Assessment of pre and postoperative psychiatric comorbidity among patients scheduled for elective cataract surgery in Lagos, Nigeria

Objective: Comorbid psychiatric disorders have been reported to be associated with pre and postoperative periods. Studies on pre and postoperative comorbid psychiatric disorders among ophthalmological patients are scanty in Nigeria and other sub-Saharan countries. This study was aimed at determining pre and postoperative comorbid psychiatric disorders among patients scheduled for elective cataract surgery in Lagos, Nigeria.Methods: Seventy-seven adult patients scheduled for elective cataract surgery at the ophthalmology clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria were recruited and assessed 24 hours pre and 24 hours postoperatively for psychiatric morbidity by asking them to complete the twentieth version of the Self-rating Questionnaire and the Hospital Anxiety and Depression Scale.Results: The findings of this study showed that only 5.2% of the participants experience preoperative mental illness and anxiety respectively while the 9.1% experienced depression. Post-operative assessments revealed that none of the participants experienced any mental illness or depression apart from 1.3% who experienced anxiety postoperatively. There were no statistically significant findings between the sociodemographic variables and anxiety, depression and mental illness.Conclusions: The findings of this study indicated that there were comorbid psychiatric disorders among ophthalmological patients scheduled for cataract surgery in Lagos, Nigeria. Therefore, patients who are to undergo surgery should be screened for psychiatric morbidity. Likewise, adequate and appropriate surgical information should be given to patients to reduce associated comorbid psychiatric disorders.Keywords: Psychiatric morbidity, preoperative, postoperative, anxiety, depression, catarac

Malignant Glaucoma: Report of a Presumed Bilateral Spontaneous Case

Background: Malignant glaucoma is an ocular emergency and may lead to blindness if not promptly recognized and treated effectively. It is usually reported after trabeculectomy, and spontaneous or bilateral cases are not common in the literature.Case report: This article reports the case of a Nigerian woman who  developed spontaneous bilateral malignant glaucoma with resultant visual impairment. A literature review on the subject is also undertaken. Possible etiology and management challenges of the case are also discussed.Conclusion: This study is aimed at drawing attention to this potentially blinding eye disease, and ultimately improves knowledge on its diagnosis and management, to reduce the visual morbidity.Key words: Malignant glaucoma, closed angle glaucoma, blindness, visual impairment, aqueous misdirection, vitrectom

How do things become strategic? ‘Strategifying’ corporate social responsibility

How do things become ‘strategic’? Despite the development of strategy-as-practice studies and the recognized institutional importance of strategy as a social practice, little is known about how strategy boundaries change within organizations. This article focuses on this gap by conceptualizing ‘strategifying’ – or making something strategic – as a type of institutional work that builds on the institution of strategy to change the boundaries of what is regarded as strategy within organizations. We empirically investigate how corporate social responsibility has been turned into strategy at a UK electricity company, EnergyCorp. Our findings reveal the practices that constitute three types of strategifying work – cognitive coupling, relational coupling and material coupling – and show how, together and over time, these types of work changed the boundaries of strategy so that corporate social responsibility became included in EnergyCorp’s official strategy, became explicitly attended to by strategists and corporate executives and became inscribed within strategy devices. By disambiguating the notions of strategifying and strategizing, our study introduces new perspectives for analysing the institutional implications of the practice of strategy

Could a burst toy balloon cause a major ocular injury like cataract in a child? A case report

Ocular injuries in children remain a largely preventable phenomenon, and the resulting morbidity may be life-long. A variety of objects have been implicated as causes of ocular injuries in children, but that resulting from a burst balloon on the face is rare, as this toy may not be recognised as potentially hazardous, especially in children. The case of a 3-year old Nigerian girl who presented with left cataract and esotropia (squint) following a burst toy balloon on the face is reported. This is aimed at drawing attention to the possibility that this common toy may have the potential of causing a major ocular injury especially in children. The need for adequate safety measures to be taken, while children are at play, is also emphasized

Ocular Diseases in the Paediatric Age Group – a Retrospective Study at a Tertiary Hospital in Lagos. Nigeria.

To determine the pattern of ocular disease presentations among the paediatric age group (0-15 years) as well as  their demographic and clinical characteristics. We conducted a retrospective review of the medical records of  patients 15 years and less who presented in the Eye Clinic of the Lagos State University Teaching Hospital (LASUTH) Ikeja between January 2010 and end of December 2010. Data on age at presentation, gender, affected eye/eyes,  duration of disease at presentation and clinical diagnosis were retrieved from patients' medical records. Information was analyzed using SPSS version 17. A p-value of less than 0.005 was accepted as indicative of statistical  significant. We evaluated the report of 294 children. 176(59.9%) were males and 118(40.1%) were females. The following ocular ailments were seen - Allergic(including Vernal) conjunctivitis 17.3%, Refractive Errors  17.0%,Trauma 13.6%, Congenital Cataract 5.4%, Developmental cataract 4.1%,Preseptal/Orbital cellulitis 3.1% and Cortical blindness in 3.4% Allergic conjunctivitis was more common in the 6-10 years age group and seen more in males. The prevalent childhood eye diseases recorded here can be managed in well established secondary eye -care centres in the state. Parents/ Guardians should be encouraged to obtain glasses for their children/wards. Also to encourage the hospital management to set up a standard paediatric ophthalmology unit and train a paediatric ophthalmologist for proper management of ophthalmic diseases in children.Keywords: paediatric age-group, ocular diseases, blindness, Allergic conjunctivitis, cataract, refractive error

Orbital Cellulitis: Clinical Course and Management Challenges. The Lagos State University Teaching Hospital Experience

Background: Orbital cellulitis is a devastating acute infection of orbital soft tissues located posterior to the orbital septum. It is both vision and life-threatening. It is an ocular emergency which most often present in childhood.Objective: This article reviewed cases presenting during the study period with the view of examining the pattern of presentation, clinical course and management challenges.Methods: A retrospective study was conducted on patients presenting with orbital cellulitis between January 2008 and June 2011. Socio-demographic data, entry and discharge visual acuity, presenting complaints, predisposing factors, duration of complaints, admission period and complications were extracted from clinical records and analyzed.Results: Seventeen (17) patients presented with orbital cellulitis constituting 6.2% of ocular emergency admissions during the study period. Twelve (70.6%) were males. Thirteen (76.5%) were children. The major predisposing factors were upper respiratory tract infections, and facial and globe injuries in five (22.7%) cases respectively. Only five (29.4%), presented within three days of disease onset. Average duration of admission was 10.6 days. Complications during the course of disease were category 4 and 5 blindness in five (23.5%), orbital abscess four (23.5%), cavernous sinus thrombosis two (11.8%), contralateral preseptal cellulitis two (11.8%) and exposure keratopathy in one (5.9%).Conclusion: Orbital cellulitis has remained a disease with high ocular morbidity. The major management challenges were poor financial status of patients precluding necessary diagnostic laboratory and imaging studies. Early recognition, diagnosis and treatment are crucial to the preservation of vision and reduced occurrence of complications. The importance of record keeping is also highlighted.Keywords: Orbital cellulitis, facial and globe injury, odontogenic infection, blindness

A study of the level of awareness of different Cadre of eye care providers among tertiary institution students in Nigeria

Background: The choice of a qualified eye care practitioner, a critical factor in eye care services, pre-supposes that the practitioner has the requisite training and skill. Often, lack of this knowledge among patients, relative overlap of functions among practitioners and attempts occasionally, to assume responsibility, has led to poor outcomes. Adequate patient information about eye care providers would reduce the time and money wasted from inappropriate consultations and possibly minimizes the ocular morbidity from such delays. The study is aimed at assessing the awareness of the various categories of eye care workers among students of tertiary Institutions in Ilorin, Nigeria. Methods: Structured questionnaire was administered on 460 students undergoing tertiary education in Ilorin, Kwara-State, Nigeria, chosen by stratified random sampling method. The demographic data, level of education, previous eye problem, care provider and knowledge of cadre of eye workers were provided. The results were analyzed using SPSS version 14 statistical package. Result: 282 (61.3%) of the respondents were unaware that different cadre of eye care workers exist. 161(35.0%) were sure of different cadre of eye workers with 65.8% more familiar with the opticians than any other cadre. About 50% who visited an eye care provider consulted with other cadre other than the Ophthalmologist. Conclusion: The knowledge of different eye care cadre among the students of tertiary Institutions in Ilorin is poor even among those who have had reasons to access eye care facilities. key words: Cadre, Ophthalmologist, Optometrist, Optician, Ophthalmic Nurse

Challenges of Managing Orbital Floor Blow–out Fracture in a Developing Country

Background: Orbtal blow-out fracture can be associated with ocular injuries which may involve the anterior or posterior segments of the eye. This can present significant morbidity to patients which can impact on the quality of life.Objective: To evaluate cases of orbital floor blow-out fractures seen at two centres.Methodology: A retrospective study of patients seen with a diagnosis of orbital blow-out fracture between July 2009 and March 2010 was done. Diagnosis was based on history, clinical examination and computerised tomography (CT) scan. The patients had lower lid incision – transcutaneous or transconjunctival. Silicone and bone implants were used to reconstruct the defects.Results: Five patients – 3 males and 2 females were reviewed, age range between 21 to 26 years. The fracture occurred as a result of road traffic injury in 3 patients (60%), and the involved eye had poor visual acuity on presentation, but no associated ocular injury was noticed in 3 (60%) of the patients. The interval between injury and presentation ranged from 9 to 120 days. Vertical limitation of ocular motility and significant enophthalmos were noticed in all the 5 patients; 2 had diplopia and hypoesthesia in the distribution of the infraorbital nerve. The average time interval between injury and surgery were 49 days and 3 of the patients (60%) had repairs after 14 days of presentation. Postoperatively, slight improvement in ocular motility was observed.Conclusion: The challenges of managing orbital fracture include late presentation, lack of synthetic implant materials, increased morbidity with graft harvesting, and poor cosmetic outcome.Keywords: Challenges, enophthalmos, road traffic injur