Dermis-fat grafts and enucleation in Ghanaian children: 5 years’ experience

Background: Enucleation in young children often results in retarded orbital growth ipsilaterally. The need for an implant that will naturally grow with the child, like Dermis-fat Graft (DFG), for managing the anophthalmia has been of interest over the years.Objective: To evaluate the use of DFG as an implant for volume replacement post-enucleation.Study Design: A prospective non-comparative case series involving 18 consecutive children who had DFG either primarily or secondarily in  conjunction with enucleation for intraocular pathologies, from December2007 to September 2012, at the ophthalmology unit, Korle-Bu. Data from patients who had a minimum of three months follow up(FUP) were analysed.Outcome measures: Complete covering of DFG with healthy conjunctiva, increase in volume of DFG, and presence or absence of   complications.Results: Fifteen patients were analysed, aged nine months to ten years (mean (SD), 3.7±2.7years). Eight (53.3%) were females. Thirteen (86.7%) DFGs were secondary and 2(13.3%) primary. Indications for enucleationwere intraocular retinoblastoma (n=10, 66.7%), unexplained retinal detachment mimicking retinoblastoma (n=3,20.0%), anterior staphyloma(n=1,6.7%) and medulloepithelioma (n=1,6.7%). Fourteen (93.3%) patients showed increase in volume of DFG. Time for Conjunctival  reepithelialisation of the dermal surface was four to fourteen weeks(mean/median=5.5/4.0). Complications encountered were infection (n=1,6.7%), infection with necrosis (n=1,6.7%), melanosis /keratinization (n=2, 13.3%) and cysts(n=2,13.3%). The patients were followed upfor 3 to 54 months (mean/median 20.13 /16.00).Conclusion: DFG for management of post-enucleation anophthalmia in Ghanaian children showed 93.3% success. Keywords: Dermis- fat graft, enucleation, volume replacement,anophthalmi

Epidemiology and recurrence rate of pterygium post excision in Ghanaians

Objectives: To determine the epidemiology and recurrence rate of pterygium after excision using bare sclera techniqueDesign: Prospective non-comparative study.Setting: Ophthalmology unit, Korle-Bu Teaching Hospital, Accra, Ghana.Methods: The study involved 60 consecutive patients with primary apterygial from July 1998 to December 2000 who had bare sclera excision after informed consent. They were post-operatively followed up for 30-months.Results: Thirty-five patients (58%) were females. The patients' ages ranged from 17-75 years, mean (±12.6). Overall recurrence was 22(37%). The main complications encountered include were granuloma 20 %( n=12), restriction in medial rectus muscle motility 2(3%), persistent vascularisation at excision site 2(3%) and adherence leucoma with uveitis 1(2%). No significant association was found between recurrence and pterygium morphology, calcification, allergy and occupation (indoor or outdoor).Conclusion: The recurrence rate after pterygium excision using bare sclera technique in Ghanaians is high (37%).Keywords: Pterygium, epidemiology, bare sclera excision, recurrence, conjunctival growth

A prospective trial of postoperative Lodoxamide (Alomide) on pterygium recurrence

Background: To compare pterygium recurrence after bare sclera excision with and without topical lodoxamide.Design: Randomised double-blind study.Methods: The study involved 61 patients with primary pterygia who had bare sclera excision after informed consent. They were post-operatively treated by either of 2 treatment groups for 4 weeks, with a 30-months follow-up: Controls/placebo = Guttae prednisolone 1% with chloramphenicol 0.5% plus guttae distilled water. Test group = Guttae prednisolone 1% with chloramphenicol 0.5% plus guttae lodoxamide 0.1%.Results: Sixty patients were analysed. Control Group had 20 females and 10 males, aged 28-69.5 years, mean 42.0(± 10.9). Test Group had 15 males and 15 females, aged 17-75 years, mean 46.0(±12.6). Recurrence for the Test Group was 11(37%) within 30 months and 11(37%) for the Control Group within 30 months (OR=1.00, CI: 0.35-2.858). Main complications encountered were granuloma: 7(11.7%) from the controls and 5(8.3%) from the test group; restriction in the motility of medial rectus muscle: 1(1.7%) from each group; persistent vascularisation at site of excision: 1(1.7%) from each group and adherence leukoma with uveitis 1(1.7%) from the control group, the latter also had persistent peripheral corneal epithelial defect later resulting in a dellen. No significant difference was found between the treatment groups with respect to recurrence, type and time of complications, orientation and morphology of pterygium, P>0.05.Conclusion: The recurrence of pterygium is high (about one third) with or without the use of adjuvant lodoxamide.Keywords: Pterygium, epidemiology, bare sclera, Lodoxamide (Alomide), recurrence

Presentation of retinoblastoma at a paediatric eye clinic in Ghana

Background: Retinobalstoma, the commonest childhood malignant intraocular tumour, is usually diagnosed early with over 90% survival rate indeveloped countries. In developing countries, the diagnosis is late resulting in less than 50% survival.Objective: To determine retinoblastoma stages at presentation and patients¡¦ outcomes.Design: Retrospective case series.Methods: The clinical and histopathological records of children with retinoblastoma seen from May 2004 to December 2005 were studied. Data was analysed for mode of presentation, laterality, clinical staging usingReese-Ellsworth (R-E) classification, histopathological high risk features (HHRF) for metastasis, and patient outcome.Setting: Ophthalmology Unit, Korle-Bu Teaching Hospital, Ghana.Results: Twenty-three patients presented with retinoblastoma over the period. Males were 12(52.2%). The age range from 1 to 84 months, mean 36.3(„b22.15) and median (36 months). Nineteen (82.6%) hadunilateral and 4(17.4%) bilateral disease. The common clinical presentations were leukocoria in 20(87.0%), proptosis 8(34.8%), strabismus 5(21.7%) and red eye 5(21.7%). The clinical features were commensurate with R-E stage V in 20(87.0%) patients, 2(8.7%) withorbital recurrence and 1(4.3%) with post-enucleation anophthalmos. HHRFs were present in 9(75%) enucleated eyes with invasion of optic nerve as thecommonest site (7/9). The patients were followed up for 1 day to 19 months. Eight abandoned treatment, 2 were discharged for palliative treatment, 2 out of 5 with metastasis died and 6 had no metastases at their last visit. Common sites for metastasis were the bonemarrow, brain and orbit.Conclusion: Majority of the patients presented with advanced disease manifesting as leukocoria, proptosis, RE stages V disease and poor outcome

Adapted motivational interviewing to improve the uptake of treatment for glaucoma in Nigeria: study protocol for a randomized controlled trial.

BACKGROUND: Glaucoma is a chronic eye disease associated with irreversible visual loss. In Africa, glaucoma patients often present late, with very advanced disease. One-off procedures, such as laser or surgery, are recommended in Africa because of lack of or poor adherence to medical treatment. However, acceptance of surgery is usually extremely low. To prevent blindness, adherence to treatment needs to improve, using acceptable, replicable and cost-effective interventions. After reviewing the literature and interviewing patients in Bauchi (Nigeria) motivational interviewing (MI) was selected as the intervention for this trial, with adaptation for glaucoma (MIG). MI is designed to strengthen personal motivation for, and commitment to a specific goal by eliciting and exploring a person's reasons for change within an atmosphere of acceptance and compassion. The aim of this study is to assess whether MIG increases the uptake of laser or surgery amongst glaucoma patients where this is the recommended treatment. The hypothesis is that MIG increases the uptake of treatment. This will be the first trial of MI in Africa. METHODS: This is a hospital based, single centre, randomized controlled trial of MIG plus an information sheet on glaucoma and its treatment (the latter being "standard care") compared with standard care alone for glaucoma patients where the treatment recommended is surgery or laser.Those eligible for the trial are adults aged 17 years and above who live within 200 km of Bauchi with advanced glaucoma where the examining ophthalmologist recommends surgery or laser. After obtaining written informed consent, participants will be randomly allocated to MIG plus standard care, or standard care alone. Motivational interviewing will be delivered in Hausa or English by one of two MIG trained personnel. One hundred and fifty participants will be recruited to each arm. The primary outcome is the proportion of participants undergoing laser or surgery within two months of the date given to re attend for the procedure. MIG quality will be assessed using the validated MI treatment integrity scale. DISCUSSION: Motivational interviewing may be an important tool to increase the acceptance of treatment for glaucoma. The approach is potentially scalable and may be useful for other chronic conditions in Africa. TRIAL REGISTRATION: ISRCTN79330571 (Controlled-Trials.com)

Alternate Eye Care Services in a Ghanaian District

OBJECTIVE: To determine eye care services sought outside the regular hospital system and their providers. STUDY SETTING: Akwapim South district METHOD: Questionnaire survey and in depth interviews. RESULTS: We recruited 1,537 persons with a previous history of eye disease and alternate service providers (21 chemical shop attendants and 55 herbalists). There was no significant difference between patronage of the regular and the alternative providers (p value 0.78). Most of the herbalists were trained by relations; parents (29/55) and grandparents (10/55). Two thirds had some formal education and 96% practiced part-time. Over 75% claimed they treated cataracts, eye injuries, and “kooko” and 28% also treated red eyes. Chemical shop attendants were all literates, sold only antibiotic eye drops, and 64% practiced full time. CONCLUSIONS: Herbalists and chemical sellers provided substantive eye care along the regular hospital services but some of their practices may be harmful