Editorial Comments: Nigerian Journal of Ophthalmology, May–August 2025 Edition

Abstract

Our dear esteemed readers, we welcome you to the May–August 2025 issue of the 33rd volume of our widely read journal. There are nine articles comprising one review article, seven original articles, and one case report. We are happy to note that our journal continues to receive international attention, as there are four publications by international authors in this issue. This edition particularly features research and practice on challenging topics of interest globally, cutting across community health, glaucoma, vitreo-retina, anterior segment, and neuro-ophthalmology. I hereby warmly invite our readers to make time and read through each of these articles, as they will surely add knowledge and improve practice. They would also further stimulate research interests. The review article on surgical outcomes of various application methods of mitomycin C (MMC) in trabeculectomy done in Abakaliki, Nigeria, by Ginger-Eke highlights that emerging newer approaches in MMC application during trabeculectomy offer superior surgical outcomes and reduced complications compared to the conventional application of MMC by soaking a sponge and applying it to the subconjunctival space. The author highlighted that increasing the concentration or amount of MMC improves its intrascleral penetration, while the length of exposure and the method used for its delivery impact outcomes and complications. The methods of application identified include the direct sponge method, posterior scleral application method, subconjunctival MMC injection, intra-tenon MMC injection, and application of high concentrations of MMC. Subconjunctival injection of MMC has been investigated as an alternative to the use of sponges.[1] The traditional approach has the advantage of allowing adjustment of drug concentration and duration to reduce the probability of failure. Posterior application of MMC has been proposed to reduce the complications of failed drainage in trabeculectomy associated with previous methods of application of MMC, and has also been found to be safe.[2] Adegbehingbe et al. carried out a retrospective study of 1956 adult patients who presented to the eye clinic of a tertiary hospital in Akure to determine the prevalence and spectrum of eye diseases. The study showed that cataract, refractive error, and glaucoma, in descending order, were the most common ocular morbidities. These are avoidable causes of visual impairment; therefore, planning for the establishment of low-cost cataract surgical services, refractive services, and the availability of antiglaucoma medication would reduce their incidence.[3] Saha and Saxena from India, in a prospective randomized controlled trial, demonstrated that short-term eplerenone treatment assisted better anatomical recovery in patients with acute central serous chorioretinopathy. Their study showed statistically significant evidence on optical coherence tomography (OCT) imaging after accelerated visual recovery was observed when compared to results among the control group (treated with topical nonsteroidal anti-inflammatory drugs and oral multivitamins). Patients were evaluated for best-corrected visual acuity, neurosensory detachment, and choroidal thickness at baseline and after 90 days of treatment. Though both groups reported improvement, that of the control group did not show statistically significant improvement after 90 days of treatment. Patients, however, reported satisfaction. This drug is encouraging to be used; therefore, this study could be replicated in a larger cohort to further establish the efficacy of oral eplerenone. This will, however, depend on its availability in the intended study area. Mahmud-Ajeigbe et al. carried out a hospital-based cross-sectional study of adult male diabetics in sub-Saharan Africa attending the outpatient department of a secondary health care center in Zaria. They sought to determine the prevalence and the relationship between diabetic retinopathy (DR) and erectile dysfunction (ED). They observed that ED or impotence was self-reported in 35% of the study population, while 65% had DR. The study also demonstrated a relationship between ED and DR among patients with type 2 diabetes, irrespective of age, duration of diabetes, and fasting blood sugar. In a case series, Shamsi et al. from Iran studied the effects of transorbital alternating current stimulation (tACS) in patients with methanol-induced optic neuropathy (MION). Those who met the inclusion criteria were recruited for this interventional study and divided into two groups: group 1 (very severe vision loss − <logMAR 2.3) and group 2 (mild-to-severe visual loss- logMAR 0.09 and logMAR 2.3). Ten sessions of tACS were applied daily for both groups. Visual acuity, contrast sensitivity, and visual-evoked potentials were measured before treatment and 3 weeks after the last day of stimulation. tACS was not clinically effective in patients with MION, though subtle vision improvement was detected in 50% of patients in group 2. The treatment of MION is thought to be more challenging compared to other types of optic nerve neuropathies because of the associated diffuse damage to the visual pathway and brain in methanol toxicity. The availability of the equipment is necessary to be able to treat these cases. The government is hereby enjoined to help equip our hospitals with modern equipment such as this for effective service delivery and patient care. Glaucoma care and treatment in Africa are difficult due to various problems such as late presentation, poor acceptance of surgery, and poor adherence to medications. In light of this, Abdullahi et al. carried out a prospective study to investigate the need for an alternative treatment that is effective and also acceptable to patients. They treated 124 eyes of patients with advanced glaucoma using transscleral diode laser cyclophotocoagulation (TDLC) set at an 810 nm diode laser and followed up the patients for 12 weeks. Results showed a reduction in intraocular pressure (IOP) of 58%; the proportion of patients with IOP less than 20 mm Hg was 78%, while 5% of eyes lost two or more lines of visual acuity. This study shows that TDLC is not only a potentially safe and effective short-term primary treatment for patients with different types of advanced glaucoma but also cost-effective. It could also be used as a combined therapy at intervals, in addition to medication, for recalcitrant glaucoma not responding to drug therapy. This diode laser equipment is very important for every eye care center to have. The use of this equipment will go a long way in helping reduce and prevent blindness in glaucoma patients. A cross-sectional study conducted by Sovogui et al. at the Bartimée Ophthalmology Clinic, Conakry, over a period of 6 months investigated reasons for delay in taking up surgery among patients with blinding cataracts. A total of 150 (4.97%) of 3015 patients who had blinding cataracts were studied. The main obstacle was the high cost of treatment (86.5%), followed by the fear of having an uncertain result (72.7%) and ignorance of the pathology (58%). Concerted efforts are needed to make cataract surgery and eye care services more affordable to the population. A retrospective review was carried out by Imarengiaye et al. to determine the profile and complications of anesthesia among pediatric ophthalmic patients in a tertiary institution in Benin City. They also aimed to describe the type of anesthesia used and the anesthesia-related perioperative outcomes among children undergoing pediatric ophthalmic procedures. Of 426 patients reviewed, 357 (83.8%) children received general anesthesia, with those aged <12 years more likely to receive general anesthesia compared to the older age group of 13 to 18 years. Bradycardia from oculocardiac reflex (36.6%), tachycardia (21.9%), and difficult intubation (17%) were the most common anesthetic complications. Anesthesia-related complications during pediatric ophthalmic surgery were mainly cardiovascular. The authors concluded that anesthetists should take steps to reduce the occurrence of such complications during the perioperative care of pediatric ophthalmology patients when developing the anesthetic plan for ocular surgeries. Hussain and Sharma report a case series on various outcomes of intraocular foreign bodies. The foreign bodies were described as the “Unseen Intruders” and showed different outcomes and prognoses depending upon factors such as the angle at which the foreign body entered the globe, the zone of injury, as well as the type and size of the foreign body. Intraocular foreign body injuries represent a significant challenge in ophthalmic trauma, with variations in presentation, timing of intervention, and surgical approach influencing the prognosis. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.