Neuroprotection in Glaucoma: A Review

Background: Glaucoma, globally the second most common cause of blindness and the commonest cause of preventable visual disability, is a progressive neurodegenerative disease of the retinal ganglion cells and their axons .Neuroprotection is an evolving area in the management of glaucoma. This review aims to highlight the current neuroprotective agents under investigation and the promise they hold for future management of glaucoma.Method: The available literature on the use of Neuroprotection in Glaucoma was reviewed using available journals and internet based search engines such as pubmed and Medline. Keywords employed were Neuroprotection and Glaucoma.Results: There is ongoing research on neuroprotective agents in management of glaucoma. A few of the currently available anti glaucoma medications also have neuroprotective functions. The mainstay of glaucoma management however remains lowering of intraocular pressure. Nigerian literature on neuroprotection was not available.Conclusion: It has become increasingly obvious that glaucoma represents a complex multifactorial disease that produces an accelerated rate of ganglion cell atrophy related to a numerous pathogenic mechanisms that not only most certainly involve IOP, but also include defective auto regulation and ischaemia; neurotrophic factor deficiency; glutamate mediated excitotoxicity, immune related phenomenon; intracellular calcium influx and free 3 radical damage. IOP lowering still remains the mainstay of treatment. Neuroprotection has promise for preventing retinal cell ganglion death independent of IOP. It therefore presents an exciting development in the pursuit for a treatment modality for this debilitating disease.Keywords: Neuroprotection; Glaucoma

The Burden of Blindness According To Age and Sex In Some Communities In Niger Delta Of Nigeria

Background: There are differences in the impact of blindness by age and sex; blind males having a higher risk for death than females. The aim of this study was to describe the age and sex difference among the blind in some Niger Delta communities of Nigeria.Methods: A community based, cross-sectional study was done and age and sex data analyzed for the 19 blind persons seen. A total of 1513 subjects were studied and their ages estimated from historical events or verified from hospital/immunization cards. Ocular examination of subjects included visual acuity, pen torch examination, fundoscopy and applanation tonometry.Results: A total of 1513 subjects were examined consisting of 754 males and 759 females. Subjects less than 20years accounted for 31.5%, those above 60years accounted for 26.4% while others contributed 42.1%. All the 19 blind persons were over 50years. The difference in age among the blind was statistically significant (p<005). The sex specific prevalence for blindness was 0.79% for males and 1.71% for females. Females were more likely to be blind than males.Conclusion: The study found blindness to be commoner in older age groups and female gender appeared to be an important risk factor. Eye health education should target the elderly and females more and factors contributing to their vulnerability addressed.Keywords: Blindness; Age; Sex; Niger Delta; Nigeri

The relationship between vertical cup‑disc ratio and body mass index in Port Harcourt, Nigeria

Background: Glaucoma is the leading cause of irreversible blindness in the world and risk factors to developing glaucoma must be determined early to prevent blindness from the disease. Aim: To determine the relationship between vertical cup disc ratio (VCDR) and body mass index (BMI) in a population screened for glaucoma in Port Harcourt, NigeriaMaterials and Method: This study was part of a one-day screening exercise for glaucoma at the University of Port Harcourt. Demographic data included age, sex, race and occupation. Height was measured with a wall-mounted tape and weight with a bathroom scale. Intraocular pressure was measured with Perkins applanation tonometer and funduscopy was with direct ophthalmoscope. BMI was calculated as weight in kilograms divided by the square of height in meters (Weight/Height2).Results: A total of 491 subjects were screened; consisting of 230 males (46.8%) and 261 females (53.2%). The mean age was 35±13.29 years. About 28%(n=141) of the participants were overweight while 17.7%(n=87) were obese. The mean BMI was 25.39 ± 4.82 kg/m2 and the mean VCDR for both eyes was 0.38±0.13mmHgratios have no units. Most participants (n=864; 89.4%) had normal VCDR. Only 102 (10.6%) had cupped discs. There was no statistically significant relationship between BMI and VCDR (P= 0.947; R2 = 0.01).Conclusion: Obesity was not associated with a larger VCDR.Keywords: Body mass index, relationship, vertical cup/disc ratioNigerian Journal of Clinical Practice • Oct-Dec 2013 • Vol 16 • Issue

Visual disability in Newly Diagnosed Primary open Angle Glaucoma (POAG) Patients in a Tertiary Hospital in Nigeria

Background: Glaucoma remains the second leading cause of blindness worldwide and the highest cause of irreversible blindness worldwide. In Nigeria, Glaucoma accounts for 16% of blindness and primary open angle glaucoma is the most prevalent clinical type. Aim: The aim of this study is to assess the visual disability resulting from glaucoma in newly diagnosed POAG patients in University of Port Harcourt Teaching Hospital. Materials/Method: This is a retrospective study of newly diagnosed glaucoma patients referred from the general ophthalmology clinic to the glaucoma clinic over a 12 month period (January-December 2010). All patients had a glaucoma workup including Snellen distant visual acuity, slit lamp examination, Goldman applanation tonometry, gonioscopy, dilated fundoscopy with +78 diopter lens as well as perimetry. All examinations were carried out by both authors. Patients with other co-morbidities such as cataract and retinal/macular pathologies were excluded from the study. Results: A total of 98 patients were reviewed. There were 34 males and 27 females, giving a male to female ratio of 1.3:1.The average age was 54.2 years and most patients (>80%) were in the 40-59 year age group. Of the 98 patients reviewed, 62.2%had POAG. 30 patients were blind by distant visual acuity criteria while 45 patients were blind by central visual field criteria. Conclusion: POAG is the most prevalent clinical subtype of glaucoma in Nigeria and sub-Saharan Africa. Paucity of symptoms in early stages of the disease and late presentation is a characteristic finding in our clinical environment. Our study showed that POAG in our environment is associated with marked visual disability at the time of presentation. Keywords: Visual disability, POAG, Tertiary Hospital, Nigeri

Pattern of paediatric refractive errors seen in Port Harcourt, Southern Nigeria

No Abstract

Outcome of Trabeculectomy in Advanced Glaucoma in a tertiary hospital in Rivers State, Nigeria

Aim: To evaluate the outcome of Trabeculectomy in advanced glaucoma in a hospital in Rivers State, Nigeria. Methods: This was a non-randomized interventional study in which each patient served as its own control. Patients with advanced glaucoma and demonstrable field defects and Mean defect ≥-12 were included. The intervention employed was Trabeculectomy and IOP and visual acuity pre operative, as well as post op were collected and compared at pre- op, post -op day 1, one week, one month, 6 months. Data was analyzed using SPSS version 20. Results: Thirteen (13) eyes from ten (10) patients with advanced glaucoma were involved in the study. Mean age of study population was 53±19.62 years. Mean of mean defect was -19.05±5.23dB while mean of vertical cup disc ratio (VCDR) was 0.88±0.04. Mean of Pre- op Visual acuity (log MAR) was 0.46 and dropped to 0.72 first day post-op but improved over 6 months to 0.42. The mean of IOP pre-op was 24.15mmHg and dropped to 11.23mmHg (58.24%) over 6 months (p=0.001). Conclusion: Trabeculectomy still remains the gold standard surgical treatment for glaucoma. In our study it resulted in a 58.24% drop in IOP over 6 months with mean visual acuity maintained at pre-op levels after 6 months follow up. It therefore is effective and safe surgical intervention in advanced glaucoma

Clinical forms of glaucoma in a tertiary hospital in Nigeria

Background: Glaucoma is responsible for 16% of blindness in Nigerian adults and the foremost cause of irreversible blindness among Nigerian adults. Clinical care of glaucoma must therefore be individualized to the specific forms of the disease. Aim: To evaluate the relative frequencies of the different clinical types of glaucoma among newly diagnosed glaucoma patients in University of Port Harcourt Teaching Hospital (UPTH).Methods:  A retrospective study of all new patients referred to the Glaucoma Clinic of UPTH from December 2009 to December 2010. All patients had measurement of intraocular pressure, gonioscopy, slit lamp examination with +78D super field lens and central visual field analysis. Diagnosis of glaucoma was based on cupping and atrophy of the optic disc, visual field loss, with or without raised intraocular pressure. Patients so diagnosed were classified according to the European Glaucoma guidelines as Primary Open Angle Glaucoma (POAG) including Normal Tension Glaucoma (NTG), Secondary Open Angle Glaucoma (SOAG), Primary Angle Closure Glaucoma (PACG), and Secondary Angle Closure Glaucoma (SACG).Results:  Ninety-eight patients were studied. Of this, 52% were males and 48% females; their mean age was 49.70±14.06 years. The distribution of the clinical forms of glaucoma were as follows: Congenital Glaucoma (CG) 1 %( n=1), JOAG 3.1 %( n=3), PACG 3.1% (n=3), SOAG 5.1% (n=5), SACG 11.2% (n=11), NTG 14.3%(n=14) and POAG 62.2%(n=61).  More than 75% of the patients were over 40 years with a peak presentation in the sixth decade.Conclusion: Primary Open Angle Glaucoma was the most prevalent subtype of the disease in this study. Peak presentation was in the sixth decade of life

Pattern of strabismus in a tertiary hospital in Nigeria: a six-year review

Background: Strabismus (ocular misalignment) is frequently seen in clinical practice.  Its prevalence varies in different parts of the world with no sex predilection. Stabismus is a significant cause of ocular morbidity. Esotropia is often the commonest form of presentation among children.Aim: To determine the frequency and clinical features of patients presenting with strabismus in the ophthalmic clinic a past 6-year period.Methods: This was a hospital based study of all the patients diagnosed having strabismus in University of Port Harcourt Teaching hospital between January 2007 and December 2013. The medical records of a total of 74 patients who visited the ophthalmic clinic and diagnosed as having strabismus were retrospectively reviewed and subsequently analysed using Statistical Package for Social Sciences (SPSS) version 17 computer soft ware package.  Ethical clearance was obtained from the Ethics committee of the University of Port Harcourt Teaching Hospital.Results: A total of 12,334 case files were reviewed in this study. Five thousand one hundred and eighty-one (42%) were males and 7,153 (58%) females. A total of 74 cases had strabismus (0.6%). Twenty- three were  males and 51 females (M:F=1:2.2). Twenty-eight (37.8%) had alternating squint, twenty- three (31.1%) had esotropia,   twenty- one (28.4%) had exotropia and two (2.7%) had hypertropia.Conclusion: This study confirmed the relatively high frequency of alternating squint and esotropia in patients with strabismus.Keywords:   Strabismus, Prevalence, Patter