or oculo-auriculo-vertebral is a rare abnormality affecting the craniofacial region having extracranial manifestations as well. First described by Maurice Goldenhar, its etiology still remains uncertain. We report here the case of a 7-year-old boy with the classic signs of Goldenhar syndrome in the form of accessory tragi, bilateral ocular dermoids, and mandibular hypoplasia (micrognathia).

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Background: Uncorrected refractive errors continue to remain a public health problem in the different population groups. Among children, it has a considerable impact on learning and academic achievement, especially in under-served communities. Optical correction of refractive errors in children is indicated when the refractive errors are sufficiently large to cause amblyopia or impairing the child's ability to function normally. Objective: The study aimed to investigate the distribution pattern of refractive errors and related visual impairment due to amblyopia in children. Materials and Methods: The recorded data of 183 children examined at optical center during the period (2007-2011) were reviewed and analyzed to show refractive status. The examination included visual acuity measurements, cover test, and noncycloplegic refraction (retinoscopy and/or autorefraction). The best-corrected visual acuity was noted. Results: The age range of children was 5-15 years, of whom 72 (39.3%) were males and 111 (60.7%) females. There was no significant difference in the correction of the two eyes and no gender associations. In this study, 97 (53.0%) were myopic, 17 (9.3%) hypermetropic, 42 (22.9%) pure astigmatic, and 27 (14.8%) normal. An adequate improvement of vision after correction in each eye reached 1.0 (6/6) achieved in 123 (67.2%) children (P < 0.0001) while binocular amblyopia found in 46 (25.2%) children and monocular amblyopia found in 14 (7.6%). Cover test mainly for near showed 126 (68.9%) children with associated exophoria, 7 (3.8%) with esophoria, and other 7 (3.8%) have manifest strabismus, and only 43 (23.5%) have orthophoria. Conclusions: Significant refractive errors revealed among children aged 5-15 years. Therefore, there is a need to have eye examination in school-age children at least at the commencement of school so as to early tackle disabilities due to amblyopia in children.

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Purpose: To study the compliance of contact lens (CL) wearers and the prevalence of CL-related ocular complications. Materials and Methods: This was a cross-sectional study conducted from December 2012 to May 2013 which included CL wearers coming to outpatient department or emergency department where these patients underwent ophthalmic examination. An interview was performed about the use and care of CLs. Results: The study included 102 patients, where 26 (25.50%) were men and 76 (74.50%) were women. Patient's ages ranged from 13 to 55 with an average (mean ± standard deviation) 29.48 years. Results showed myopia in 41 (40.19%), hyperopia 13 (12.74%), astigmatism 37 (36.27%), keratoconus 8 (7.84%), and others 3 (2.94%). More than 2/3 of the patients had, at least, one complication in their eyes. The average complication rate of gas permeable (GP) lenses was significantly (P < 0.04) lower than soft CLs (SCLs) (0.75). The most common complications were papillae, giant papillary conjunctivitis, conjunctival injection, corneal infiltrates, and corneal abrasions in both GPs and SCLs wearers. Silicone SCLs had a lower average number of complication rates per eye (0.73) than nonsilicone SCLs (0.76), but the difference was not statistically significant (P = 0.19). Extended wear CL use was associated with higher complication rate (86.84%) as compared to daily wear CL use (67.85%) and it was statistically significant (P < 0.03). Conclusion: Use of CL is associated with ocular complications. Most of these complications are minor and easily manageable. It is advised that patients should adhere with the recommendations of both manufacturer and optometrist to avoid complications.

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Introduction: Color vision examination is of great clinical interest in diabetes mellitus, since changes in color vision can be accepted as an indication of pathological condition. Color vision as a psychophysical measurement was performed with a view to providing an assessment of early neural functional integrity in the presence of no or minimal diabetic retinopathy. Materials and Methods: The investigation was carried out on a healthy visual system control group and a number of age and sex-matched non-insulin dependent diabetic groups with different levels of diabetic retinopathy. The psychophysical test used was the Farnsworth Munsell 100-Hue test. Results: The results were considered in terms of the presence of functional changes relative to the severity of retinopathy and the duration of diabetes. The color vision test differentiated between normal and those with diabetes but without retinopathy. Clearly the color vision score error mean is increased in the diabetic groups compared with the normal subjects and the level of the score error mean increases with the severity of retinopathy, but not to duration. Conclusion : C0 hanges in color vision are not strongly related to the duration of diabetes, but more to the severity of the retinopathy.

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Background: Visual evoked potential (VEP) is a useful noninvasive neurological diagnostic tool affected by certain physical and physiological parameters, age being the major of all. However, only few baseline studies have been conducted in India and none in Gujarat. Materials and Methods: Monocular pattern reversal VEP (PRVEP) was carried out using a standard protocol in medical students of same age group. Latencies of various waveforms were calculated and effects of gender, body mass index (BMI), and head size were studied. Results: Observations revealed normative VEP latencies in line with other studies. Difference observed for only N70 wave, head size were statistical significant and that for BMI, gender, and between eyes were not. Conclusion: Normative VEP data of age, BMI-matched healthy medical students showed no ethnic variation; disproved gender influence on VEP latencies and slight sex difference observed is due to head size.

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Introduction: The visual evoked potential is suggested to be a sensitive indicator of functional changes in the visual processing pathway. Visually evoked potentials have previously been reported to be affected in diabetes. Materials and Methods: The equipment consisted of a Nicolet 1000 clinical averager, Nicolet HGA 200A amplifier and Nicolet N/C 1015 visual stimulator. The pattern check sizes used were 10 and 40 minute arc with contrast of 80 and 40% for each check size. The non-insulin dependent diabetes (NIDD) patients were recruited from the University of Bradford Diabetic Retinopathy Screening Programme. The non-diabetic control group was recruited from patients, partners and members of the University in departments other than Optometry. The age and duration of diabetes for all subject groups were normally distributed. Results: Correlation coefficients between the duration of diabetes and VEP latencies of the three diabetic groups individually and the diabetics as a group all failed to reach significance, reflecting the large variance within the data. Similarly, correlation coefficients between the duration of diabetes and VEP amplitudes of the three diabetic groups individually and the diabetics as a group all failed to reach significance, reflecting the large variance within the data. Conclusion: The visual evoked potential latency and amplitude seemed to be poor indicators of the duration and severity of diabetic retinopathy in diabetes.

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Purpose: To compare two different methods of determining the post-operative position of the toric IOL and to calculate the alignment error with each method. Setting/Venue: Cataract and Intraocular Lens Implantation Service, Shroff Eye Center, New Delhi, India. Design: Case series Materials and Methods: Eighty-nine eyes of 61 patients with cataract and co-existing corneal astigmatism ranging from 1 to 4 diopters planned for toric IOL implantation were included. All eyes underwent pre-operative automated keratometry and biometry. Toric IOL cylindrical power, axis of implantation, and anticipated residual astigmatism were calculated using the web-based Acrysof Toric calculator. All eyes underwent pre-operative reference marking to denote the 0° and the 180° positions (using bubble marker) followed by digital slit-lamp photography. All eyes were operated by the same surgeon, at the same incision location. At 3 months, the achieved IOL alignment was analyzed by aligning the slit-beam of the slit-lamp with the pair of marks denoting the axis of the IOL after pupillary dilation. Additionally, the IOL position was determined after capturing a digital retro-illuminated slit-lamp photograph, which was superimposed on the pre-operative photograph using single prominent major episcleral vessel around the limbus as landmark. The axis of orientation of the toric IOL was determined using tools in Adobe Photoshop (version 7.0) by aligning a line through the marks denoting the IOL axis. The amount of alignment error (in degrees) by both methods induced with respect to the desired axis of alignment was calculated and statistically analyzed. Results: The mean pre-operative keratometry was 44.19 ± 1.51 D, and the mean corneal cylinder was 2.54 ± 0.90 D. The mean post-operative absolute cylinder was 0.57 ± 0.28 D. Toric IOL models used were T3(1.03 D): 28 eyes (31.5%), T4(1.55 D): 21 eyes (23.6%), T5(2.06 D): 18 eyes (20.2%), T6(2.57 D): 11 eyes (12.4%), T7(3.08 D): 4 eyes (4.5%), T8(3.60 D): 4 eyes (4.5%), and T9(4.11 D): 3 eyes (3.4%). Mean post-operative alignment error was 3.44 ± 2.60 D by the slit-lamp method and 3.89 ± 2.86 D by the Photoshop method with no significant difference seen between the two methods (P = 0.384). Fifty-six eyes (62.9%) by the slit-lamp method and 52 eyes (58.4%) by the Photoshop method had rotation error ≤ 5 degrees (P = 0.526), and 78 eyes (87.6%) by the slit-lamp method and 75 eyes (84.3%) by the Photoshop method had rotation error ≤ 10 degrees (P = 0.422). Conclusions: Both Adobe Photoshop method and slit-lamp observation were reliable and predictable methods of assessing IOL alignment. Although the sensitivity is more with the Photoshop method, the slit-lamp method is more accessible in an outpatient setup. The clinical outcome following toric IOL implantation can be refined by reducing the alignment error, which is dependent on an accurate keratometry and biometry, surgeon-specific SIA, reference and intra-operative marking, and finally, placement of IOL in the bag.

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Objective: To compare corrected visual functions between spectacles and rigid gas permeable (RGP) lenses, and to evaluate the association of cone location with corrected visual functions with RGP lenses in keratoconus patients. Materials and Methods: Thirty-four eyes from 19 newly diagnosed keratoconus patients were included. All subjects were fitted with hyper Dk (160) RGP lenses. All subjects were divided into two groups following their corneal cone location (central and paracentral). Manifest refraction, best spectacle visual acuity (BSVA) and visual acuity (VA) with an RGP contact lens (RGPVA) using Snellen chart, best spectacle contrast sensitivity (BSCS) and CS with RGP (RGPCS) using Pelli-Robson chart, slit lamp, and topography measurements were conducted. Results: A mean age of all subjects was 26.63 ± 8.58 years. Sixteen eyes (47.1%) have central cones, and 18 eyes (52.9%) have paracentral cones. At baseline, mean refraction was −5.62 ± 3.62 D, mean CA was −6.74 ± 4.75 D, mean best spectacle-corrected VA (BSCVA) was 0.59 ± 0.33, and mean BSCS was 1.54 ± 0.33. Visual functions improved significantly with contact lens wear (P < 0.05). No significant difference was detected between both groups in keratometer readings, mean CA, BSVA, RGPVA, BSCS, and RGPCS (P > 0.05). A significant relation was noted between the mean K and BSCVA, BSCS, RGPCS (P < 0.05), but the insignificant relation was detected between mean K and RGPVA (P > 0.05). No association was found between the cone location and RGPVA or RGPCS (P > 0.05). Conclusion: RGP contact lens is significantly improving visual functions of keratoconus patients. Cone location in keratoconic eyes has no effect on corrected VA or CS and therefore, is not a factor in trial contact lens selection.

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Context: Globally, there are 366 million patients living with Type 2 diabetes mellitus (DM), of which, 62.4 million are living in India alone. Thus, diabetic keratopathy is an important entity for all ophthalmologists. Aims: The study aims to identify variables associated with Type 2 DM, which correlate well with specular microscopy parameters. Settings and Design: This is a population-based case–control study aimed at determining the correlation between severity of DM Type 2 and corneal morphology. Subjects and Methods: After obtaining informed consent, detailed history of onset, duration, and treatment of Type 2 DM was ascertained. A comprehensive eye examination was done including specular microscopy using noncontact technique. Blood investigations were performed by the endocrine department for documenting whether disease was controlled or not. Statistical Tests: Unpaired t-test and linear regression analysis were used to determine the effects of multiple variables on the various specular microscopy parameters. Results: There were 100 eyes of diabetic patients with the mean age of 52.02 years, and 100 eyes of nondiabetic subjects with the mean age of 54.76. Short-term glycemic control parameter such as fasting blood sugar (FBS) and postlunch blood sugar (PLBS) showed no correlation with three specular microscopy parameters. However, HbA1c and severity of diabetic retinopathy influenced those parameters significantly. Conclusions: Corneal endothelium in diabetic patients was compromised, and it correlated well with the long-term glycemic control (HbA1c) but not with the short-term glycemic control (FBS, PLBS) or the duration of disease.

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Purpose: To clinically correlate the various ocular findings with the neurological status in cases of closed head injury and between ocular involvement and mortality rate. Study Design: Prospective study. Methods: In 189 patients with closed head injury, the Glasgow Coma Scale (GCS) and Revised Trauma Score (RTS) were applied to grade the severity. A detailed ophthalmological examination was carried out within 12 h of sustaining injury. Ocular neurological signs, GCS and RTS were then used to prognosticate the outcome. Apart from suturing of laceration, patients were managed by a multidisciplinary approach. Conclusion: Ocular complications occurred in 129 of 189 (68.3%) head-injured individuals with 172 cases, (91%) male and 17 cases (9%) female in the age range 3-75 years with a mean of 28.68 years. Young adult males (16-30 years) were more vulnerable to head injury. Road traffic accident was the most common cause of head injury in 130 cases (68.8%) leading to soft-tissue injuries to the globe and adnexae in maximum no. of patients. The most frequently encountered neuro-ophthalmic manifestation was pupillary involvement, followed by papilloedema and optic nerve trauma. The association between ocular signs and the outcome was significant (P = 0.003). All the patients that died had ocular signs of neurological significance. There was a significant co-relation of the GCS, neurodeficit and the ocular signs with the outcome. Pupillary abnormalities, papilloedema and lateral rectus palsy pointed towards a poorer outcome. The GCS, neurodeficit and ocular signs contribute significantly to the prediction of outcome.

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Aim: The aim of the study was to compare the efficacy of trabeculectomy with releasable suture (RS) and trabeculectomy with mitomycin C (MMC) in post keratoplasty glaucoma (PKG). Methods: This observational study was conducted for the patients who developed refractory PKG. Patients who underwent trabeculectomy with RS and with MMC 0.2mg/ml for 2 minutes under the sclera flap were randomly divided into two groups as group I and II respectively. Postoperative follow up of all patients was complete till 6 months for intraocular pressure (IOP) and complications if any. The criteria for surgical success and failure were defined as complete success if final IOP <21 mm Hg achieved without anti-glaucoma medication (AGM), qualified success as achieving the same IOP criteria with AGM and failure as IOP > 21 mm Hg with more than one medications. Results: A total of 52 eyes of 52 patients were included with 26 eyes in each group. Most frequent indication for PK was corneal opacity 25(48.07%). The preoperative mean IOP was 42.11 ± 5.90mmHg and 46.38 ± 8.51mmHg on three AGM in group I and group II respectively. The mean IOP was lowered after both the procedures significantly at all the postoperative follow ups (P=0.000). In group I, the IOP stabilized to 13.12 ± 5.23mmHg by two weeks and remained same till three months with further mild rise in IOP to 17.13 ± 4.28mmHg at six months. In group II, the IOP decreased to 11.27 ± 4.35mmHg on Ist POD and it stabilized at around 22mmHg at two weeks and remained same till six months of follow up. Conclusion: IOP control in trabeculectomy with RS was very good till three months as compared to trabeculectomy augmented by MMC with comparable results at six months of follow up.

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Aim: This study aimed to determine the prevalence and causes of childhood blindness and visual impairment among Quranic boarding schools children in Al-Gazira state of Sudan. Materials and Methods: A total of 822 children were screened, and they distributed in 8 traditional Quranic schools. The study divided into two phases, the first one was designed to detect the visually impaired children, and in the second one, the affected children were investigated deeply through inner eye, refraction, and cover test examinations. Results: The findings indicated that the prevalence of childhood visual impairment (6/12 and worse binocularly) with the best correction was 12 (1.5%) in children of traditional Quranic boarding schools in Al-Gazira state of Sudan. The prevalence of visual impairment among children was increased with the age of children (P ≤ 0.001). The uncorrected refractive errors was the main cause of visual impairment which represented (36%) of impaired children followed by cataract (21.5%), corneal opacities (21%), optic nerve lesion (10.7%), retinitis pigmentosa (3.6%), glaucoma (3.6%), and squint (3.6%). Conclusion: The study concluded that the most causes of childhood visual impairment in traditional Quranic boarding schools in Al-Gazira state of Sudan were avoidable. Uncorrected refractive errors was a major cause of visual impairment among children; this pointed out the need for urgent a comprehensive childhood eye care plan to deliver eye care services for them, through cooperation between governmental, community stakeholders, and nongovernmental organization working in the prevention of childhood blindness.

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Introduction: This is a prospective study to evaluate and report the reasons of cancellation of elective cataract surgeries in an eye camp, from April 5, 2017, to April 10, 2017. The proportion of elective cataract surgeries cancelled on the day of surgery was obtained from the data of the eye camp, and reasons for cancellations were recorded. Materials and Methods: The selected patients for the surgery have gone through preoperative investigations including complete blood count, random blood sugar, coagulation profile, viral serology (hepatitis B, hepatitis C, and HIV), eye examination, intraocular lens calculation, and their medical condition assessed for chronic diseases. Results: A total of 509 patients were listed for elective cataract surgery in an eye camp Hodeidah Governorate. Forty-nine cases (9.6%) were cancelled due to different reasons on the day of surgery. Main reasons for cancellation were eye infections (14), absence of general anesthesia in eye camp for some cases (9), uncontrolled diabetes (8), and late arrival of some patients when there was no time to do the operation (7). Conclusions: Postponing cataract surgery for patients scheduled for surgery in an eye camp is a stressful situation to the patients, their relatives, and the eye camp organizers. Most reasons for canceling the cataract surgery can be avoided, and efforts to reduce the number of postponed cases have to be increased. Ophthalmic examination and medical fitness should be done properly before scheduling for cataract surgery.

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Objectives: (1) To review progress in the prevention of blindness in Sudan compared to Vision 2020 targets. (2) To show gaps and shortfalls. Materials and Methods: Reports of national Vision 2020 program covering the period 2003-2010 are reviewed, including data generated from six RAAB surveys conducted in 2009-2010. Results: Prevalence of blindness is 1% compared to 1.5% in 2003. Cataract surgical out-put, cataract surgical rate (CSR), and IOL implantation rate increased steadily. It is estimated that 70% of the population are covered with refractive errors services. Low vision services are provided by four centers. Trachoma mapping completed for Northern Sudan except Darfur. SAFE strategy is implemented. Prevalence of childhood blindness is not known. Two centers provide specialized pediatric eye services. There is community-directed treatment with Ivermectin (CDTI) in 3 out the 4 onchocerciasis foci. Ophthalmologists tripled in number. Optometists exceeded 1000, compared to less than 500 in 2003. Secondary and tertiary level facilities increased in major cities. There is no primary eye-care program. Conclusion: Northern Sudan shows good progress in most of the components of Vision 2020, namely cataract, trachoma, onchocerciasis, refractive errors, and low vision. However, scaling up and attention to diabetic retinopathy and glaucoma are still needed to reach all the targets by the year 2020.

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Cyclopentolate is an anticholinergic, antimuscarinic tertiary amine which has been widely used as a topical cycloplegic and mydriatic agent by ophthalmologists. Systemic absorption of the drug can occur transconjunctivally or through nasolacrimal duct through highly vascular nasal mucosa. This can lead to central anticholinergic syndrome which includes restlessness, hallucination, psychosis, hyperactivity, seizures, incoherent speech, and ataxia. We report a case series of three patients developing central nervous system toxicity following instillation of cyclopentolate. This article lays stress on the judicious use of this drug and outlines the steps that can be taken to reduce systemic absorption and toxicity include using the lowest available concentration of the drug.

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