Neovascular Glaucoma in a Nigerian African population

No Abstract.The East African Medical Journal Vol. 83 (10) 2006: pp. 559-56

Combined central retinalartery and vein occlusion complicating orbital cellulitis

Orbital Cellulitis is a dreaded ophthalmologic disease. Itmay destroy vision and the eye andmay even become life threatening. Often visual loss is the result of exposure and subsequent destruction of ocular tissue commonly the cornea and the uvea. We report a case of combined central retinal artery and vein occlusion complicating orbital cellulitis in a 35 year old patientwho was 37 weeks pregnant resulting in loss of vision in the affected eye. There have been fewcase reports of this type of complication of orbital cellulitis. Keywords: Combined; Central Retinal Artery and Vein Occlusion; Orbital Cellulitis; Pregnancy Nigerian Journal of Clinical Practice Vol. 11 (1) 2008: pp.75-7

Suppurative Keratitis in a Nigerian Tertiary Hospital

Purpose: Microbial keratitis is a potentially vision threatening condition that requires prompt diagnosis and treatment to prevent untoward outcome. This study describes the demographic characteristics, clinical presentation, and microbiological features of patients diagnosed with suppurative keratitis between April 2005 and May 2006 in the University College Hospital lbadan, Nigeria. Methods: A retrospective review of case notes of patients who presented with suppurative keratitis between April 2005 and May 2006 was done. The outcome measures were: interval between onset and presentation, aetiology of keratitis, extent of corneal involvement and final visual acuity. Results: There were 23 (65.7%) males and 12 (34.3%) females. The mean age was 32.8±18.64. A positive history of trauma was present in 48% of patients. In 6% of the patients, the predisposing factor was severe allergic conjunctivitis. The presenting visual acuity was <6/60 in 66% of the patients, <6/18—6/60 in 14%, and 6/6-6/18 in 17% of the patients. At discharge, 40% had a visual acuity of 6/6-6/18, 15% had borderline vision (<6/18-6/60), 40% had severe visual impairment (<6/60), while 5% had no light perception. The most common organisms isolated microbiologically were Staphylococcus aureus in 28.6%, Streptococus pneumoniae in 8.6%, and Pseudomonas aeruginosa in 2.9%. The risk factors for poor visual outcome were late presentation, farming, stromal thinning and large corneal involvement. Conclusion: Bacteria is responsible for most cases of suppurative keratitis in a developing country like Nigeria and the risk for poor visual outcome includes late presentation, farming, stromal thinning and large corneal involvement.Key words: cornea, suppurative keratitis, visual outcom

Visual Outcome after Small Incision Cataract Surgery in Southwestern Nigeria

Objective: The aim of this study was to determine the visual outcome of patients who had manual small incision cataract surgery in a high volume secondary eye hospital in southwestern Nigeria, and to identify reasons for poor outcome. Methodology: This is an observational descriptive, longitudinal study of consecutive patients undergoing cataract surgery at St Mary’s Catholic Eye Hospital, Ago Iwoye (SMEH) Nigeria conducted between May and October 2007. A total of 146 patients who presented to the hospital and met the inclusion criteria were recruited for the study. Patients were examined preoperatively, 1st day and 8th week post-operatively. Results were analyzed using the SPSS statistical software. Significant association was taken at 95% confidence interval i.e. < 0.05. Results: A total of 146 patients who met the inclusion criteria were studied. The mean age was 65.3±10.04 years; and the male to female ratio was 1.4:1. Preoperatively, 110 patients (75.3%) were blind in the operated eye, while 33 patients (22.6%) were blind in both eyes at presentation. At 1st day post-operatively, 17 patients (11.6%) had pinhole visual acuity of 6/6-6/18. Out of 137 patients that had refraction, 114 patients (83.2%) had a visual acuity of 6/6-6/18. The number of blind patients also reduced from 33 (22.6%) to 1(0.7%). Uncorrected refractive error was the commonest cause of poor vision post-operatively. Conclusion: This study demonstrates that good results can be obtained with small incision cataract surgery with intraocular lens implantation in the developing world. Increasing cataract surgery with IOL implantation should reduce the number of eyes with poor functional vision after cataract surgery.Key words: cataract, cataract surgery, visual outcom

Visual outcome after cataract surgery at the University College Hospital, Ibadan

Aim: The aim of this study was to determine the visual outcome of patients who had cataract surgery in the University College Hospital Ibadan. Methodology: This is an observational descriptive, longitudinal study of consecutive patients undergoing cataract surgery at the University College Hospital conducted between May and October 2007. A total of 184 patients who presented to the hospital and met the inclusion criteria were recruited into the study. Patients were examined preoperatively, 1st day postoperatively and 8th week postoperatively. Results: The mean age was 66.5 years; and the male to female ratio was 1.2:1. Preoperatively, 137 patients (74.5%) were blind in the operated eye, while 39 patients (23.6%) were blind in both eyes at presentation. At 1st day postoperatively, 87 patients (47.3%) had pinhole visual acuity of 6/6-6/18. Best corrected vision after refraction eight weeks postoperatively showed that 127 patients out of 161 patients (78.8%) had good vision while 28 patients (17.4%) had borderline vision, and six patients (3.8%) had severe visual impairment after refraction. The number of bilaterally blind patients also reduced from 39 (23.6%) to one (0.6%). Uncorrected refractive error was the commonest cause of poor vision prior to refraction. Glaucoma was the commonest ocular co-morbidity accounting for poor vision in 9.1% of patients eight weeks after cataract surgery. Conclusion: This study demonstrates that good results can be obtained with cataract surgery and intraocular lens implantation in the developing world. More attention should be directed towards ensuring that successful outcomes are indeed being realized by continued monitoring of postoperative visual outcomes and prompt refraction for all patients.Keywords: Cataract, Visual outcome, Cataract surger

Causative agents of keratomycosis in Ibadan: review of laboratory reports

Introduction: Fungi are responsible for less than 2.0 % of corneal infection around the globe. Trauma to the cornea is the leading cause of fungal keratitis especially with history of corneal trauma with vegetable or organic matter. Because of the dearth of data on the aetiological agents of Keratomycosis in this hospital, this study was aimed at finding the prevalence and fungal etiological agents responsible for this condition Ibadan, Nigeria. Methods: A retrospective review of the laboratory reports of corneal scrapings of patients that presented with signs and symptoms suggestive of Keratomycosis was carried out. The scrapings were subjected to wet preparation with 10.0 % KOH, Gram staining and Giemsa staining to rule out inclusion bodies. The diagnosis of Keratomycosis was made on the basis of the recognizable and characteristic appearance of fungal hyphae and fruiting bodies under microscopy. The media with no obvious growth after 3-4 weeks of incubation were regarded as negative. Results: A total of 48 specimens from patients with suspected diagnosis of Keratomycosis were included in the analysis. The patients consisted of 42 (87.3%) males and 6 (12.5%) females. The ages at diagnosis ranged from 3 to 73 years with a mean of 36.46 years and a median of 35.5 years. The prevalence of Keratomycosis among this group of patients in this hospital was 8.4 %. Candida albicans and Fusarium spp were the fungal isolates in these patients as it occurred in 4.2 % (2/48) of them respectively. Conclusions: Corneal scarring due to trauma or infections is a major cause of monocular blindness, especially in developing countries like Nigeria. Despite the low level of Keratomycosis in this study, high index of suspicion of possible diagnosis should be giving to patients with history of trauma, tissue devitalization with topical steroids and immunocompromised immunity.Keywords: Keratomycosis, Corneal, Fusarium and Candida

Challenges of Loss to Follow-up in Tuberculosis Research.

In studies evaluating methods for diagnosing tuberculosis (TB), follow-up to verify the presence or absence of active TB is crucial and high dropout rates may significantly affect the validity of the results. In a study assessing the diagnostic performance of the QuantiFERON®-TB Gold In-Tube test in TB suspect children in Tanzania, factors influencing patient adherence to attend follow-up examinations and reasons for not attending were examined. In 160 children who attended and 102 children who did not attend scheduled 2-month follow-up baseline health characteristics, demographic data and risk factors for not attending follow-up were determined. Qualitative interviews were used to understand patient and caretakers reasons for not returning for scheduled follow-up. Being treated for active tb in the dots program (OR: 4.14; 95% CI:1.99-8.62;p-value<0.001) and receiving money for the bus fare (OR:129; 95% CI 16->100;P-value<0.001) were positive predictors for attending follow-up at 2 months, and 21/85(25%) of children not attending scheduled follow-up had died. Interviews revealed that limited financial resources, i.e. lack of money for transportation and poor communication, were related to non-adherence. Patients lost to follow-up is a potential problem for TB research. Receiving money for transportation to the hospital and communication is crucial for adherence to follow-up conducted at a study facility. Strategies to ensure follow-up should be part of any study protocol

Refractive ocular conditions and reasons for spectacles renewal in a resource-limited economy

<p>Abstract</p> <p>Background</p> <p>Although a leading cause of visual impairment and a treatable cause of blindness globally, the pattern of refractive errors in many populations is unknown. This study determined the pattern of refractive ocular conditions, reasons for spectacles renewal and the effect of correction on refractive errors in a resource-limited community.</p> <p>Methods</p> <p>A retrospective review of case records of 1,413 consecutive patients seen in a private optometry practice, Nigeria between January 2006 and July 2007.</p> <p>Results</p> <p>A total number of 1,216 (86.1%) patients comprising of (486, 40%) males and (730, 60%) females with a mean age of 41.02 years SD 14.19 were analyzed. The age distribution peaked at peri-adolescent and the middle age years. The main ocular complaints were spectacles loss and discomfort (412, 33.9%), blurred near vision (399, 32.8%) and asthenopia (255, 20.9%). The mean duration of ocular symptoms before consultation was 2.05 years SD 1.92. The most common refractive errors include presbyopia (431, 35.3%), hyperopic astigmatism (240, 19.7%) and presbyopia with hyperopia (276, 22.7%). Only (59, 4.9%) had myopia. Following correction, there were reductions in magnitudes of the blind (VA<3/60) and visually impaired (VA<6/18-3/60) patients by (18, 58.1%) and (89, 81.7%) respectively. The main reasons for renewal of spectacles were broken lenses/frame/scratched lenses/lenses' falling off (47, 63.4%).</p> <p>Conclusions</p> <p>Adequate correction of refractive errors reduces visual impairment and avoidable blindness and to achieve optimal control of refractive errors in the community, services should be targeted at individuals in the peri-adolescent and the middle age years.</p

A method for assessing robustness of the results of a star-shaped network meta-analysis under the unidentifiable consistency assumption

Background In a star-shaped network, pairwise comparisons link treatments with a reference treatment (often placebo or standard care), but not with each other. Thus, comparisons between non-reference treatments rely on indirect evidence, and are based on the unidentifiable consistency assumption, limiting the reliability of the results. We suggest a method of performing a sensitivity analysis through data imputation to assess the robustness of results with an unknown degree of inconsistency. Methods The method involves imputation of data for randomized controlled trials comparing non-reference treatments, to produce a complete network. The imputed data simulate a situation that would allow mixed treatment comparison, with a statistically acceptable extent of inconsistency. By comparing the agreement between the results obtained from the original star-shaped network meta-analysis and the results after incorporating the imputed data, the robustness of the results of the original star-shaped network meta-analysis can be quantified and assessed. To illustrate this method, we applied it to two real datasets and some simulated datasets. Results Applying the method to the star-shaped network formed by discarding all comparisons between non-reference treatments from a real complete network, 33% of the results from the analysis incorporating imputed data under acceptable inconsistency indicated that the treatment ranking would be different from the ranking obtained from the star-shaped network. Through a simulation study, we demonstrated the sensitivity of the results after data imputation for a star-shaped network with different levels of within- and between-study variability. An extended usability of the method was also demonstrated by another example where some head-to-head comparisons were incorporated. Conclusions Our method will serve as a practical technique to assess the reliability of results from a star-shaped network meta-analysis under the unverifiable consistency assumption.This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI19C1178). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript